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© Economist Intelligence Unit 1 The role of the private sector in healthcare: An approach to assessing national readiness and capacity for PPPs The Role of Non-State Providers in Delivering Basic Social Services for Children UNICEF-ADB Regional Workshop April, Manila Tony Nash Global Director, Client Research Economist Intelligence Unit
© Economist Intelligence Unit 2 Agenda The role of the private sector and PPPs in healthcare Observations from the healthcare sector The use of benchmarking in developing and implementing PPPs Case study of the Economist Intelligence Units Infrascope Index
© Economist Intelligence Unit 3 Healthcare in Asia 2010: A public-private affair Two-day initiative organised by the Economist Group, convening more than 180 healthcare professionals from across Asia Speakers and participants from the public and private sector including: health ministers representatives from government academia regulators associations hospital administration pharmaceutical medical equipment insurance doctors and patient groups.
© Economist Intelligence Unit 4 There is no single regional model for the public-private split of healthcare funding and provision. How any country decides to pay for its health system involves a complex balancing act of efficiency considerations with matters of equity and morality. The result is invariably a combination of public and private funding and provision. As governments in the region struggle to expand and adapt their healthcare systems, there is a growing reliance on the private sector either through choice or neglect. If wealthier countries are looking at increasing private funding, poorer ones are seeing an even greater role for the private sector and non-state actors. The profit-seeking tendencies of private-sector involvement may further effect health equity. Already the access gap is manifested in the polarisation of medical facilities and personnel in urban settings, at the expense of rural patients. The increasing disparity in wealth in many Asian countries will exacerbate problems with access to care.
© Economist Intelligence Unit 5 Most countries seem to be heading for a bigger private-sector role in funding and investing in healthcare Developed Asia Currently, governments are struggling to contain costs and find new sources of funding. Taiwan and South Korea, have both attempted to use regulation to cut prescription drug costs and looked at increasing medical tourism. Hong Kong, meanwhile, is considering raising the level of private financing, either through greater use of private insurance or the creation of medical savings accounts. Developing Asia Governments seek the participation of private and non-state actors for the rapid and efficient mobilisation of capacity. Such strategies are typically linked to short term programmeswith implications for long-term health system sustainability. For instance, Indonesia is actively encouraging private sector investment to bridge the gaps which the state cannot afford to fill. The biggest exception to this slow shift towards more private sector involvement is China, which is engaged in a major effort to reform its public-health system.
© Economist Intelligence Unit 6 Current healthcare sector thinking on the private sectors role in driving innovation in healthcare Healthcare in Asia delegates noted that there is a currently a lack of engagement between governments and the private sector in terms of proactive discussion of policy and reforms. There is a need for creating such regular frameworks for dialogue at a national level across Asia, so that private sector views are taken into account at an early stage in policy development. The private sector could work together through industry associations to make substantial progress and greater impact on key initiatives, so that efforts are not piecemeal and of little overall impact.
© Economist Intelligence Unit 7 In particular, collaboration and knowledge sharing is required in the development and implementation of health PPPs in Asia-Pacific. Asian governments that have already made progress with establishing private-public partnerships need to engage with other Asian governments, to assist in developing PPPs across Asia. Healthcare in Asia, 2010 Key questions: While lessons can be learnt from other Asian countries, can PPP solutions be regional given that healthcare systems are national, or even sub-national creations? To what extent are Asian countries ready for PPPs? Are national frameworks in place to manage potentially complex private- public partnerships and contracts, particularly in resource-constrained settings?
© Economist Intelligence Unit 8 Lessons from benchmarking research: The Infrascope Index Governments worldwide have long partnered with the private sector to develop and maintain infrastructure economic growth. But structuring deals between the public and private sectors is complex and time- consuming, with financial and political risks for all sides. To understand the potential for these PPPs in Latin America and the Caribbean, the Multilateral Investment Fund (MIF) and the Program to Promote Public-Private Partnerships in Latin America and the Caribbean commissioned the Economist Intelligence Unit to measure the readiness of governments in the region to carry out such essential projects.
