Private Public Mix Working Model of a Teaching Hospital, Benefits for the Organizations and End users

 

MUHAMMAD ZAHID LATIF1, INTZAR HUSSAIN2, RAHILA NIZAMI3, UMAR FAROOQ4 , HAROON RIAZ5

1Department of Community Medicine, Azra Naheed Medical College Lahore

2Services Institute of Medical Sciences Lahore

3University of Management & Technology Lahore

4Institute of Public Health Lahore

5Health Care Diagnostics & Research Centre

Correspondence to Dr Muhammad Zahid Latif,  Assistant Professor  Email: mzahidlatif@yahoo.com 0333-4428870

 

ABSTRACT

 

Aim: To find out the benefits of Private Public Mix Working Model of a Teaching Hospital for the organizations and end users.

Study design: Cross sectional Survey

Methods: The study was conducted at Islamic International Medical College (IIMC) and Pakistan Railway Hospital (PRH) Rawalpindi. Retrospective data was collected on a semi structured, pre tested questionnaire from the records of PRH. The benefits of PPM working model were assessed using variables like training of students, hiring of academic staff, availability and utilization of different services.

Results: 600 undergraduate, 7 postgraduate and 26 nursing students were being trained after implementation of model. Academic staff increased from 17 to 127 doctors. Number of departments increased from 4 to 15 and range of laboratory test increased from 16 to 92. Outpatient and indoor flow of patients increased up to 500% after the intervention. There are evident benefits for both the organizations and end users through this private public mix working model.

Keywords: Private public mix working model, IIMCT, Pakistan railway hospital

 

INTRODUCTION

 

Pakistan has an extensive public health care delivery system, but it is unable to provide quality health services to the growing population. The health status of the nation is characterized by a population growth rate of over 2%, infant mortality rate of 90/1000 live births and maternal mortality rate of 450/100,000 live births that is one of the highest in the world while communicable infectious and parasitic diseases are still remain a severe burden1. Private sector is also providing health care services to 80% of the population with satisfactory progress2. Free health care has historically been considered as a basic right in Pakistan. On the other hand government is unable to afford the entire expenditures of health due to financial crisis3. As a matter of fact the role of Governments in the contemporary world has been changed and they are unlikely to have the resources and capacity to fulfill the variety of needs and levels of demand for health services4. Planning commission of Pakistan has identified the crisis of health care and suggested for an acute change5. In 9th five year plan the Commission has recommended to introduce Private public mix working models gradually6.

Private public mix model is an alternative measure to improve the health care delivery system which has been experienced in Indonesia and Cambodia7,8. Private and public groups have their own special strengths and by taking advantages of those synergies can be achieved, leading to better outcomes9. World Health Organization has also recommended Private Public mix models as a priority area for research, training & development10.

Pakistan railway hospital Rawalpindi was facing a financial crisis due to which fixed and running expenditure was a big problem for Pakistan Railways whereas Islamic international medical college trust started its medical college in 1998. The trust was in dire need of a teaching hospital for clinical training of students. Both the organization joined hands and developed a Private Public Mix working model.

 

MATERIAL & METHODS

 

This research was a cross sectional descriptive study of private public mix working model of a teaching hospital which was conducted at Islamic International Medical College Trust (IIMCT) and Pakistan Railway hospital Rawalpindi. IIMCT is a nongovernmental, not for profit educational organization. The first institute of this Trust was a medical college which was started in 1998. Pakistan Railway Hospital is a 400 bedded public sector hospital directly managed by Pakistan Railway. It serves a large number of general population along with the employees of Pakistan Railway. Both of these organizations joined hands and agreed upon a mutually beneficial document in the form of Private Public Mix Working Model. Through this agreement the hospital is catering the academic needs of medical students at under graduate and post graduate level where as the improvement of clinical and  teaching activities provides better health care services to the general population and employees of Pakistan railways.

For this study a semi structured questionnaire was developed, this questionnaire was pre tested and changes were made accordingly. The retrospective data was collected for variables like teaching and training of undergraduate, post graduate and nursing students, hiring and availability of academic staff, availability and utilization of hospital services e.g. diagnostic tests, annul visits of patients in emergency/ OPD, number of Normal deliveries from the previous record. This data was analyzed using SPSS 16 and descriptive statistics were presented comparing the outcome variables before and after the implementation of Private Public Mix Working Model in Pakistan Railway Hospital, Rawalpindi.

 

RESULTS

 

The results of this study for both of the organizations and end users are presented in the form of academic benefits, availability, cost, level and utilization of different services. Around 600 undergraduate, 7 postgraduate and 26 nursing students are getting academic training from this hospital where as there was no student before this model (Table 1). There were only 2 specialist doctors and 15 medical officers before this model but the number of academic staff has been increased to 127 after this private public mix working model (Table-2).Number of departments is increased from 4 to 15, range of laboratory test increased from 16 to 92, annual visits of patients in OPD/ emergency, diagnostic tests, surgical procedures and indoor admissions are also increased (Table 3). Situation of user charges for the patients related with Pakistan railway is absolutely free whereas charges for general patients are also very low (Table 4). Expense of railway patients if referred to any other institution is paid by Islamic international medical college trust.

