A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho

Abstract

Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes.

Hospital Public–Private Partnerships in Low Resource Settings: Perceptions of How the Lesotho PPP Transformed Management Systems and Performance

“…Key informants identified major improvements in the new hospital network compared to the government-managed facilities it replaced and related those changes to staff motivation and patient care outcomes. The qualitative data largely support the quantitative findings, previously reported, 17 which showed significant improvements in clinical outcomes. Some differences noted by informants, such as new clinical services and better infrastructure, are to be expected with any new facility, and such investments could also have been introduced in a publicly run hospital.…”

“…Emergency clinical carts were more accessible, a higher proportion of patients were triaged appropriately, and drugs were more available. 12,17 QMMH had 882 staff as of December 2012, including 70 physicians and 284 registered nurses: this is 37% more than the 642 staff at QE II, with most of the additional staff in clinical and allied health positions. In light of these quantitative findings, documented in more detail in other publications, 12,17 analysis of qualitative data provides an opportunity to better understand how the model of the PPP had achieved these results.…”

“…The perceptions of increased volume are corroborated by service statistics: inpatient admissions were 51% higher, deliveries had increased 45%, and the PPP hospital network was seeing 126% more outpatients. 17 Several informants mentioned that the case mix at QMMH has also changed, with an increase in very sick patients, malnourished children, and very premature and low-birth-weight infants. (Because it was not possible to measure differences in acuity using hospital administrative data, we could not corroborate these findings.…”

Public‐private partnerships in non‐profit hospitals: Case study of China

“…The government received more value for its money, patient fees remained the same, and quality improved. 24,25 Table A1).…”

Will markets be master or servant to health at the World Bank?

“…10 A 2014 Oxfam analysis found that the IFC's $1bn Health in Africa initiative, which channels capital to healthcare firms, had primarily targeted wealthy and middle class people-for example, by investing in costly urban hospitals. 11 Through its advisory work, the IFC also supported an agreement between the government of Lesotho and a private firm to build and operate a new hospital in the capital city; although the hospital achieved important service improvements, 12 it also consumed over half the annual health budget and squeezed out spending for more basic health services for rural poor citizens, while expecting to pay attractive returns to private investors. 13 Sridhar and colleagues concluded: "The World Bank Group more broadly is reinventing itself, from a lender for major development projects to a broker for private sector investment."…”