Public-private partnerships in Maltese healthcare : an evaluation of the financial aspects

Abstract

Given that the recent introduction of healthcare PPPs in Malta is an unexplored field, it was considered essential to conduct a study aimed at evaluating the financial aspects underlying existing healthcare PPPs. The focus was set on three selected healthcare PPPs namely, MRIs, cataracts operations and A&E. The study was aimed at identifying and evaluating the main differences and similarities between the selected PPPs, gaining an understanding of how available financial information was used in the decision-making process and evaluating the process of setting the prices in each of the three cases. In achieving the above mentioned objectives, semi-structured interviews were carried out with people involved in the decision-making of the selected healthcare PPPs. In ensuring data triangulation, high ranking officials from different areas involved in PPPs namely, finance, clinical, monitoring, and contracting, were interviewed. The study underscored the salient financial aspects that were involved in the process of engaging in the selected PPPs, including the setting of prices and the use of available financial information in arriving at important decisions. Furthermore, it was evidenced how a competitive environment amongst competing private clinics and hospitals can lead to better negotiation of prices for the public sector. This was further highlighted in instances where such competitive environment was lacking, leading for higher prices to be charged due to the public sector's inability to negotiate better prices. Additionally, the study emphasised the importance that costing information has in the decision-making process and price setting of healthcare PPPs. The study revealed that notwithstanding their differing nature MRI and cataracts operations PPPs are more comparable whereas A&E PPP is somewhat unique. Financial information and decision-making proved to play a crucial role in the setting up of all selected healthcare PPPs, underpinning the importance of maintaining an up-to date and accurate costing information system on which sound decision-making can be based. Based on the conclusions reached, it is hoped that such study can be used as a basis for exploring the financial side of healthcare PPPs in more depth, both from a public point of view as well as from a private one.