Fiedler John L, Wight Jonathan B
University of Richmond, Department of Economics, Richmond, VA 23173, USA.
Int J Health Plann Manage. 2003 Jul-Sep;18(3):179-204. doi: 10.1002/hpm.709.
Efforts to privatize portions of the health sector have proven more difficult to implement than had been anticipated previously. One common bottleneck encountered has been the traditional organizational structure of the private sector, with its plethora of independent, single physician practices. The atomistic nature of the sector has rendered many privatization efforts difficult, slow and costly-in terms of both organizational development and administration. In many parts of Africa, in particular, the shortages of human and social capital, and the fragile nature of legal institutions, undermine the appeal of privatization. The private sector is left with inefficiencies, high prices and costs, and a reduced effective demand. The result is the simultaneous existence of excess capacity and unmet need. One potential method to improve the efficiency of the private sector, and thereby enhance the likelihood of successful privatization, is to transfer managerial technology--via franchising--from models that have proven successful elsewhere. This paper presents a feasibility analysis of franchizing the successful Bolivian PROSALUD system's management package to Zambia. The assessment, based on PROSALUD's financial model, demonstrates that technology transfer requires careful adaptation to local conditions and, in this instance, would still require significant external assistance.
事实证明，卫生部门部分业务私有化的努力比此前预期的更难实施。遇到的一个常见瓶颈是私营部门的传统组织结构，其中存在大量独立的个体医生诊所。该部门的原子化性质使得许多私有化努力在组织发展和管理方面都困难重重、进展缓慢且成本高昂。特别是在非洲许多地区，人力和社会资本短缺以及法律机构的脆弱性削弱了私有化的吸引力。私营部门效率低下、价格和成本高昂，有效需求减少。结果是产能过剩与需求未得到满足的情况同时存在。一种提高私营部门效率从而增加私有化成功可能性的潜在方法是，通过特许经营将管理技术从其他地方已证明成功的模式转移过来。本文对将成功的玻利维亚“健康促进计划”（PROSALUD）系统的管理方案引入赞比亚进行特许经营的可行性进行了分析。基于“健康促进计划”的财务模型进行的评估表明，技术转让需要仔细适应当地情况，在这种情况下，仍需要大量外部援助。
