How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong

Abstract

The World Health Organization advocates the goal of universal coverage of health systems to ensure that everyone can avail the services they need and are protected from the associated financial risks. Governments are increasingly engaging and interacting with the private sector in initiatives collectively referred to as public-private partnerships (PPPs) to enhance the capacity of health systems to meet this objective. Understanding the values that motivate partners and demonstrating commitment for building relationships were found to be key lessons in building effective PPPs; however there, remain many research gaps. This study focusses on the practice of PPPs at the inter-organisational (meso) level and interpersonal (micro) level in Hong Kong Special Administrative Region (HKSAR). The influence of the structural components of different PPPs on stakeholder interpretation and actions, as well as the eventual outcomes of the PPPs, is examined, in terms of a realist evaluation, which applies a context-mechanism-outcome configuration as the research methodology. Seven key factors initiating commitment in a partnership, critical for sustainable PPPs, were identified as follows: (1) building of trust; (2) clearly defined objectives and roles; (3) time commitment; (4) transparency and candid information, particularly in relation to risk and benefit; (5) contract flexibility; (6) technical assistance or financial incentive behind procedural arrangements; and (7) the awareness and acceptability of structural changes related to responsibility and decisions (power and authority).

Status of public–private partnership recognition and willingness to pay for private health care in China

“…Patients see PPPs as an alternative choice of health care when linked to incentives in terms of time, finance, and quality. Thus, developing trust between patients and the private sector is also important for shifting the utilization habits of patients …”

“…The results claimed that the WTP intention of respondents was positively associated with family financial support, financial condition, and positive attitudes toward the new programs (such as vouchers) and negatively associated with family caregiving support. Older people's acceptance of copayment mechanisms is also affected by employment strategies, proper use of the information system, quality control compliance, the provision of market incentives, financial condition, and shared responsibility of care …”

“…The most common model of PPPs in Europe is private finance initiatives by which quality services are purchased from the private sector on a long‐term basis, while building hospitals by design–build–operate contracts is more common in Australia. In the United States and HKSAR of China, PPPs have been used to enhance the contractual relationship between a public organization and a private entity, promoting greater private‐sector participation in the delivery and/or financing of government‐initiated infrastructure projects . The PPP model in Mainland China has been extended to public hospital reform, and the generalized form of the model includes the three major categories of outsourcing, franchising, and privatizing.…”

Public Private Partnerships and Collaboration in the Health Sector in the Kingdom of Saudi Arabia: A Qualitative Study

“…Generally, the term refers to a contractual agreement between public and private sector entities, which together enhance the delivery and operation of public infrastructure projects, such as roads, prisons and hospitals (Wong, Yeoh, Chau, Yam, Cheung, & Fung, 2015). It is notable that the concept shifts the role of public sector clients from being owners or operators of infrastructure projects into that of being purchasers of long-term services from the private sector, which is often responsible for designing, building, financing and operating the asset.…”

Evaluating public and private partnership to improve food and language nutrition among children 0-5 years

“…In public health, varied forms of public-private partnerships have emerged, in which the overlapping missions of the partners have resulted in an inconsistent pattern of facilitators and challenges in implementing interventions (Wong et al, 2015). Various factors including guidance from an inter-organizational governance mechanism, and the management of stakeholder relationships have been reported as pivotal to developing collaborative partnerships (Wong et al, 2015). In the United States, various state programs develop and continuously enhance partnerships through the implementation of an inclusive state plan with strategies designed to leverage resources and manage interventions (Rieker & Jernigan, 2010).…”