Strategies on Public-private Partnership in the Provision of Health Care Services: A Descriptive Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Qin , WANG Hong , LI Lei , ZHANG Fan , LI Juan , SONG Wenfeng , LIU Hui ,  WANG Yang

School of Public Health, Chongqing Medical University, Chongqing 400016, China;

Corresponding?author：

WANG Yang, Email: wangyang8289@163.com

Keywords：

Public health sector; Private health sector; Public-private partnership; Health care; Systematic review

DOI：

10.7507/1672-2531.20090092

Video：

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Objective 　To describe the range of Public-private partnerships (PPP) in the provision of healthcare services, and how the authors have assessed these partnerships.
Methods 　We searched 19 international electronic databases and 3 grey literature databases up to September 2008. Nine websites of relevant organizations and Google were searched for any missing information. Search terms were determined by both health policy experts and search specialists after repeated discussion and pilot searching. Our inclusion criteria were research papers that reported describing or evaluating any public-private partnerships in provision of healthcare services. Two reviewers independently screened, appraised and extracted the data, and disagreements were resolved by discussion or by consulting a third researcher. The studies that scored A or B in terms of quality assessment were analyzed.
Results 　Of the 38 studies included in the analysis, 22 studies aimed to describe strategies, while 16 ones were to evaluate the effectiveness of strategies. The targeted populations were tuberculosis patients, AIDS patients, psychiatric patients, community residents and children. Six partnership mechanisms were categorized: ① formal/ informal contract; ② working group committee; ③ supervision, training and regulation; ④ support and subsidizing; ⑤ integration of health care organizations; and ⑥ co-location. Most of the studies evaluating effectiveness were observational studies. Only three studies were comparative studies, pre- and post- intervention. The results of the most evaluation studies showed that PPP had positive impact on service provision, while it also had some problems and challenges.
Conclusion 　Current studies show that PPP could improve health service provisions to some extent. There are limitations in the range of health services and the depth of the studies, especially evaluation studies that lack rigorous design. However, people should be cautious when they try to learn from the experience from internationally successful PPPs and consider the Chinese context, as the effect of PPP is closely associated with the relevant implementation context.

Citation： LIU Qin,WANG Hong,LI Lei,ZHANG Fan,LI Juan,SONG Wenfeng,LIU Hui,WANG Yang. Strategies on Public-private Partnership in the Provision of Health Care Services: A Descriptive Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(5): 492-502. doi: 10.7507/1672-2531.20090092 Copy

