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Private Hospitals for the Public Good



Private Hospitals for the Public Good

Introduction

Uganda National Association of Private Hospitals (UNAPH) is undertaking initiatives to positively re-position the private hospital sector in relation to stakeholder and public awareness.
Health is both a public good and to a considerable extent a private good. Purchasers of health benefit directly from what they pay for, making it a private good. Health care is treated as a public good because it is not an ordinary commodity that works efficiently in a free market. For economists, a public good is not simply something that is “good for the public”; it is something that benefits many people, including those who do not pay for it. When someone is sick they are not necessarily worried about price, the price they are willing to pay may become near limitless because the alternate could be death. Healthcare in terms of supply and demand does not fit efficiently into a free market and externalities provided by healthy citizens indicate that healthcare should indeed be treated as a public good.
                                       
One argument, in support of the private healthcare system is that we already spend massive amounts of public money on healthcare and only cover a portion of the population. Healthcare is not a typical private commodity and while it may not be a pure public, it would fit more efficiently in a regulated market as opposed to the free market system. The free market system may not work efficiently to meet the supply and demand for healthcare. It may create higher costs and insufficient coverage.

It is increasingly noted that healthcare is evolving as a pure public good. The basic question is no longer whether the government should have a universal health insurance but what specific healthcare policies and attitudes should we adopt in order to strengthen the markets and to maximize social welfare as effectively as possible.

If we were to rely on private health only, poor people would never obtain it. These arguments lead inevitably to the claim that the government and private organizations must help to provide health, and, indeed, governments are heavily engaged in supplying this “public good. But it is at least in part a “bad” public good. When ideal amounts of a good cannot adequately be provided publicly, many people, economists and non-economists alike, argue that privately financed provision should be forthcoming from private means.

Under current economic theory, the assumption is that health will be sub-optimally provided. This probable under-provision has led to the claim that some control and private sector must intervene to provide health. And, indeed, in the private hospital sector, is trying to provide such service. The problem that arises is that the quality of government-provided services, including health, is often inadequate. Private hospitals are uniquely positioned to make a difference in the public domain. Given the societal turf private hospitals occupy, the considerable resources they command, and the powerful network of caring and influential people they attract, private hospitals have the opportunity and the obligation to do more than treat the nation's population exceptionally well.

Private hospitals should anticipate growing public scrutiny and possible opposition if they fail to engage the communities in the greater public good. Most public health providers and administrators have difficulty equating the public world they work in with the variable circumstances of private sector. They also believe that private providers have much to learn from them, beginning with how to serve truly poor populations and how to treat to the full range of diverse populations and income class differences. However, this is challenged by high levels of dual employment and multijobholding in the health sector which is coupled with conflict of interests and view private players as competitors.

This public purpose commitment derives from the notion that human beings have both the desire and the capacity to make the world a better place. Similarly, private hospitals should be viewed as recovery institutions that make populations healthy, in large part, by the extent to which their patients contribute positively to society. For a hospital to develop public purpose initiatives, it should provide the opportunity to engage more in public health programs compared curative services. Another is that institutional modeling can have an enduring impact on the communities they serve, including their corporate social responsibility and volunteer decisions.

In Uganda, private hospitals are most times adequate substitutes and alternatives for public hospitals and should receive public subsidies, funding (both at clinical levels and governance levels) and tax-exemptions. It is clear good health doesn’t depend on big government budgets. Unfortunately, these private hospitals currently face regulatory, legal, financial and taxation threats. If they disappear, patients will have even fewer choices in health.

Situation Analysis

-          In Uganda, the private sector, which is estimated to include 65% of all qualified doctors, 80% of clinics and dispensaries and 40% of hospitals, remains an important health care provider, catering to between 60 and 70% of those seeking healthcare in urban and rural areas.

