Public-Private Mix

Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care
Wouters O; Cylus J; Yang W; Thomson S; McKee M: Health Economics, Policy and Law, 1(3)321-35, 2016

Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. The authors draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts.

The world's health sector is expanding. Can it heal our economies?
Tulenko K: World Economic Forum, May 2016

The author writes that the health sector is predicted to be the largest source of job creation for the next decade globally. Its growth is being driven by increasing numbers of older people and by the expansion of the global middle class. As these two groups grow, the higher levels of healthcare they demand will cause seismic shifts in the amount of money being spent in the health sector, driving employment. Even without these trends, the world would need millions more health workers. Despite increased training, it is not meeting population demand. The world no longer dominated by infectious diseases requiring episodic treatment, and is instead becoming dominated by non-communicable, chronic diseases such as heart disease, diabetes, cancer, and mental-health conditions, which require continuous treatment. Unlike traditional employment sectors such as agriculture and manufacturing, which shed jobs as technology advances, healthcare tends to add jobs with increasing technology. The author argues that the health sector will be an economic engine that not only creates new jobs and business but, by making workers in other sectors healthier and more productive, will enable those sectors to grow faster creating tens of millions of new jobs.

African Newsletter on Occupational Health and Safety Issue of Infectious Diseases
African Newsletter on Occupational Health and Safety 25 (1), 2015

This issue of the African Newsletter on Occupational Health and Safety examines infectious disease and occupational health. Marie-Paul Kelly explores governance and leadership, both at regional and global levels in preventing health emergencies. The issue explores guidance to workplaces and occupational health professionals in prevention of occupational infections and examines the workplace as an arena for raising awareness on infectious diseases. Further papers look at protecting front-line health care workers and enterprise workers from Ebola. Jeanneth Manganyi and Kerry Wilson author a paper on the importance of respirator fit testing and proper use of respirators. Further articles in the issue explore food-borne illnesses at workplaces, the effectiveness of personal protective equipment to prevent Ebola transmission and the use of blunt suture needles to halve the risk of needle stick injuries among surgeons.

Expensive private healthcare highlighted at inquiry
Mashego P: BDLive, February 2016

The high cost of private health care in South Africa was profiled in a February 2016 health market inquiry amid revelations that South Africans pay six times the international average for hospital stays. A World Health Organisation study on price levels for private hospitals found that 42% of the funds spent on private voluntary health insurance in South Africa were equivalent to 4% of the country’s gross domestic product. This is six times the average in the Organisation for Economic Cooperation and Development (OECD) countries, despite the expenditure in SA only covering 17% of the population. The report found that South Africans stayed in hospitals for an average of 3.9 days compared to 5.1 days in OECD countries and paid an estimated R20bn in out-of-pocket payments for healthcare. Speaking on the sidelines of the inquiry, Health Minister Aaron Motsoaledi said that healthcare prices were "exorbitant" and that needed to change.

Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso
Beogo I; Huang N; Gagnon MP; Amendah D: BMC Research Notes 9(1)34, 2016

This study investigated the level and determinants of out-of-pocket (OOP) spending among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. A cross-sectional study was conducted with a representative sample of 1017 households in 2011. Among the surveyed sample, 29.6% persons reported a sickness or injury. Public providers were the single most important providers of care, whereas private and informal providers accounted for 29.8 and 34.0%, respectively. Almost universally (96%), households paid directly for care, with an average expenditure per episode of illness of 17.4USD. The total expenditure was higher for those receiving care in private facilities compared to public ones and the insured patients’ bill almost tripled uninsured. Medication was the most expensive component of expenditure in both public and private facilities. OOP was the principal payment mechanism of households. Considering the importance of private healthcare in Burkina Faso, the authors argue that regulatory oversight is necessary and an extensive protection policy to shield households from catastrophic health expenditure is required.

A Trojan horse of the private sectors interests at the World Health Organisation
People’s Health Movement; Medicus Mundi International: 26 January 2016

A January 2016 statement of the People's Health Movement (PHM) and Medicus Mundi International (MMI) identified that the Framework of Engagement with Non-State Actors (FENSA) currently under discussion at the World Health Organisation (WHO) fails to provide a robust framework against undue influence of the corporate sector and its philanthropies. In the statement the PHM and MMI argue that FENSA is symbolic of a more fundamental issue of the compromise to WHO’s independence due to its under-funding and tightly earmarked voluntary contributions making it vulnerable to such influence. They argue for an end to the dual freeze on the WHO Programme Budget and on assessed contributions which severely limits WHO’s functioning. "Until and unless this is addressed, WHO stands at risk of private sector capture and further loss of its integrity, independence, and credibility", the statement warned.