1.	Involving private medical practitioners in TB and STI control, Report of an Informal Consultation Bangkok, World Health Organization Regional Office for South-East Asia, 2001. (7). Available from: URL: http://www.searo.who.int/LinkFiles/AIDS_tb-235.pdf.
2.	Forging Partnerships - With Private Health Sector. Available from: URL: http://www.searo.who.int/LinkFiles/Tuberculosis_left32.pdf.
3.	于廣軍, 高解春. 公立醫院改革的國際比較研究, 中國醫院院長, 2007, 9: 39-42.
4.	Huntington D, Sulzbach S. Public Policy and Franchising Reproductive Health: Current Evidence and Future Directions, World Health Organization, 2007.
5.	Dewan PK, Lal SS, Lonnroth K, et al. Improving tuberculosis control through public-private collaboration in India: literature review. British Medical Journal, 2006, 7541(332), 574-577.
6.	張宏. 巴西初級衛生保健的新嘗試, 中國衛生人才, 2007, 11: 38-39.
7.	高光明. 公立與私立醫療機構的劃分, 國外醫學, 醫院管理分冊, 1998, (3): 115-116.
8.	Sheikh K, Porter J, Kielmann K, et al. Public-private partnerships for equity of access to care for tuberculosis and HIV/AIDS: lessons from Pune, India, transactions of transactions of the royal society of tropical medicine and hygiene, 2006, 4(100): 312-320.
9.	Arora VK, Sarin R, Lonnroth K. Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India. International Journal of Tuberculosis and Lung Disease, 2003, 12(7): 1131-1138.
10.	Lonnroth K, Thuong LM, Linh PD, et al. Utilization of private and public health-care providers for tuberculosis symptoms in Ho Chi Minh City, Vietnam. Health Policy and Planning, 2001, 1(16): 47-54.
11.	Malmborg R, Mann G, Thomson R, et al. Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable? Bulletin of the World Health Organization, 2006, 9(84):752- 758.
12.	Karki DK, Mirzoev TN, Green NT, et al. Costs of a successful public-private partnership for TB control in an urban setting in Nepal, BMC Public Health, 2007, 84.
13.	Hurtig AK, Pande SB, Baral SC, et al. Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal. Health Policy and Planning, 2002, 17(1): 78-89.
14.	Newell JN, Pande SB, Bara SC, et al. Control of tuberculosis in an urban setting in Nepal: public–private partnership. Bulletin of the World Health Organization, 2004, 82: 92-98.
15.	Schwartz JB, Bhushan I. Improving immunization equity through a public-private partnership in Cambodia. Bulletin of the World Health Organization, 2004, 82(9): 661-667.
16.	Banda EN, Simukonda HP, et al. The public/private mix in the health care system in Malawi. Health Policy and Planning, 1994, 9(1): 63-71.
17.	Nishtar S, Bile KM, Ahmed A, et al. Process, Rationale, and Interventions of Pakistan’s National Action Plan on Chronic Diseases. Preventing Chronic Disease, 2006, 3: 1.
18.	Quy HT, Lan NTN, Lönnroth K, et al. Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: An assessment of its impact on case detection. International Journal of Tuberculosis and Lung Disease, 2003, 7(5): 464-471.
19.	Raman AV, Björkman JW. Public-private partnership in the provision of health care services to the poor in India. Global Development Network, 2007, 32.
20.	Dewan PK, Lal SS, Lonnroth K, et al. Improving tuberculosis control through public-private collaboration in India: literature review, BMJ, 2006, 332: 574-578.
21.	Annigeri VB, Prosser L, Reynolds J, et al. An assessment of pubic-private partnership opportunities in India. Poptech, 2004.
22.	Sehgal S, Dewan PK, Chauhan LS, et al. Public-Private Mix TB activities in Meerut, Uttar Pradesh, North India: delivering DOTS via collaboration with private providers and non-governmental organizations. Indian J Tuberc, 2007, 54: 79-83.
23.	Kumar MKA, Dewan PK, Nair PKJ, et al. Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002. International Journal of Tuberculosis and Lung Disease, 2005, 9(8): 870-876.
24.	Rangana S, Ambeb G, Borremans N, et al. The Mumbai experience in building field level partnerships for DOTS implementation. Tuberculosis, 2003, 83: 165-172.
25.	Arora VK, Sarin R, Lönnroth K. Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India. International Journal of Tuberculosis and Lung Disease, 2003, 7(12): 1131-1138.
