1. Contracting vs PPPs Making our terminology clear Bangkok, May-June 2011 course

2. Contracting non-clinical support services common terms Options Contracting clinical support services Contracting specific clinical services Buying hospital services Private management of public hospital Private financing, construction, and leaseback of new public hospital Private financing, construction, and operation of new public hospital Sale of public hospital for alternative use Services & capital contract BOO BOOT PFI Operating contract Private sector responsibilityPublic sector responsibility Provides nonclinical services (cleaning, catering, laundry, security, building maintenance) and employs staff for these services. Finances, constructs, and operates new public hospital and provides nonclinical or clinical services, or both. Reimburses operator for capital costs and recurrent costs for services provided. Reimburses operator for capital and recurrent costs for services provided. Takes facility ownership at end. Finances, constructs, and owns new public hospital and leases it back to government Manages public hospital under contract with government or public insurance fund; provides clinical and nonclinical services. May employ all staff. May also be responsible for new capital investment, depending on terms of contract. Contracted private hospitals provide services in accordance with contractual provisions Provides specific clinical services (such as lithotripsy; dialysis) or routine procedures (cataract removal). Provides clinical support services such as radiology or laboratory services. Purchases facility and converts it for alternative use depending on sales agreement Provides all clinical services (and staff) and hospital management; manages contract and pays for support services Manages hospital and provides clinical services; manages contract and pays for services. Manages hospital and provides most clinical services; manages contract and pays for services. Contracts with private hospitals, monitors, pays for services. Contracts with private firm for provision of public hospital services, pays private operator for services provided, and monitors and regulates services and contract compliance. Manages hospital and makes phased lease payments to private developer. Monitors conversion to ensure adherence to contractual obligations. Outsourcing; PPP Privatization Outsourcing Contracting Co-location Co-location of private wing or department within or beside public hospital Operates private wing or department (for private & public (?) patients); fulfills payment and service access conditions agreed Manages public hospital for public patients and contracts with private wing for sharing joint costs, staff, and equipment.; supervises fulfillment of patient access and other conditions Outsourcing; PPP Contracting; Purchasing

3. Contracting non-clinical support services common terms Options Contracting clinical support services Contracting specific clinical services Buying hospital services Private management of public hospital Private financing, construction, and leaseback of new public hospital Private financing, construction, and operation of new public hospital Sale of public hospital for alternative use Services & capital contract BOO BOOT PFI Operating contract Private sector responsibilityPublic sector responsibility Provides nonclinical services (cleaning, catering, laundry, security, building maintenance) and employs staff for these services. Finances, constructs, and operates new public hospital and provides nonclinical or clinical services, or both. Reimburses operator for capital costs and recurrent costs for services provided. Reimburses operator for capital and recurrent costs for services provided. Takes facility ownership at end. Finances, constructs, and owns new public hospital and leases it back to government Manages public hospital under contract with government or public insurance fund; provides clinical and nonclinical services. May employ all staff. May also be responsible for new capital investment, depending on terms of contract. Contracted private hospitals provide services in accordance with contractual provisions Provides specific clinical services (such as lithotripsy; dialysis) or routine procedures (cataract removal). Provides clinical support services such as radiology or laboratory services. Purchases facility and converts it for alternative use depending on sales agreement Provides all clinical services (and staff) and hospital management; manages contract and pays for support services Manages hospital and provides clinical services; manages contract and pays for services. Manages hospital and provides most clinical services Contracts with private hospitals, monitors, pays for services. Contracts with private firm for provision of public hospital services, pays private operator for services provided, and monitors and regulates services and contract compliance. Manages hospital and makes phased lease payments to private developer. Monitors conversion to ensure adherence to contractual obligations. Outsourcing; PPP Privatization Outsourcing Contracting Co-location Co-location of private wing or department within or beside public hospital Operates private wing or department (for private & public (?) patients); fulfills payment and service access conditions agreed Manages public hospital for public patients and contracts with private wing for sharing joint costs, staff, and equipment.; supervises fulfillment of patient access and other conditions Outsourcing; PPP Contracting; Purchasing Contracting

4. Contracting non-clinical support services common terms Options Contracting clinical support services Contracting specific clinical services Buying hospital services Private management of public hospital Private financing, construction, and leaseback of new public hospital Private financing, construction, and operation of new public hospital Sale of public hospital for alternative use Services & capital contract BOO BOOT PFI Operating contract Private sector responsibilityPublic sector responsibility Provides nonclinical services (cleaning, catering, laundry, security, building maintenance) and employs staff for these services. Finances, constructs, and operates new public hospital and provides nonclinical or clinical services, or both. Reimburses operator for capital costs and recurrent costs for services provided. Reimburses operator for capital and recurrent costs for services provided. Takes facility ownership at end. Finances, constructs, and owns new public hospital and leases it back to government Manages public hospital under contract with government or public insurance fund; provides clinical and nonclinical services. May employ all staff. May also be responsible for new capital investment, depending on terms of contract. Contracted private hospitals provide services in accordance with contractual provisions Provides specific clinical services (such as lithotripsy; dialysis) or routine procedures (cataract removal). Provides clinical support services such as radiology or laboratory services. Purchases facility and converts it for alternative use depending on sales agreement Provides all clinical services (and staff) and hospital management; manages contract and pays for support services Manages hospital and provides clinical services; manages contract and pays for services. Manages hospital and provides most clinical services Contracts with private hospitals, monitors, pays for services. Contracts with private firm for provision of public hospital services, pays private operator for services provided, and monitors and regulates services and contract compliance. Manages hospital and makes phased lease payments to private developer. Monitors conversion to ensure adherence to contractual obligations. Outsourcing; PPP Privatization Outsourcing Contracting Co-location Co-location of private wing or department within or beside public hospital Operates private wing or department (for private & public (?) patients); fulfills payment and service access conditions agreed Manages public hospital for public patients and contracts with private wing for sharing joint costs, staff, and equipment.; supervises fulfillment of patient access and other conditions Outsourcing; PPP Contracting; Purchasing “PPPs”