Abstract
The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.
Highlights
Health is undergoing a paradigm shift from disease-focus toward systems-focus on a global level in response to both the financial crisis and in response to problems encountered in disease-specific projects in honoring targets and internationally agreed benchmarks [1]
It is worth noting that participants from both groups at times failed to distinguish between the internal and external environment during the SWOT analysis; some modifications were, necessary during transcribing to ensure that the final versions of the value chains were in line with the definitions of SWOT
The group recognized the importance of patient experience in the value chain: We thought about patient experience, because we want to go from quality outcome to quality experience, which is even more important to some extent - less patient complaints
Summary
Health is undergoing a paradigm shift from disease-focus toward systems-focus on a global level in response to both the financial crisis and in response to problems encountered in disease-specific projects in honoring targets and internationally agreed benchmarks [1]. Governments are, increasingly scrutinizing returns on health-care expenditure and pushing health actors to reorganize inefficient and badly functioning public systems. The challenges are greater for small states as these do not have a large portfolio of institutions to provide health-care services. In a narrative literature review on policy challenges and reforms in small European Union (EU) member states, AzzopardiMuscat et al [5] conclude that “lack of capacity and small market size give rise to common challenges in governance and delivery of health services in small states” Dafflon and Vaillancourt [6] argue that competition between private and public hospitals/clinics does exist and is challenging for coordination of services. Competition between providers may be asymmetric [9], in that, if the public sector provides excellent health-care delivery the private healthcare sector loses competitive advantage; if the private health-care sector is successful, pressure on the public sector is reduced
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