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Regulating private hospitals. Professor EK Yeoh. Harding-Preker Framework. Assessment. Strategy. Grow. Issues and Goals. Focus. Harness. Convert. Distribution (equity) Efficiency Quality of Care. PHSA Gather available information Identify additional needs In-depth studies.

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Regulating private hospitals

Regulating private hospitals

Professor EK Yeoh


Harding preker framework
Harding-Preker Framework

Assessment

Strategy

Grow

Issues and Goals

Focus

Harness

Convert

  • Distribution (equity)

  • Efficiency

  • Quality of Care

  • PHSA

  • Gather available information

  • Identify additional needs

  • In-depth studies

Private Sector

Instruments

  • Activities

  • Hospitals

  • PHC

  • Diagnostic labs

  • Producers / Distributors

  • Ownership

  • For-profit corporate

  • For-profit small business

  • Non-profit charitable

  • Formal/ Informal

  • Policy Tools

  • Regulation

  • Contracting

  • Training/Info

  • Social marketing

  • Social franchising

  • Info. to patients

  • Demand-side

  • (incl. Vouchers)

  • PPP transactions

  • Enable environment improvement

PublicSector

Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.


Harding preker framework1
Harding-Preker Framework

Assessment

Strategy

Grow

Issues and Goals

Focus

Harness

Convert

  • Distribution (equity)

  • Efficiency

  • Quality of Care

  • PHSA

  • Gather available information

  • Identify additional needs

  • In-depth studies

Private Sector

Instruments

  • Activities

  • Hospitals

  • PHC

  • Diagnostic labs

  • Producers / Distributors

  • Ownership

  • For-profit corporate

  • For-profit small business

  • Non-profit charitable

  • Formal/ Informal

  • Policy Tools

  • Regulation

  • Contracting

  • Training/Info

  • Social marketing

  • Social franchising

  • Info. to patients

  • Demand-side

  • (incl. Vouchers)

  • PPP transactions

  • Enable environment improvement

Regulation

PublicSector

Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.


Outline for presentation
Outline for Presentation

  • Define regulations

  • Regulatory strategies and instruments

  • Regulating quality

    • Compliance-based

    • Incentive-based

    • Self-regulation

  • Regulatory regime and effectiveness

  • Key Messages

  • Further Reading and References


Regulation
Regulation

Three basic categories

  • Regulation as setting forth mandatory rules that are enforced by a state agency

  • Regulation incorporates all efforts by state agencies to steer the economy… include state ownership and contracting, taxation and disclosure requirements

  • Regulation to include all mechanisms of both intentional and unintentional social control

Saltman and Busse (2002)

Baldwin et al (1998)


Regulation1
Regulation

  • Regulation is the range of factors exterior to the practice or administration of medical care that influences behaviour in delivering health care

Brennan and Berwick (1996)


Dimensions purposes of health sector regulation
Dimensions [Purposes] of health sector regulation

Saltman and Busse (2002)


Social and economic policy objectives
Social and economic policy objectives

  • Equity and justice

  • Social cohesion

  • Economic efficiency

  • Health and safety

  • Informed and educated citizens

  • Individual choice

Harding and Preker (2003)

Saltman and Busse (2002)


Health sector management mechanisms
Health sector management mechanisms

  • Regulating quality and effectiveness

  • Regulating patient access

  • Regulating provider behaviour

  • Regulating payers

  • Regulating pharmaceuticals

  • Regulating physicians

Harding and Preker (2003)

Saltman and Busse (2002)


Regulatory strategy
Regulatory strategy

  • Command and control

  • Self regulation

  • Incentive-based regimes

  • Market harnessing controls

  • Disclosure

  • Direct action

  • Rights and liabilities laws

  • Public compensation and social insurance

Saltman and Busse (2002)


Actors
Actors

Government

Professional/ provider organizations

Patients’/ Consumers’ organizations


Regulatory actors
Regulatory actors

  • self-regulators tend to be strong on specialist knowledge but weak on accountability to the public;

  • local authorities strong on local democratic accountability,

  • weak on coordination;

  • parliament strong on democratic authority, weak on sustained scrutiny;

  • courts and tribunals strong on fairness, weak on planning;

  • central departments strong on coordination with the government, weak on neutrality;

  • agencies strong on expertise and combining functions, weak on neutrality;

  • directors general strong on specialization and identification of responsibility, weak on spreading discretionary powers.

