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
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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.
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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.
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Public health providers send patients to their preferred private-run clinics
and laboratories for diagnostic tests and surgeries.
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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.
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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.
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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.
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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;
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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.
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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.
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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.
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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.
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Engage constructively with government to gain recognition and value for private
hospitals’ role in healthcare.
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Engage, arm and mobilize hospitals with ‘value-adding’ programs and ‘being
seen’ championing industry interests to grow the membership-base.
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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.
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Redevelop UNAPH’s internal member networks, website, blogs
and private hospital Bulletin as vehicles to drive issues – increasing
interaction, usage and circulation, respectively.
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Advance the value of private hospitals’ contribution to healthcare to influence
consumers.
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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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