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Ministry of Healthcare and Social Development of the Republic of Kazakhstan
Department of Investment Policy and Development of Public-Private Partnership
Astana, 2015
Planning, investment management and development of public-private partnership
Restructuring regional networks of healthcare organisations in accordance with international
standards
Developing an algorithm of phase-in implementation of
restructuring regional networks of healthcare organisations
Developing a rational and efficient investment policy in the context
of developing the network of healthcare organisations in
accordance with international standards
1. Improving the standards for healthcare infrastructure planning in accordance with international standards
2. Developing master-plans of restructuring regional medical organisations
3. Increasing the potential for investment planning in respective organisations at the various healthcare levels
4. Producing recommendations on the application of PPP mechanisms in the healthcare sector
The strategy of development of the network of healthcare organisations in accordance with international standards
Aim:To establish a
rational network of healthcare
organisations for the provision of affordable high-quality medical
care to people in accordance with
international standards
«Sanigest International»
Tasks
Actions
Long-term plans of development of the network of healthcare organisations for 2015-2025 by regions of
the RK
Private establishments - 1069
Inpatient hospitals - 729
Outpatient hospitals - 231
Outpatient units - 1561
Medical & obstetrical stations - 852
Medical stations - 3329
Total numbers of healthcare facilities
“KAZAKHSTAN -2050” STRATEGY
New policy of an established state
Priority tasks
80.Implementation of mandatory social health insurance. Priority financing of the primary health care
81. Development of private health care, implementation of corporate management in medical facilities.
THE NATION’S PLAN – 100 concrete steps to implement the 5
institutional reforms
Healthcare challenges and development priorities
Challenges
1. Minimal social standards2. Prioritized development of PHC3. Optimizing and refocusing of
hospital organisations 4. The increase of public costs of
implementing new medical technologies
5. Developing private medicine6. Developing new forms of PPP7. Adopting the mandatory medical
insurance system
• Increasing life expectancy to 73 years by 2020• Increasing the accessibility and quality of medical services• Improving the financing and management system in healthcare
Strategic healthcare targets(The strategic plan for development of the Republic of Kazakhstan until the year 2020)
Draft project of The National program of
healthcare development in the Republic of Kazakhstan “Densaulyk” for 2016-2019
Implementing a new healthcare policy based on an integrated approach to disease prevention and control Ensuring the efficiency of management and financing of healthcare Rational use of resources and optimization of the system’s infrastructure
“…Our primary goal is to become one of the 30 most developed countries of the world by 2050
…The creation of an efficient private sector of the economy and the development of public-private partnership ..
…Establish the environment for the growth of private medicine..
…improve and unify the supply of equipment and materials to medical institutions…”
Kazakhstan’s healthcare system in comparison with OECD countries
Distinctive features OECD countries(of total GDP)
Kazakhstan(of total GDP)
Notes
Healthcare expenditure 8% 3,8% At least 5% is required in developing countries (WHO)
Priority development of PHC
34% – inpatient care 61% – PHC
62% – inpatient care and 34% – PHC
At least 40% of all healthcare expenditure is
recommended to be allocated towards PHC
(international evidence)
Maximum access to essential medicines at the PHC level
80% in outpatient care, no more than 20% in
inpatient care
55% in outpatient care, around 50% in inpatient
care
Low level of private healthcare expenditure
19,6% 35,4% Above 20% is considered a sign of a healthcare
system’s financial instability (WHO)
Healthcare priority Increased attention to and concern with non-
communicable diseases (NCD)
Preventative work on NCD is in the early
stages
Only 10% of a person’s health depends on the
healthcare system, while 50% depends on the
lifestyle (WHO)
Medical science priority The proportion of domestic expenditure on
research and development – 3%
0,26%
The proportion of private sector in healthcare
44% 26,8
The history of public and private sector cooperation in Kazakhstan
Early 90s The start of implementing the mechanisms of public and private sector cooperation that are new for the country
Participation of the state as the shareholder of corporate bodies along with the private sector, trust management of public property objects, public purchases, privatization.PPP was viewed mainly as an element of public assets management.
December 23, 1991
The first «On concessions» Act The terms of loaning public property, land, natural resources to foreign investors are defined.Regulating the organizational, economic and legal terms of granting facilities under the concession agreements only to foreign investors within the territory of the Republic of Kazakhstan
July 7, 2006 The new «On concessions» Act Legal terms of concession, types of government support provided to the concessioner and the regulation of social relations during the process of entering into, implementing and terminating the concession contracts are defined. Transferring the right of constructing public property objects to domestic investors became possible.