Saltman and Busse (2002)

Baldwin and Cave (1999)


Targets
Targets

Quality

Capacity

Price

Market structure and levels of services

Entitlements

Saltman and Busse (2002)


Regulatory instruments
Regulatory instruments

  • Control-based regulation

    • Licensing

    • Registration

  • Incentive-based regulation

    • Contracts

    • Accreditation

  • Market-structure regulation

    • Encourage desired behaviour

Harding and Preker (2003)


Control based regulatory instrument
Control-based regulatory instrument

Harding and Preker (2003)


Control based regulatory instrument1
Control-based regulatory instrument

Harding and Preker (2003)


Incentive based regulatory instrument
Incentive-based regulatory instrument

Harding and Preker (2003)


Incentive based regulatory instrument1
Incentive-based regulatory instrument

Harding and Preker (2003)


Regulatory instruments by regulatory strategy and target of regulation
Regulatory instruments by regulatory strategy and target of regulation

Harding and Preker (2003)

Harding and Preker (2003)


Self regulation
Self-regulation regulation

  • A state-generated mandate that allows certain professionals or enterprises to set standards for the behaviour of its membership

    • Private self-regulation without state enforcement e.g. some professional organisations or voluntary organisations

    • Publicly mandated self-regulation e.g. professional self-regulation by physicians, dentists and pharmacists, etc.

    • Joint self-regulation with non-governmental actors

Saltman and Busse (2002)

Baldwin and Cave (1999)


Self regulation1
Self-regulation regulation

Harding and Preker (2003)

Baldwin and Cave (1999)


Regulatory body in hong kong
Regulatory body in Hong Kong regulation

  • The Medical Council of Hong Kong

  • Hong Kong Academy of Medicine

  • Hong Kong Hospital Authority


The medical council of hong kong
The Medical Council of Hong Kong regulation

Empowered by the Medical Registration Ordinance, Cap. 161, Laws of Hong Kong, the Medical Council maintains a register of eligible medical practitioners, administers the Licensing Examination, issues guidelines and a Professional Code and Conduct, exercises regulatory and disciplinary powers for the profession, and answers general enquiries from doctors and the public.

http://www.mchk.org.hk


The medical council of hong kong1
The Medical Council of Hong Kong regulation

  • Standards of practice

    • Licensing

    • Entry to the professions

    • Re-certification not required

    • Continuing medical education not required

    • Clinical audit and quality assurance not required

  • Accreditation of specialties

  • Code of practices and ethics


The medical council of hong kong2
The Medical Council of Hong Kong regulation

  • 24 medical members, 4 lay members

  • Preliminary Investigation Committee

  • Licentiate Committee

  • Education and Accreditation Committee

  • Ethics Committee

  • Health Committee


Hong kong academy of medicine hkam
Hong Kong Academy of Medicine (HKAM) regulation

In recognition of the need for essential postgraduate medical education and training in Hong Kong, the Hong Kong Academy of Medicine was formally established under the Hong Kong Academy of Medicine Ordinance (Cap 419) with the statutory power to organise, monitor, assess and accredit all medical specialist training and to oversee the provision of continuing medical education.

http://www.hkam.org.hk


Role of hkam
Role of HKAM regulation

  • To maintain the standard of specialist training and specialist continuing medical education (CME) and continuous professional development (CPD) in the territory

