Feasibility study of Public-Private Mix in Health Care in Bangladesh

Bangladesh has good physical structure for health care in rural area called Thana Health Complex, the first referral level of health care institution. But unfortunately Thana Health Complex are under utilized especially the inpatient department. Therefore, the study has intended to search possible causes for that and to find measure for improving the under utilization problems. It is clear that the government can not do some thing better alone when the health care system is tax financed and tax collection system is very weak. Therefore, involvement of patients as well as private providers and NGOs are needed to do something better than present. Private/Public mix in health care is the solution. There are many types of p/p mix in health care but for Thana Health Complex contracting out is one of the suitable ways to solve some problems of under utilization. Cataract care is chosen for contracting out as visual disability is the highest cause of disability in Bangladesh and cataract is the number one cause for visual disability. The objectives of the study are to explore contracting out as a remedial measure of P/P mix to improve the problem of under utilization of Thana Health Complex of Bangladesh and assess the additional cost and potential benefit of contracting out models for cataract surgery and to explore possible design of contracting out for Thana Health Complex. To assess additional cost for contracting out the study considers capital cost and recurrent cost and to assess potential benefit it considers equity, efficiency, quality of care as well as patient's satisfaction. Finally, the study has chalked two designs for contracting out for cataract surgery at Thana Health Complex; one is Purchasing model to buy service from private providers and share the finance with patient and the other one the Leasing model to give lease the Operation Theater of Thana Health Complex for cataract surgery to NGO or private provider. Compare and contrast between two models has placed in terms of additional cost and potential benefit. Enforcement of government regulation and consumer education is recommended for proper for proper utilization of Thana Health Complex and changing health seeking behavior of people.孟加拉国农村地区设有名为分区医疗中心（Thana Health Complex）的基层医疗架构，其作为该国首层级的转诊医疗保健机构，具备良好的实体服务基础。但遗憾的是，这类分区医疗中心的资源利用率偏低，尤其是住院病房部门。因此本研究旨在探究其利用率不足的潜在成因，并寻求改善该问题的可行方案。 显而易见，当医疗保健系统为税收资助型，且本国税收征管体系极为薄弱时，政府单靠自身无法实现最优的医疗服务供给。因此，亟需吸纳患者群体、私立医疗服务提供者以及非政府组织（NGO）的参与，以优化当前的医疗服务状况。医疗领域的公私合营（Public/Private mix，简称P/P mix）是破解该困境的可行方案。医疗领域的公私合营模式类型多样，而针对分区医疗中心而言，服务外包是解决其利用率不足问题的适宜途径之一。 鉴于视力残疾是孟加拉国国民残疾的首要成因，而白内障又是导致视力残疾的头号诱因，本研究选取白内障护理作为外包服务的试点领域。本研究的目标包括：一是探索以公私合营为导向的外包模式，作为改善孟加拉国分区医疗中心利用率不足问题的补救措施；二是评估白内障手术外包模式的额外成本与潜在效益；三是探索适配分区医疗中心的外包服务具体设计方案。 为评估外包模式的额外成本，本研究将纳入资本成本与经常性运营成本；而为评估潜在效益，则将考量医疗公平性、服务效率、医疗质量以及患者满意度四大维度。最终，本研究为分区医疗中心的白内障手术外包设计了两种方案：其一为采购模式，即从私立医疗服务提供者处采购服务，并与患者共同分担医疗费用；其二为租赁模式，即将分区医疗中心的手术室租赁给非政府组织或私立医疗服务提供者，用于开展白内障手术。本研究将从额外成本与潜在效益两个维度，对这两种模式进行对比分析。 研究建议，应强化政府监管与消费者健康教育，以推动分区医疗中心的合理利用，并改善民众的就医行为。