26.	Murthy KJR, Frieden TR, Yazdani A, et al. Public-private partnership in tuberculosis control: experience in Hyderabad, India. International Journal of Tuberculosis and Lung Diseas, 2001, 5(4): 354-359.
27.	Patel A, Ramani KV, Mavalankar DV, et al. Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad. Research and Publications, 2007.
28.	Ramiah I, Reich MR. Building effective public–private partnerships: Experiences and lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP). Social Science and Medicine, 2006, 63(2): 397-408.
29.	Dreesch N, Nyoni J, Mokopakgosi O, et al. Public-private options for expanding access to human resources for HIV/AIDS in Botswana. BMC Human Resources for Health, 2007, 5: 25.
30.	Ramiah I, Reich MR. Public-private partnerships and antiretroviral drugs for HIV/AIDS: lessons from botswana. Health Affairs, 2005, 24: 2.
31.	Clark P, O’Brien K. Fighting AIDS in Sub-Saharan Africa: is a public--private partnership a viable paradigm? Med Sci Monit, 2003, 9(9), 28-39.
32.	Mantala MJ. Public-private mix DOTS in the Philippines, Tuberculosis, 2003, 83(1-3): 173-176.
33.	Sinanovic E, Kumaranayake L. Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa. BMC Cost Effectiveness and Resource Allocation, 2006, 4: 11.
34.	Ardian M, Meokbun E, Siburian L, et al. A public-private partnership for TB control in Timika, Papua Province, Indonesia. International Journal of Tuberculosis and Lung Disease, 2007, 11(10): 1101-1107.
35.	Lönnroth K, Uplekar M, Arora VK, et al. Public-private mix for DOTS implementation: What makes it work? Bulletin of the World Health Organization, 2004, 82: 580-586.
36.	Fisher WH, Dorwart RA, Schlesinger M, et al. Contracting between Public Agencies and Private Psychiatric Inpatient Facilities. Medical Care, 1991, 29(8): 766-774.
37.	Romana HW. Overview of the Community Care Network Demonstration Program and Its Evaluation. Medical Care Research and Review, 2003, 60, 5S.
38.	Morrow H, Collins BK, Smith DR. Public health coalitions: patterns and perceptions in state immunization programs. Jhhsa Fall, 2007: 157-175.
39.	Shortell SM, Zukoski AP, Alexander JA, et al. Evaluating Partnerships for Community Health Improvement: Tracking the Footprints. Journal of Health Politics, Policy and Law, 2002, 27: 1.
40.	Weiner BJ, Alexander J. A The Challenges of Governing Public-Private Community Health Partnerships. Health Care Management, 1998, 23(2): 39-55.
41.	Bazzoli GJ, Stein R, Alexander JA, et al. Public-Private Collaboration in Health and Human Service Delivery: Evidence from Community Partnerships. The Milbank Quarterly, 1997, 75 (4): 533-561.
42.	Pirkis J, Livingston J, Herrman H, et al. Improving collaboration between private psychiatrists, the public mental health sector and general practitioners: evaluation of the Partnership Project. Australian and New Zealand Journal of Psychiatry, 2004, 38: 125-134.
43.	Browna L, Barnett JR. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. Social Science & Medicine, 2004, 58: 427-444.
44.	Pirkis J, Herrman H, Schweitzer I, et al. Evaluating complex, collaborative programmes: the Partnership Project as a case study. Australian and New Zealand Journal of Psychiatry, 2001, 35(5): 639-646.
45.	Thaldorf C, Liberman A. Integration of Health Care Organizations Using the Power Strategies of Horizontal and Vertical Integration in Public and Private Health Systems. The Health Care Manager, 2007, 26(2): 116-127.
46.	Malmborg R, Mann G, Thomson R, et al. Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable? Bulletin of the World Health Organization, 2006, 84(9): 752-758.
47.	Patouillard E, Goodman CA, Hanson KG, et al. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. BMC International Journal for Equity in Health, 2007, 6: 17.
48.	Waters H, Hatt L, Peters D. Working with the private sector for child health, Health. Policy and Planning, 2003, 18(2): 127-137.
49.	Uplekar M, Pathania V, Raviglione M. Involving Private Practitioners in Tuberculosis Control: Issues, Interventions, and Emerging Policy Framework. WHO, 2001, 285.
50.	周成武, 嚴肅勤, 陳建平, 等. 公私合作伙伴關系在衛生領域的應用, 中國衛生經濟, 2006, 25(5): 73-75.