 

Table: 1 Training of students before and after private public mix working model

Categories of Students

No. of Students

Before

After

Undergraduate

Nil

600

Postgraduate

Nil

7

Nursing

Nil

26

Total

Nil

633

Table: 2 Academic staff before and after private public mix working model

Designation

No. of Academic Staff

Before

After

Professors

Nil

15

Associate Professors

Nil

7

Assistants Professors

Nil

14

Senior Registrar

Nil

7

Specialists

2

2

Registrar

Nil

9

Medical officer

15

37

House officer

Nil

36

Total

17

127

 

Table: 3 Availability and utilization of services before and after Private Public Mix Working Model

Services

1998

Before PPM Model

After PPM Model

Department

4

15

Availability of diagnostic tests

16

92

Annul visits of patients in emergency/ OPD

65822

114390

Annual laboratory investigations

34339

163416

Annual radiology tests

5910

24214

Annual surgical procedures

693

1925

Annual indoor admissions

3098

5505

 

Table: 4 Situation of user charges before and after private public mix working model

Cost of services in rupees

1998

2002

Railway

Pts of Pak. Railway

General Patients

OPD per visit

Nil

Nil

10

Indoor per day

Nil

Nil

155

Emergency per visit

Nil

Nil

10

Blood C/E

Nil

Nil

100

Urine C/E

Nil

Nil

30

X-Ray Chest

Nil

Nil

100

Normal delivery

Nil

Nil

1000

 

DISCUSSION

 

Crisis of health care services in Pakistan is among the most serious national problems. Despite of the availability of wide spread infrastructure, the present system has been failed to cope with this situation11. Internationally accepted concepts of decentralization and autonomy are in practice, but still there is no tangible improvement. Private public mix models are being practiced worldwide as an alternative mechanism for better health care provision. Pakistan is still lacking in this concept. This research was conducted to study the benefits of an existing private public mix model of a teaching hospital for the organizations and end users. World health Organization recommends private public mix model as priority areas for research12.

This private public mix working model is a kind of contracting out system as experienced successfully by ministry of Health in Cambodia. 13 They handed over health infrastructure of various districts to private sector. Private sector was made responsible for any change in human resource but finance was provided mainly by MOH14. Although this private public mix model is same in infrastructure and induction of new human resource but it differs in the sense that finance provision is the responsibility of private sector.

This study shows that there is a clear evidence of improved academic activities after this private public mix working model. The number of students and academic staff has been increased to 633 and 127 respectively (Table 1 & 2). Table 3 reveals that the availability and utilization of services in different areas is also improved resulting in a direct benefit to end users and indirect benefit to organizations. These services are presented in the form of departments, diagnostic tests, surgical procedures and indoor admissions. The private sector is well known for the quality of its hospitals and enhanced regulatory environment for the improvement of services14. Another very important area of concern is about the cost of services after this private public mix working14. This study revealed that the employees of Pakistan Railway are enjoying free health services in this model whereas the cost of general patients is also very low.

 

CONCLUSIONS

 

This study showed that Private Public Mix Working Model is very much beneficial for the organizations and end users. Although there are issues related to user charges but in the present model these are properly addressed. This model should be treated as alternative measures to improve the health care services. Government should make necessary legislative changes and encourage the process of private public mix working models.

 

REFERENCES

 

1.     Planning Commission of Pakistan, Poverty reduction and human development strategy, Islamabad. P. 10, 11 January 2002.

2.     Planning Commission of Pakistan of five year plan report of working group, Islamabad P. 11, October 1997.

3.     Planning Commission of Pakistan 9th five year plan report of working group, Islamabad. P. 41 October 1997.

4.     Summary of proceedings Private Public Partnership in Health Program Thailand P. 1 November 2000.

5.     Planning Commission of Pakistan 9th five yar plan report working group P. 22,23 October 1997.

6.     Planning Commission of Pakistan 9th five year plan working group P. 11, 22, 23, 34 October 1997. (11)

7.     LaksonoTrismantaro Director, Center for Health Services Management, Gadah Mada University Indonesia. Summary of Proceedings PPP in Health 30th October to 3rd November 2000 Ayuttaya Thailand P. 11. (21)

8.     Summary of Proceedings Private Public Partnership in Health Programme Thailand P. 1 November 2000. (6)

9.     World Health Organization regional office for the eastern Mediterranean 11th call for application November 2003. (13)

10.   Planning Commission of Pakistan, Poverty reduction and human development strategy, Islamabad. P. 10, 11 January 2002 (1)

11.   Charles Collins, decentralization, management and development of developing health system, Oxford University Press 1994, P. 80. (12)

12.   Nancy Fronczak, Krang S. Lorn Cambodia. Summary of Proceedings PPP in Health 30th October to 3rd November 2000 Ayuttaya Thailand P. 10. (22)

13.   Nancy Fronczak, Krang S. Lorn Cambodia. Summary of Proceedings PPP in Health 30th October to 3rd November 2000 Ayuttaya Thailand P. 10. (22)

14.   Mitchell M. An Overview of Public Private Partnerships in Health. Harvard School of Public Health;21-2. Available at

http://www.hsph.harvard.edu/ihsg/publications/pdf/PPP-final-MDM.pdf