Disguising Trade in Development Partnerships
Public-private partnership (PPP) once christened to improve on quality and economic efficiency of public services in developed countrie s, is now widely promoted as a development tool that could ensure basic social services in LDCs. Th is paper analyses the doctrine of PPP and the application of various models to LDCs health delive ry systems. It examines different types of PPP arrangements including in international trade, othe r economic arrangements, development PPPs and domestic health initiatives. Examples are drawn fro m LDC countries especially Sierra Leone, to illustrate the practice of respective health PPPs a nd regulatory challenges inherent in complex PPP mix. A crucial issue is the appropriateness of mark eting 'Public-Private for profit partnerships' as a development mechanism for health delivery in poor countries. The paper recommends a more pro- active role for LDC governments in the design, impl ementation and surveillance of health PPPs as essential in achieving health development goals.
Public Hospitals : Options for Reform through Public-Private Partnerships
Globally, health expenditures rose from an average of 3 percent of GDP in 1950 to 8 percent (US$3 trillion) in 1999 (WHO 2000). The increase in spending has been driven by rising income, changing demographic and epidemiological trends, and costly new pharmaceuticals and technology. Although technology is allowing a shift to outpatient care, hospitals still account for 30–50 percent of health expenditures. Public funding has not kept pace with the growth in spending. Much of the increase has been financed from private sources (out-ofpocket payments and private insurance), while the share funded publicly (by tax revenue and national insurance) declined by 6 percent between 1977 and 1997. Constraints on public funding, combined with rising costs, have forced public hospitals to cut costs wherever possible while still endeavoring to guarantee universal (and often free) access to public patients.1 Governments have used different strategies to address these problems, such as shifting financing from general tax revenue to payroll-financed national health insurance, narrowing the basic package of services available to all citizens, linking hospital funding to outputs and efficiency, amalgamating hospitals into networks, increasing autonomy and incentives for management, and reducing the number of hospital beds. Some governments have also turned to public-private partnerships to bring private sector efficiency into public hospitals.
Liberalizing trade in services: from Marrakech to Seattle
WTO Members are currently preparing the ground for a new services round to be launched in Seattle, in December 1999. This article reviews recent developments in services trade, the underlying economic factors and the political response given hitherto by WTO Members. Critical issues in the preparation of the new round, including the choice of the basic negotiating approach, are discussed.