1. Involving private medical practitioners in TB and STI control, Report of an Informal Consultation Bangkok, World Health Organization Regional Office for South-East Asia, 2001. (7). Available from: URL: http://www.searo.who.int/LinkFiles/AIDS_tb-235.pdf.
2. Forging Partnerships - With Private Health Sector. Available from: URL: http://www.searo.who.int/LinkFiles/Tuberculosis_left32.pdf.
3. 于廣軍, 高解春. 公立醫院改革的國際比較研究, 中國醫院院長, 2007, 9: 39-42.
4. Huntington D, Sulzbach S. Public Policy and Franchising Reproductive Health: Current Evidence and Future Directions, World Health Organization, 2007.
5. Dewan PK, Lal SS, Lonnroth K, et al. Improving tuberculosis control through public-private collaboration in India: literature review. British Medical Journal, 2006, 7541(332), 574-577.
6. 張宏. 巴西初級衛生保健的新嘗試, 中國衛生人才, 2007, 11: 38-39.
7. 高光明. 公立與私立醫療機構的劃分, 國外醫學, 醫院管理分冊, 1998, (3): 115-116.
8. Sheikh K, Porter J, Kielmann K, et al. Public-private partnerships for equity of access to care for tuberculosis and HIV/AIDS: lessons from Pune, India, transactions of transactions of the royal society of tropical medicine and hygiene, 2006, 4(100): 312-320.
9. Arora VK, Sarin R, Lonnroth K. Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India. International Journal of Tuberculosis and Lung Disease, 2003, 12(7): 1131-1138.
10. Lonnroth K, Thuong LM, Linh PD, et al. Utilization of private and public health-care providers for tuberculosis symptoms in Ho Chi Minh City, Vietnam. Health Policy and Planning, 2001, 1(16): 47-54.
11. Malmborg R, Mann G, Thomson R, et al. Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable? Bulletin of the World Health Organization, 2006, 9(84):752- 758.
12. Karki DK, Mirzoev TN, Green NT, et al. Costs of a successful public-private partnership for TB control in an urban setting in Nepal, BMC Public Health, 2007, 84.
13. Hurtig AK, Pande SB, Baral SC, et al. Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal. Health Policy and Planning, 2002, 17(1): 78-89.
14. Newell JN, Pande SB, Bara SC, et al. Control of tuberculosis in an urban setting in Nepal: public–private partnership. Bulletin of the World Health Organization, 2004, 82: 92-98.
15. Schwartz JB, Bhushan I. Improving immunization equity through a public-private partnership in Cambodia. Bulletin of the World Health Organization, 2004, 82(9): 661-667.
16. Banda EN, Simukonda HP, et al. The public/private mix in the health care system in Malawi. Health Policy and Planning, 1994, 9(1): 63-71.
17. Nishtar S, Bile KM, Ahmed A, et al. Process, Rationale, and Interventions of Pakistan’s National Action Plan on Chronic Diseases. Preventing Chronic Disease, 2006, 3: 1.
18. Quy HT, Lan NTN, Lönnroth K, et al. Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: An assessment of its impact on case detection. International Journal of Tuberculosis and Lung Disease, 2003, 7(5): 464-471.
19. Raman AV, Björkman JW. Public-private partnership in the provision of health care services to the poor in India. Global Development Network, 2007, 32.
20. Dewan PK, Lal SS, Lonnroth K, et al. Improving tuberculosis control through public-private collaboration in India: literature review, BMJ, 2006, 332: 574-578.
21. Annigeri VB, Prosser L, Reynolds J, et al. An assessment of pubic-private partnership opportunities in India. Poptech, 2004.
22. Sehgal S, Dewan PK, Chauhan LS, et al. Public-Private Mix TB activities in Meerut, Uttar Pradesh, North India: delivering DOTS via collaboration with private providers and non-governmental organizations. Indian J Tuberc, 2007, 54: 79-83.
23. Kumar MKA, Dewan PK, Nair PKJ, et al. Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002. International Journal of Tuberculosis and Lung Disease, 2005, 9(8): 870-876.
24. Rangana S, Ambeb G, Borremans N, et al. The Mumbai experience in building field level partnerships for DOTS implementation. Tuberculosis, 2003, 83: 165-172.
25. Arora VK, Sarin R, Lönnroth K. Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India. International Journal of Tuberculosis and Lung Disease, 2003, 7(12): 1131-1138.
26. Murthy KJR, Frieden TR, Yazdani A, et al. Public-private partnership in tuberculosis control: experience in Hyderabad, India. International Journal of Tuberculosis and Lung Diseas, 2001, 5(4): 354-359.