2008 The creation of “The public-private partnership center of Kazakhstan” joint-stock company
Role: conducting the economic evaluation of projects, working towards improving the legislative environment and strategic development of the PPP system in Kazakhstan
2011 The adoption of the Programfor PPP development in Kazakhstan for 2011-2015
Aim: To ensure the implementation of policies on raising the profile of PPP mechanisms
2013-2014 The creation of regional PPP centers
Role: supporting regional PPP projects
2014 The creation of the Support Center for PPP projects
Involved at the stages of preparing and structuring the projects, conducting negotiations among the projects’ actors, as well as developing proposals on the financing structure of potential PPP projects
2015 The adoption of the «On public-private partnership» Act
Stipulates the lifting of restrictions on the areas of PPP application, increases the number of PPP actors, enhances the role of the private sector in initializing and preparing PPP projects
Development of masterplans for restructuring medical organisations
20162010-2014
Development and approval of long-term plans based on the master plans*
2014
Monitoring the implementation of long-term plans*
Implementing the master-plans developed by «Sanigest International»
Improving the long-term plans*
Developing the Action plan for
PPP in Healthcare of
the Republic of Kazakhstan
2015
* Long-term plans of development of the network of healthcare organisations for 2015-2025 by regions of the RK
Investment projects planning
The National program of healthcare development in the Republic of Kazakhstan “Densaulyk” for 2016-2019
In the provision of medical services within the framework of the guaranteed volume of free medical care (GVFMC) through the provision of various government support measures
EXPANDING THE INVOLVEMENT OF PRIVATE MEDICAL ORGANISATIONS
To private companies, including foreign ones (on the basis of standard bidding documentation)
TRANSFERRING THE MANAGEMENT OF NATIONAL AND LOCAL HEALTHCARE ORGANISATIONS
For the construction and management of healthcare facilities (PPP, concession), including the creation of a favourable environment for placing PHC organisations on the ground floors of apartment buildings
PRIVATE CAPITAL RAISING
Surgical complexes, dialysis centers, oncological centersUPDATING THE SERVICE CONTRACT EQUIPMENT
The forms of public-private partnership in healthcare
Potential types of PPP contracts in the healthcare sphere
Within the “On concessions” ActWithin the “On public-private
partnership” Act
Construction/reconstruction of healthcare facilities with utilizationTrust management of healthcare facilitiesRenting healthcare facilities from private partners Shared management of healthcare facilities
Construction/reconstruction, maintenance, renting and trust management of healthcare facilities.Shared management of healthcare facilitiesLife cycle contracts. Service contracts for the maintenance of medical and non-medical equipment. Outsourcing selected types of medical and non-medical services . Purchasing, renting/leasing equipment. Small-batch production of medical products and medicines. Implementing innovations. Private initiative projects. The possibility of implementing “small” PPP projects, which are executed on the regional level.
The action plan for PPP in the healthcare of the Republic of Kazakhstan
Developing the Action plan for PPP in healthcare• Shaping the vision of the Local Executive Authorities (LEA)• Formation and approval of the catalogue of prospective PPP projects with preplanning of the scheme• Improving the industry-specific legislation due to the following necessities:
• Flexible tariffs for medical services (the possibility of withholding the utilization component)• Changes in equipment and medical appliances purchasing for PPP• A warranty system of the volume of services for LEA and the compensation of the loss of profit to
ensure the return of investments• Domestic financing of small and large PPP projects without hard collaterals
• Attracting private operators and investors
The foundation:• Critical need for updating the healthcare infrastructure• The draft of the «On public-private partnership» Act and the “On concessions” Act• The development of private medicine (step number 81 of the institutional reform)• A draft policy standard of PPP in healthcare of the European Economic Commission of UN• Recommendations on PPP in healthcare provided by the European Bank for Reconstruction and
Development
Based on the recommendations of the Standard of National policy on PPP in healthcare of the European Economic Commission of UN
The outcome of developing the Action plan: • Marketable projects (for which funds may be raised) with payment mechanisms and a basis for assessing the
cost of each service. • Changes to the industry-specific legislation in order to provide an opportunity to structure the principal
schemes of PPP contracts• Cost cutting at the development stage and ensuring the consistency of approach within the regions• Improving the quality of development, decreasing the possibility of failed tenders • Developing interest in the projects pool from the private sector and a PPP scheme that may be accepted by the
investors• Regarding the service contract and transfer to trust management contract drafts - a basic template stipulating
the terms by which efficiency is achieved on the public part• The stability of the implementation of PPP projects and its conformity to the plan• The end result Fulfilling the needs of the population and the healthcare sector
Thank you for your attention!