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The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Social and economic trends toward local governance form the context for health and mental health policy and the reorganization of care systems for cost-containment in the United States. Local management of public–private collaborations is promoted by state agencies as a means of rationalizing mental health care and community support services. This chapter analyses the local process of developing public–private partnerships for mental health care, based on an ethnographic case study of county Mental Health/Mental Retardation and behavioral health committees and coalitions in Texas, from 1995 to 2001. Following this period, local service agencies continued collaboration to increase community awareness and resources for care. Findings were that while the rapid transition to local control under conditions of reduced resources impeded implementation of a public–private mental health care system, commitment to a service safety net for persons with mental disabilities was sustained.

This paper describes the methodology of a PhD thesis that was a study of the regulatory practices in the private health care sector of Bangladesh. The paper begins by situating the methodology in the nature, context and significance of the study. As the study involved a policy analysis and evaluation these are defined and described. The paper concentrates on the research design and methodology, which involved the use of qualitative methods. The sampling is described and the methods used included in‐depth interviews, the taking of field notes based on observations and document analysis. Attention is also given to ethical issues. The problems that emerged and the limitations of the study design and methodology are also discussed.

As the health care sector is changing rapidly, there is a growing need to develop new ways to make data-driven decisions, especially at the organizational level. Data utilization, like business intelligence (BI) activities, benefits health care organizations. The purpose of this paper is to study the potential of Big Data and the utilization of BI tools in creating value in the private health care industry in Finland.

Intellectual capital (IC) components and Möller et al.’s (2005) work on value capabilities are used as a framework to point out the roles of data utilization and BI tools in value creation. Thematic interviews enable understanding of the value creation based on Big Data potential and utilization of BI tools in the Finnish private health care industry.

The findings will provide an understanding of the existing data sources and BI tools used in private health care. In addition, it provides an insight into the future-oriented Big Data potential, which can create new business concepts. The approach provides valuable insights for value identifying the future needs of data utilization and creates an understanding on the current state within the private health care sector.

Data-driven value creation is one of the most discussed topics in private health care sector. By analyzing the current data-source utilization, challenges with data and BI tool utilization and the future vision and development roadmaps, the authors gain a better understanding of the IC components and value creation capabilities.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

The provision of private health-care services by public hospitals is common in Iran. Examining factors associated with patients’ preferences to use private health services and using this knowledge in health planning and policymaking can help expand the use of such services. Thus, this study aims to investigate patients’ preferences for private health services delivered in public hospitals.

Based on a discrete choice experiment from a sample of 375 patients in a public training hospital in Qazvin, northwest city of Iran, the authors evaluated participants’ preference over the health-care attributes affecting their choice to use private health-care services delivered in the hospital. The authors also estimated the marginal willingness to pay to determine the maximum amount a patient was willing to pay for the improvement in the level of each health-care attributes.

The findings revealed that patients were 2.7 times more likely to choose private hospital services when the waiting time was reduced to less than a week. Furthermore, as patients had complimentary insurance coverage, they were over 60% more likely to receive such services from training hospitals. Finally, continuity of care and reduced health-care tariffs were significant factors that increased patients’ preference to choose private services by 52 and 37%, respectively.

Examining factors associated with patients’ preferences to use private health services and using this knowledge in policymaking can help expand such services. The findings affirmed that various incentives, including service quality factors, are required to increase the likelihood of patients choosing private services.

Thailand, like a number of other less‐developed countries, has experienced a rapid rise in the share of its national product that is being devoted to health. This paper examines the ways in which the country is paying for its preventive and curative care. Section 1 provides the context by discussing age‐structure and geographical distribution of the population, together with the rates of mortality and morbidity. Section 2 explores the delivery of medical attention, private and State. Section 3 evaluates seven ways in which medical care is financed in Thailand. It also makes recommendations for the future of social insurance which are of relevance both to Thailand and to other countries at a similar stage of economic development.

The purpose of this study/paper is to identify the importance of the partnership between the public and private health-care institutions to improve interhospital patient transfers. Scientific research and statistical data show the increased number of interhospital transportation services; therefore, timely and qualified patient transportation between different health-care institutions must be considered, the activity that directly and significantly impacts the patient’s health status and overall quality of the health-care services. The successful patient transportation from the smaller hospitals to the health-care institutions with advanced intensive care or urgent care units can be enhanced through the partnership between private and public health-care institutions.

The methodology included quantitative method, statistical data analysis and theoretical data generalization. Both primary and secondary data were collected and analyzed during the research. Expert quantification was performed using the survey research method. The survey was conducted in Lithuania. The respondents were selected to be the general managers of the health-care and urgent care institutions, the chief doctors of the reanimation and intensive care department also the chief doctors of the emergency department.

Because of the centralization and regionalization of health-care services, the number of patients transferred between hospitals by the emergency medical services (EMS) and personal health-care institutions has increased. University hospitals are not sufficiently prepared to accept an increasing flow of patients in accordance with the Ministry of Health orders. Not all regional or district hospitals have the right to provide such assistance, which increases transportation time and costs as well as requires additional human resources. The five EMS categories could be used to improve the patient transfer between different levels of health-care institutions. To increase partnership between private and public health-care organizations, incentives should be provided for the development of private health-care organizations, as well as encouraging actions should be taken to increase the demand for private health-care services by Lithuanian patients.

Five EMS categories identified in this paper could be used to ensure a smooth mechanism for the patient transfer between different levels of the personal health-care institutions. The proposed categories should also be used in the pre-stationary emergency phase (for reducing the interhospital patient transportation amount).

Properly organized secondary and tertiary interhospital patient transfers influence the availability and quality of the EMS and reduce inequalities in the provided services and social exclusion.

This paper presents the classification of the interhospital transfer issues, determines the main reasons for the patient interhospital transfer, creates the model for the EMS patient process flows and defines five EMS categories for the assessment of patient conditions. Therefore, the research conducted and the results obtained have both theoretical and social-practical value.

Health is a fundamental populations’ need and an integral part of the socio-economic development of a country. However, it is required to explain the growing role of the private sectors in addressing various health care needs. The purpose of this paper is to analyse potential contribution, criticalities and conditions of success of public-private partnership (PPP) as a strategy to face the complexity of nationally relevant Italian and Indian service systems.

The methodology is built upon the basis of the viable systems approach (VSA) integrated with the fundamental interpretative elements of service science and service-dominant logic to contextualize interpretation to the management of service systems benefitting from recent advances in these research fields.

A VSA-based general framework of reference is built that is useful for analysing any relational context in which different aims and expectations need to be harmonized to make the collaboration effective. On the basis of this framework, first insights on Italian and Indian health care PPPs are proposed, highlighting key elements of analysis and criticalities that may challenge a positive conclusion on health care PPPs.

The implications of the study are both theoretical and practical. From a theoretical perspective, the study contributes to the scholarly understanding of complex health care system in Italy as well as in India with particular reference to the public-private collaboration phenomenon. It also suggests theoretical approaches in the form of a generic VSA-based framework as applicable. From a practical perspective, the study stimulates managers to a critical reflection about current health care management approaches which are reflected in the adoption of PPPs solutions.

The paper discusses relevant worldwide decision-making challenges, such as the equality in the populations’ access to health service, suggesting managers the way to create conditions of consonance among the diverse stakeholders for a successful health care PPPs.