Mudyarabikwa Oliver, Tobi Patrick, Regmi Krishna
1Lecturer in Health Management,School of Health, Sport & Bioscience,University of East London,Stratford,London,UK.
2Principal Research Fellow,Institute for Health and Human Development,University of East London,Stratford,London,UK.
Prim Health Care Res Dev. 2017 Jul;18(4):366-375. doi: 10.1017/S1463423617000147. Epub 2017 May 2.
Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries.
PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited.
A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings.
Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT.
The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical decisions may help in ensuring that assumptions in PPP activities result in outcomes that match the anticipated health benefits.
检验关于公私合作伙伴关系（PPP）活动及其在改善初级医疗手术公共采购方面作用的假设。
公私合作伙伴关系旨在提高医疗服务质量和患者满意度。然而，其在带来健康益处方面有效性的证据有限。
采用定性研究设计。对公共部门工作人员（n = 23）和私营部门经理（n = 2）进行了共计25次访谈，以了解他们对参与地方改善融资信托（LIFT）伙伴关系的私人投资者和服务承包商活动中假设的理解。在数据分析中应用了现实主义评估原则来解读研究结果。
确定了假设健康益处的六个主题领域：（i）质量改进；（ii）风险管理改善；（iii）采购成本降低；（iv）效率提高；（v）社区参与；（vi）可持续投资。选择通过LIFT采购手术的初级保健信托基金预计会通过提供有利于私人参与者实现这些益处的环境来支持其实施。发现私人参与者的活动基于一系列被认为有助于实现LIFT政府目标的明确和隐含假设。
公私合作伙伴关系的成功取决于私人参与者（i）评估PPP假设如何为其活动增加价值的能力，（ii）在预期活动中解读假设的有效性，以及（iii）使其商业原则与PPP政府目标保持一致的准备情况。由于一些限制假设实现的因素，他们有可能错过一些预期益处。私人参与者开展活动的偏好方式也影响了预期益处的实现程度。在关键决策上给予公共参与者比私人参与者更多的决定权，可能有助于确保PPP活动中的假设产生与预期健康益处相匹配的结果。