-          60% of the total health care expenditure is reported to be in the private sector and 70% of the total health expenditure is out of-pocket. Despite the role that the private sector plays as a major healthcare provider and a public good provider, it continues to be neglected by the public health system and development partners in the delivery of care for illnesses of public health importance, public policy and sometimes functions as a parallel sector, inadequately regulated. Few studies in the comparatively recent times, have contributed to our understanding of the role played by the private sector in providing this public good.


-          Public health providers send patients to their preferred private-run clinics and laboratories for diagnostic tests and surgeries.

-          Private hospitals and private clinics are the first contact of health seeking for the patients, who value it as confidential, convenient and user-friendly. Private hospitals are actively involved in the community because of their accessibility and flexibility of services.

-          Over the years, healthcare is on the public agenda and myriad interests vie to affect policy outcomes and consumer choices. Private hospitals struggle for differentiation – in public vs. private health, faith-based health providers and from private health insurers.

-          Research shows “private health” is often equated to “insurance issues” in stakeholder and public perceptions. UNAPH wants to positively engage in the healthcare debate, receive recognition for the sector’s contribution and build support for its growing role.

-          Establishing these credentials could assist in pursuing the sector’s goals on policy areas – i.e. defending the incentives and needs in the private health sector.

Hence, private hospitals have the opportunity and the obligation to develop models that contribute to the improvement of Ugandan healthcare and to extend the use of their insights, energy, and resources beyond their facilities. Therefore, private hospitals should;

-          Serve public hospitals and low income populations. Given the current challenges facing Uganda’s public hospitals and the increasing gap separating the "haves" from the "have nots," these are simply the areas where the need for assistance is greatest.

-          Collaborate, where possible, with the private hospitals associations, government programs, development partners and other appropriate public and/or nonprofit organizations. "Partnership" is our public purpose mantra; the more collaboration, the more synergy; the more synergy, the more powerful and expansive the outcomes. Our purpose is to marshal the larger community's resources in the most effective ways possible, not to be proprietary or to blow our own trumpets.

-          Develop and design initiatives that will affect substantial numbers of people. While quality, flexibility, cost, responsiveness, and leanness come first, "going to scale" is also important – both to maximize the number of people we serve and to make our programs attractive to others who might replicate them.

-          The hospitals administrations must not only embrace, but also take the lead in, promoting a public purpose agenda. Partnerships for the public good, rather than competition, should be the goal. Embed the hospital's public purpose commitment in their strategic plans, budgets, attitudes and mission.

-          Engage constructively with government to gain recognition and value for private hospitals’ role in healthcare.

-          Engage, arm and mobilize hospitals with ‘value-adding’ programs and ‘being seen’ championing industry interests to grow the membership-base.

-          Engage key stakeholders – Uganda health insurance industry, Uganda Medical Association (UMA), Uganda Private Medical Practitioners Association, medical councils, Faith-Based Medical Bureaus, development partners, local governments, authorities and build third-party advocate relationships.

-          Redevelop UNAPH’s internal member networks, website, blogs and private hospital Bulletin as vehicles to drive issues – increasing interaction, usage and circulation, respectively.

-          Advance the value of private hospitals’ contribution to healthcare to influence consumers.

-          Enhance the reputation of UNAPH among its key stakeholders and positively re-position the sector.

Overcoming negative perceptions and lack of awareness of private hospitals required demonstrating the substantial contribution of private hospitals to healthcare and leveraging this into political and community support, while harnessing and growing the collective power of UNAPH’s membership through establishing ‘value-adding’ credentials.

We need to raise the profile of private hospital issues and quality care services by building awareness of private hospitals, their role, functions and value to the community and stakeholder groups, establish confidence, trust and credibility in the information, services, expertise and endeavours of private hospitals, bringing the community and stakeholder groups along on such issues and focusing community and stakeholder attention accordingly; and ultimately, influence community and stakeholder attitudes, behaviors, decisions and choices.
                                                                                                                                                                      
Uganda National Association of Private Hospitals
(UNAPH)
P.O.Box 29324 Kampala, Uganda
Email: unaph22@yahoo.com , unaphserv@gmail.com
Medimark Suite, Lumuba Avenue, Uweal Building

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