Private providers – a quick fix for public healthcare waiting lists?
Public providers cannot meet demand. So what to do to clear a waiting list of almost 500,000 people? You pay the private sector to fix it.
This was the solution São Paulo’s millionaire mayor, João Doria hit upon, after being elected promising to get rid of the half-a-million strong list waiting for medical examinations and tests under Brazil’s Unified Health System.
Within 79 days, the number of people waiting to be seen plummeted from an eye-boggling 485,300 to just 2,876.
Throwing money at a problem had a cost, of course. In this case, around $8m went to private hospitals many of which worked 24/7, while public hospitals also received additional payments to queue-bust overnight.
Clearly, it’s not the ideal long-term solution. But then, there’s no short-term public fix. If you’ve got a public system that’s too small and lacks the facilities to provide a service to all who need it, then short of long-term investment, you need to look elsewhere.
Another solution is to look to PPPs. That could be the most cost-effective solution, and one that doesn’t require building new public infrastructure – even if in some geographies it’s a politically sensitive decision. But negotiating contracts takes time.
The short, sharp, shock solution was to negotiate short-term contracts to fix the emergency, and it worked spectacularly.
Similar arrangements take place in the UK, where the NHS buys MRI space where needed and uses the private sector for knee and hip surgery. Backlogs in Sweden have similarly been used to clear long waiting lists.
But it remains to be seen whether recognition that the private sector can be a quick-fix albeit temporary solution translates into an understanding that more permanent PPP-style arrangements would obviate the need for further emergency fixes.
We would welcome your thoughts on this story. Email your views to David Farbrother or call 0207 183 3779.