27. Patel A, Ramani KV, Mavalankar DV, et al. Implementing a Public Private Partnership Model for Managing Urban Health in Ahmedabad. Research and Publications, 2007.
28. Ramiah I, Reich MR. Building effective public–private partnerships: Experiences and lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP). Social Science and Medicine, 2006, 63(2): 397-408.
29. Dreesch N, Nyoni J, Mokopakgosi O, et al. Public-private options for expanding access to human resources for HIV/AIDS in Botswana. BMC Human Resources for Health, 2007, 5: 25.
30. Ramiah I, Reich MR. Public-private partnerships and antiretroviral drugs for HIV/AIDS: lessons from botswana. Health Affairs, 2005, 24: 2.
31. Clark P, O’Brien K. Fighting AIDS in Sub-Saharan Africa: is a public--private partnership a viable paradigm? Med Sci Monit, 2003, 9(9), 28-39.
32. Mantala MJ. Public-private mix DOTS in the Philippines, Tuberculosis, 2003, 83(1-3): 173-176.
33. Sinanovic E, Kumaranayake L. Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa. BMC Cost Effectiveness and Resource Allocation, 2006, 4: 11.
34. Ardian M, Meokbun E, Siburian L, et al. A public-private partnership for TB control in Timika, Papua Province, Indonesia. International Journal of Tuberculosis and Lung Disease, 2007, 11(10): 1101-1107.
35. Lönnroth K, Uplekar M, Arora VK, et al. Public-private mix for DOTS implementation: What makes it work? Bulletin of the World Health Organization, 2004, 82: 580-586.
36. Fisher WH, Dorwart RA, Schlesinger M, et al. Contracting between Public Agencies and Private Psychiatric Inpatient Facilities. Medical Care, 1991, 29(8): 766-774.
37. Romana HW. Overview of the Community Care Network Demonstration Program and Its Evaluation. Medical Care Research and Review, 2003, 60, 5S.
38. Morrow H, Collins BK, Smith DR. Public health coalitions: patterns and perceptions in state immunization programs. Jhhsa Fall, 2007: 157-175.
39. Shortell SM, Zukoski AP, Alexander JA, et al. Evaluating Partnerships for Community Health Improvement: Tracking the Footprints. Journal of Health Politics, Policy and Law, 2002, 27: 1.
40. Weiner BJ, Alexander J. A The Challenges of Governing Public-Private Community Health Partnerships. Health Care Management, 1998, 23(2): 39-55.
41. Bazzoli GJ, Stein R, Alexander JA, et al. Public-Private Collaboration in Health and Human Service Delivery: Evidence from Community Partnerships. The Milbank Quarterly, 1997, 75 (4): 533-561.
42. Pirkis J, Livingston J, Herrman H, et al. Improving collaboration between private psychiatrists, the public mental health sector and general practitioners: evaluation of the Partnership Project. Australian and New Zealand Journal of Psychiatry, 2004, 38: 125-134.
43. Browna L, Barnett JR. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. Social Science & Medicine, 2004, 58: 427-444.
44. Pirkis J, Herrman H, Schweitzer I, et al. Evaluating complex, collaborative programmes: the Partnership Project as a case study. Australian and New Zealand Journal of Psychiatry, 2001, 35(5): 639-646.
45. Thaldorf C, Liberman A. Integration of Health Care Organizations Using the Power Strategies of Horizontal and Vertical Integration in Public and Private Health Systems. The Health Care Manager, 2007, 26(2): 116-127.
46. Malmborg R, Mann G, Thomson R, et al. Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable? Bulletin of the World Health Organization, 2006, 84(9): 752-758.
47. Patouillard E, Goodman CA, Hanson KG, et al. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. BMC International Journal for Equity in Health, 2007, 6: 17.
48. Waters H, Hatt L, Peters D. Working with the private sector for child health, Health. Policy and Planning, 2003, 18(2): 127-137.
49. Uplekar M, Pathania V, Raviglione M. Involving Private Practitioners in Tuberculosis Control: Issues, Interventions, and Emerging Policy Framework. WHO, 2001, 285.
50. 周成武, 嚴肅勤, 陳建平, 等. 公私合作伙伴關系在衛生領域的應用, 中國衛生經濟, 2006, 25(5): 73-75.

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Chinese Journal of Evidence-Based Medicine

Strategies on Public-private Partnership in the Provision of Health Care Services: A Descriptive Systematic Review

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