1. Improving Total System Performance & Public-private Partnership Dr. FUNG Hong Hospital Authority May 2001

2. New Universalism …Rather than all possible care for everyone, or only the simplest and most basic care for the poor, this means delivery to all of high-quality essential care, defined mostly by criteria of effectiveness, cost and social acceptability… World Health Report, 2000

3. Stewardship Health policy and strategies need to cover the private provision of services and private financing Too often health policy and strategic planning have envisaged unrealistic expansion of publicly funded healthcare system

4. Service Provision Oversight and regulation of private sector providers and insurers must be placed high on national policy agendas An explicit, public process of priority setting should be taken to identify the contents of a benefit package which should be available to all, and which should reflect local disease priorities and cost effectiveness, among other criteria

5. Competition + Cooperation = Coopetition The future public-private relationship:

6. Public-private Barriers Informational Clinical Financial

7. The Health Information Infrastructure A lifelong electronic personal health record Consumer participation in health Sharing of knowledge Sharing of protocol

8. Protocol as the Common Language Protocol-based disease management Sharing of care Sharing of risks Sharing of audit

9. Public-private Partnership Building a virtual network Sharing of common clinical protocols Selective contracting out of services Self-care haemodialysis Complication screening for Diabetes

10. Introducing Control Mechanisms a l  Managing public sector costs  Re-structuring public sector fees  Mandating personal savings  Building up capacity for stewardship

11. Managing Public Sector Costs  Population-based funding  Rationalize care delivery system  Managing technologies

12. Re-structuring Public Sector Fees  Fees to reflect sharing of responsibilities  Managing new drugs and technologies  Explicitly prioritizing the use of public funds

13. Targeting Government Subsidy Reducing government subsidy for - Services with low financial risks Services subject to abuses Services to encourage patients to take up greater responsibilities Services subject to patient choices

14. Introducing Patient Choice Services New and unproven drugs and technologies Privately Purchased Medical Items Differential fees for non-protocol services Patient choice for quality

15. Mandating Personal Savings  Reduce inter-generational subsidy  Contribution reflects sharing of risks  Seeding money for pooling of private funds

16. Creating Space for Private Market Selective contracting out of services Targeting government subsidy Introducing patient choice services Sharing risk on private insurance

17. Public Funding Private Funding Public Provision Private Provision New Intermediary Market

18. Preferred Provider Partners Participation in training and education Participation in shared care programs Participation in clinical audits Participation in community care teams Contribution to clinical data and research Installation of good quality infrastructure

19. Sustainable System Performance Strengthening public accountability Ensuring a quality focus Continuous Quality Improvement Assuring clinical care quality Building up capacity for stewardship

20. Thank you!