The road to public-private
partnership (PPP) between the Hospital Authority and private medical
practitioners becomes longer and more winding. This is my impression after going through the Director
of Audit's Report No. 58 (Chapter 3), “Hospital Authority: Public-private
partnership (PPP) programmes”, published on March 28, 2012. While the Audit Commission focuses on
performance indicators and cost-effectiveness of the programmes, I look more
into the culture, attitude and intention of the Hospital Authority behind these
programmes.
In 2008, the PPP was recommended as
a means to solve the manpower and resources problem of the Hospital Authority. Since then, all we have got are several pilot
projects. These pilots were implemented “to
meet service gaps” identified. After
four years, these gaps are instead filled by increased services from the
Hospital Authority. So these pilots can
be conveniently shelved. These are
mentioned in paras 2.8 and 2.9 of the Audit Report: “Over the years, the HA had
made arrangements with the FHB to extend the operation of the Cataract
Surgeries Programme and the General Out-patient Clinic PPP Programme beyond
their original pilot periods. As at
December 2011, the two programmes were entering the fourth year of operation. The HA
did not have any plan for rolling them out as ongoing services. Audit noted that the HA commissioned two new
cataract centres in December 2009 and May 2011, and that a new clinic was
opened in Tin Shui Wai North in February 2012. It can be seen from
paragraph 2.8 that the two pilot PPP programmes have been used as stop-gap
measures to address service gaps identified. According
to the HA, such measures have short-term usefulness and objectives that will
benefit many patients. Audit considers that while the measures
have contributed to the strategic objective of managing growing service demand,
they may not be conducive to the long-term development of PPP in healthcare.”
There is no evidence of any
intention of setting up sustainable PPP programmes. The Audit Report concluded in para 2.23 that
“Four years have elapsed since the HA launched its
first PPP programme (i.e. Cataract Surgeries Programme) in February 2008. Audit considers it timely for the HA to devise
such a mechanism to take stock of the overall development of PPP, consolidate
the experience (including good practices identified and lessons learnt) and map
out the future strategy for the further development of PPP in healthcare.”
There is even no evidence of any
intention of studying or developing workable modes of PPP. The amount of subsidy from the government is
obviously a key factor in PPP programmes. However, there seems no interest from the
Hospital Authority to investigate into this factor. One example is the Share-care Programme in
which the $1200 subsidy is far below market price. This is described in para 2.11: “As noted in paragraph
2.6(c), an objective of launching the pilot PPP programmes was to test the market
and public acceptance. This could help
the HA design better PPP programmes in the future. So far, the HA has varied the eligibility
criteria for some of its PPP programmes, but it has not changed other key
parameters (e.g. levels of government subsidy and patients’ co-payment) of its
PPP programmes since they were launched.”
So what happen to these pilots? They are either extended to be never ending
pilots, or they would be ended with pending evaluations, and the participating
patients are going back to the Hospital Authority as if nothing has happened in
between. Para 2.13 describes an
interesting hidden exit plan: “Audit noted that the HA had not explicitly laid down any exit plans
for its pilot PPP programmes. Upon
enquiry, the HA informed Audit in February 2012 that, while not laid down, its
exit planning was based on the HA’s fundamental responsibility of providing healthcare
for all Hong Kong residents. According
to such exit planning, should a PPP programme be terminated, the HA was ready
to take back all affected patients.”
With such attitude
and intention, the Hospital Authority is likely to implement all other
recommendations from the Audit Commission, leaving the above mentioned “minor”
parts. Thus it is supposed to “step up efforts in promoting the charitable arrangements offered by participating ophthalmologists of the Cataract
Surgeries Programme; and in launching other PPP programmes, examine the
desirability of implementing similar charitable arrangements.” The responsibility of the government and the
Hospital Authority will be shifted to private doctors. Apart from that, private doctors are expected
to “include the HA as a co-insured party in
their insurance policies for the PPP
programmes.” The
private “partners” should be monitored more closely and be paid according to
their performance. The Hospital
Authority is recommended to “review the
effectiveness of performance-based
payments; and consider adopting performance-based payments for PPP programmes in future.” Also, it should “step up the monitoring of healthcare providers’ service delivery; and remind healthcare
providers to give due consideration to the service protocols.”
The conclusion is that the title
of this article is wrong. There has not
been any road to public-private partnership. There might or might not be a road to
public-private partnership. If there is
going to be one, it will be long and winding.
(Source: HKMA News May 2012)