© Economist Intelligence Unit 9 A tool for private- and public-sector stakeholders in designing and implementing PPPs The index and study that emerged from this research evaluated and ranked the legal, regulatory, institutional and financing environment for public-private infrastructure projects in 19 countries. The index focuses on a countrys readiness and capacity to carry out infrastructure projects using PPP models. By placing countries under a microscope for infrastructure project readiness, the Infrascope evaluates a countrys legal and regulatory framework for PPP projects the institutions that prepare, award and oversee projects; the governments ability to uphold laws and regulations for concessions, as well as the number and success rate of past projects (that is, operational maturity); the business, political and social environment for investment, and the financial facilities for funding infrastructure Legal and regulatory framework 1Peru66.7 2Chile61.1 =3Costa Rica50.0 =3Mexico50.0 5Brazil47.2 6Colombia33.3 7Argentina27.8 =8Jamaica25.0 =8Panama25.0 =8Paraguay25.0 =8Trinidad & Tobago25.0 =8Uruguay El Salvador19.4 =14Dominican Rep.16.7 =14Guatemala16.7 =14Honduras Venezuela8.3 =18Ecuador5.6 =18Nicaragua5.6 Operational maturity 1Chile73.9 2Brazil66.7 3Costa Rica55.0 4Peru53.0 5Mexico47.3 6Colombia44.7 7Ecuador39.4 8Dominican Rep Honduras El Salvador Jamaica Argentina Uruguay Panama8.8 15Guatemala8.7 =16Nicaragua8.5 =16Paraguay8.5 18Venezuela4.8 19Trinidad & Tobago4.3
© Economist Intelligence Unit 10 Indicators Legal and regulatory framework Consistency and quality of PPP regulations Effective PPP selection and decision making Fairness/openness of bids, contract changes Dispute resolution mechanisms Institutional framework Quality of institutional design PPP contract, hold-up and expropriation risk Operational maturity Public capacity to plan and oversee PPPs Methods and criteria for awarding projects Regulators' risk allocation record Experience in transport & water concessions Quality of transport and water concessions Investment climate Political distortion Business environment Social attitudes towards privatisation Financial facilities Government payment risk Capital market: private infrastructure finance Marketable debt Government support for low income users
© Economist Intelligence Unit 11 Activities Search relevant, publicly available data sources including quantitative resources as well as legal texts and regulatory reports Interview country and sector experts, distribute survey Review laws and regulations Compile secondary reports and assessments Data collection Construction, weighting, scoring of Index Qualitative analysis of laws, regulations and institutions Data normalisation Compare index results against survey responses, interviews, World Economic Forum Index Sources World Economic Forum, PPIAF PPI data base, World Bank, Economist Intelligence Unit, Transparency International, Latinobarometro survey, Multilateral Investment Guarantee Agency data, Fitch/S&P/Moodys PPIAF sector reports, IADB reports, Economist Intelligence Unit publications (Country Commerce, Country Finance, Risk Briefing) Economist Intelligence Unit analysts and model builders Research and analysis Developing the index
© Economist Intelligence Unit 12 Research findings from Latin America Results from the Infrascope Index were published in a white paper Partnerships for Progress? Evaluating the environment for public-private partnerships in Latin America and the Caribbean (2009) The index measures countries on a scale of 0 to 100, where 100 represents the perfect environment for PPP projects. Chile scored 64.3 due to a high degree of project experience, low project-cancellation rates, and a reasonably developed legal, regulatory and institutional framework (albeit one of the best in the region). Attractive investment conditions and good facilities for project finance also helped boost Chiles score. The second and third-ranked countries, Peru and Brazil, exhibited similar characteristics. Venezuela finished last in the Infrascope index, just after Nicaragua and Ecuador. All three countries, with scores ranging from 7 to 15, must improve the consistency and quality of their legal, regulatory and institutional frameworks to better facilitate concession projects. These countries also score in the bottom half of all countries for their investment and financial climates.
© Economist Intelligence Unit 13 What are the benefits of benchmarking research for PPP stakeholders? Increases transparency and accountability for policy makers, regulators and private-sector/ non-state providers Provides a clear, concise and central source of information on key laws and regulations Assesses country performance on past initiatives and identifies areas of improvement Highlights key country strengths and weaknesses The approach is applicable to social protection, healthcare and other public service pillars OVERALL SCORE 1Chile64.3 2Peru58.9 3Brazil57.8 4Mexico47.5 5Costa Rica45.1 6Colombia39.1 7Uruguay27.3 8Dominican Rep Jamaica El Salvador Honduras Trinidad & Tobago Paraguay Argentina Panama Guatemala Ecuador Nicaragua Venezuela7.1
© Economist Intelligence Unit 14 Thank you Tony Nash Global Director, Client Research Economist Intelligence Unit Tel:
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