  • To assists the Medical Council of Hong Kong, the Registration body, in the maintenance of the Specialist Register (SR) since its inception in 1997 (Medical Registration Ordinance)


Specialist training
Specialist training regulation

  • Standard 6-year format for basic and higher specialist training leading to Fellowship

  • Examinations and assessment

  • Require continuing medical education and continuous professional development to maintain specialist status


Hong kong hospital authority
Hong Kong Hospital Authority regulation

  • Public hospitals were corporatized in 1991 under the holding of a single statutory nonprofit public corporation, the Hospital Authority, independent of the government bureaucracy and established with the mandate to manage all public hospitals.

http://www.ha.org.hk


Hong kong hospital authority1
Hong Kong Hospital Authority regulation

Under the Hospital Authority Ordinance, the Hospital Authority is responsible for:

Advising the Government on the needs of the public for hospital services and of the resources required to meet those needs;

Managing and developing the public hospital system;

Recommending to the Secretary for Food and Health appropriate policies on fees for the use of hospital services by the public;

Establishing public hospitals;

Managing and controlling public hospitals; and

Promoting, assisting and taking part in education and training of persons involved in hospital or related services.

30


Management structure
Management structure regulation

  • Functions:

  • Clinical effectiveness and technology management

  • Patient safety and risk management

  • Patient relations and engagement

  • Quality and Standards

  • Infection, emergency and contingency

  • Chief Infection Control Office

  • Infectious Disease Control Training Centre


Quality assurance clinical audit
Quality assurance/ clinical audit regulation

  • Monitoring, audit and inspection

  • Implement pilot hospital accreditation program, which includes defining the quality of hospital services in line with international standards and review by an international accrediting agent

  • Key performance indicators

  • Satisfaction survey


Regulating quality
Regulating quality regulation

  • Structure

    • Facility licensing

    • Healthcare personnel licensing

  • Process

    • Facility accreditation

    • Clinical practice guideline

  • Outcome

    • Performance reporting

    • Clinical audit


Complementary synthetic role of regulatory instrument
Complementary/ synthetic role of regulatory instrument regulation

  • Licensing/ professional standards

    • Compliance/ control based

    • Self-regulatory

  • Specialist practice

    • Self-regulatory

    • Non-financial incentive-based


A framework for comprehensive regulatory assessment
A framework for comprehensive regulatory assessment regulation

Harding and Preker (2003)


Regulatory decision making
Regulatory decision-making regulation

OECD (2002)


Regulatory activity
Regulatory activity regulation

  • Legislation

  • Implementation

  • Monitoring

  • Evaluation

  • Enforcement

  • Judicial supervision

Saltman and Busse (2002)


Regulating legitimacy
Regulating legitimacy regulation

  • Acceptability

    • Political

    • Social

    • Regulated

  • Process

    • Communication

    • Transparency

  • Independent creditability of regulatory body

  • Legal foundation


Regulatory cycle
Regulatory cycle regulation

Decide to regulate

Regulation

Evaluate system performance

Secure legal authority

Impose penalties for violators

Write rules

Monitor compliance

Peter Berman


Key messages
Key Messages regulation

Regulations is an inherently complex and political process.

Regulation is a strategic, dynamic and on-going process.

Control/Compliance based regulations needs to be complemented with other instruments (e.g. (purchasing, self-regulations) to be effective.

Legitimacy and wide awareness of quality regulations are critical for effectiveness.


Reading and references
Reading and References regulation

Busse R, Hafez-Afifi N and Harding A (2000). “Chapter 4: Regulation of Health Services.” Private Participation in Health Services Handbook. Washington, DC: The World Bank

Saltman R, Busse R and Mossialos Elias (2002). European Observatory on Health Care Systems Series: Regulating entrepreneurial behaviour in European health care systems. Open University Press. World Health Organization

http://www.ps4h.org/hospital_documents

http://www.ps4h.org/Bali_documents