Common Declaration for Responsible Partnerships
International Forum on Public-Private Partnerships for Sustainable Development, December 2015

In the context of the 2015 Paris Climate Conference, COP 21, an International Forum on Public-Private Partnerships (PPPs) for Sustainable Development has been held in Annemasse. Within this framework and in view of the Sustainable Development Goals defined by the UN, the Cité de la Solidarité Internationale organised on October 30 2015 a collective intelligence workshop gathering representatives from the civil society as well as public and private stakeholders. The assembly called for PPPs that guarantee access for all to common goods and the respect of Human Rights to foster an economy of human dimension. They recommended to: Include the civil society in the entire process of public-private partnerships, upstream to downstream, by identifying the genuine needs, promoting the general interest as the final goal and avoiding conflict of interest and controlling the services of which they are the main beneficiaries. They argued that it is necessary to create a legal framework and appropriate tools to strengthen civil society legitimacy, to guarantee co-construction of equal win partnerships with general interest as a common objective to avoid an unbalanced or competitive approach and to consider alternative approaches and initiatives of collaboration (such as social and solidarity-based economy) as an evolution towards more balanced and inclusive partnerships favouring a participatory democracy.

Do financial contributions from ‘pharma’ violate WHO Guidelines?
Gopakumar K: Third World Network (TWN) Info Service on Health Issues Dec 15(01), December 2015

Millions of dollars given by major pharmaceutical companies to the World Health Organisation (WHO) raise questions of compliance with the organisation’s guidelines on interactions with commercial enterprises. Currently, WHO’s relations with commercial enterprises are guided by the “Guidelines on interaction with commercial enterprises to achieve health outcomes” . The 107th Session of the Executive Board in 2001 “noted” the Guidelines that cover cash donations, contributions in kind, seconded personnel, collaboration for product development, collaboration for meetings etc. Compliance with the Guidelines has essentially been left to the Secretariat. According to paragraph 11 of the Guidelines, “Commercial enterprises working with WHO will be expected to conform to WHO public health policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others”. It is notable that the draft Framework of Engagement with Non-State Actors (FENSA) currently being finalised by WHO Member States does not contain a provision that requires a commercial enterprise to conform to WHO’s polices, norms and standard. In the absence of such a clear provision FENSA could legitimise engagement with the private sector, which does not follow WHO’s policies in the areas of food safety, chemical safety, ethical promotion of medicinal drug products, tobacco control, and others. WHO Member States at the resumed session of the Open Ended Intergovernmental Meeting (OEIGM) on FENSA is expected to look at the regulation of WHO’s engagement with the private sector. The experience with the implementation of the Guidelines on interaction with commercial enterprises to achieve health outcomes would be useful for the consideration of Member States. In 2014, WHO received USD 6,158,153 from GlaxoSmithKline (GSK). It received USD 5,785,000 and USD 8,266,284 in 2012 and 2013 respectively from GSK. GSK Biologics paid USD 17,000. Novartis AG donated USD 5,300,000 in 2014 and USD 4,500,000 in 2013. Hoffmann-La Roche donated USD 6,158,153 in 2014 and USD 4,806,492 in 2013. The purposes of those donations were not disclosed.

Conceptualising the impacts of dual practice on the retention of public sector specialists - evidence from South Africa
Ashmore J; Gilson L: Human Resources for Health 13(3), 2015,

‘Dual practice’, or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries’ public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention. This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital. Findings suggest dual practice can impact both positively and negatively on specialists’ intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a ‘stepping stone’ to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission. The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.

New Media in Africa and the Global Public Sphere
Jacobs S: African Futures, Essays, 21 February 2013

In analysing the relationship between a “global public sphere” and social media on the African continent, the generalisations are argued to hide a far more interesting set of observations. Debates and discussions about what passes for a global public sphere often overlook and obscure dynamics of power. What is defined as the global public sphere by most observers and scholars is still very much limited to the industrial north and their public and private broadcasting systems, twitter handlers, and blogs. The term also refers, by default, it is argued, to debates and deliberation solely in English. This ignores the discussions in media in the Global South, especially social media.

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