The Ministry of Health (MoH) in August 2014 published a document [pdf] which aims to provide information on the project of a new university hospital in Bratislava, to be constructed as public-private partnerships (PPP).
We appreciate the Ministry of Health professional approach to the document, its structure, excellent English, as well as visuals. The document is clear and graphically appealing. Its conception significantly differs from the Ministry of Health standard materials.
We consider the position of the Ministry of Health a key thing in the philosophy of the project. We very much appreciate that the Ministry of Health decided to implement the project DBFOM way (design, build, financing, operating and maintenance). By this approach it was removed one of the biggest risks that the new hospital would be built by one entity only and subsequently the Ministry of Health would have difficulties to find for this hospital another entity that would operate and maintain it. There was a threat for a scenario, that the construction of a new hospital would only be a contract for a construction company and not a modern hospital construction project with long-term functionality.
It is important to emphasize that this is the first comprehensive PPP project in the health sector, which successful outcome depends on the consistent executive and project management, quality contract between the public and private partners. The main prerequisite for this is high quality and reliable input data and hospital information about the macro environment and development in health care. The document itself is not entirely convincing in terms of data, and therefore we consider being very important that we publish key HPI comments on this document.
Source: HPI, 2014
No HPI comments
In this section, it is not entirely clear, what is meant that the new hospital project is intended to function without relying on government support. In other parts of the document on there is mentioned the active role of government in the project (e.g. Government wants to ensure the contract for the new hospital with all health insurance companies).
In this section, the government provides basic information about the sources of the healthcare sector, these, however, we seem embellished:
In this section it is important to note that the new hospital should operate on ¾ of catchment area of the current University Hospital, the operation of the existing hospitals should be finished later in 2019 simultaneously with the launch of a new hospital and after a transitive period. However, the document does not specify which operation in which hospitals should ever cease. We just recall that the current University Hospital today runs hospitals Kramáre, Ružinov, Antolská, Mickiewiczova and Podnajske Biskupice.
According to the document the new University Hospital will have 945 beds (about 4% of all beds in SR), while in the first year is to have revenues of about EUR 130 million (which is about 8 % of all spending of inpatient care in SR). Therefore the average income per bed will be of orientation double the rest of Slovakia.
In this section can be seen a requirement that bidders should prepare proposals to maximize the new hospital project and ICC project (integrated care centers). Such a requirement is considered unreasonable while given very little information and ambiguous feasibility of 140 centers project, as well as because the centers are to be built from EU funds across the whole country, the new hospital is to be in Bratislava.
Second sticking point in this part is the commitment of Ministry of Health that will provide assistance in securing long-term contracts and contractual terms with insurance companies to ensure stable and continuous income for the private partner (PPP project is planned for 30 years). Are we to understand that Ministry of Health, which is two years “preparing” expropriation of private insurance companies will be actively lobbying contract for a new hospital in these insurance companies?
The third important thing in this part is the Ministry of Health’s commitment to the fact that the private partner will bear the risk of demand and Ministry of Health will avoid investment in new hospitals under its control in the region of Bratislava. The document, however, does not appear to inform that Bratislava is now preparing two large buildings:
In this part the Ministry of Health calls for public debate on this project. HPI offers its expert capacity and know-how in this field and is ready for expert discussion with the Ministry of Health, as well as a Institute of Health Policy at the MoH. Our first contribution to this constructive discussion is this HPI expert opinion on this “teaser”.
According to the complexity of the project we think, that the indicative timeline is very ambitious and in the given schedule (procurement contract closed in August 2015) only hardly implementable.
This section says that everyone interested in the project should express their interest in the project on the Ministry of Health email address until 20.8.2014. We hereby would like to ask the Ministry of Health for a list of all the companies that have expressed an interest until 20/08/2014 in this project by sending an “Expression of Interest”.
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In this HPI publication, in addition to macro prognosis of resources for health for the period 2014-2016, we are focusing on hospitals and the need for their modernization. The authors quantify the investment gap, looking for the resources to cover it, bring examples of modernization of hospitals abroad. A separate chapter is dedicated to the payment mechanism, as well as human resources in healthcare.