The Study On Government Input In PPP For Health Care

China's health condition has improved remarkably since 1949 and Chinese citizens have focused on health more and more. But, with the ongoing urbanization and an aging population,health care industry is facing changing and growing needs every day, which proposes new challenges on the government's investment and management power. The 2009 health reform raised the topic of private capital and encouraged public-private partnerships (PPP) in multi-ways. After that, under the supportive environment, public-private-partnership in the health sector has bloomed and each party is showing great enthusiasm.However, in practice, PPP for health care in China has been encountering several obstacles and problems in the stages of embarkment and operation: some projects can't attract enough private partners, some don't have enough patients for the use of medical equipment,some even come up with serious medical accidents and face tense doctor-patient relationships.The government, as the leading party in PPP, plays an important role. The activities of private sector are influenced by the public sector's policies. What the government thinks of PPP and health care industry, and how the government uses its resources to motivate and control private sector would highly affect the project's outcome. Therefore,this dissertation stems from the problems and focuses on the theories and experiences of government's role and input system, in order to propose suggestions in solving the practical problems.The first chapter starts with the topic background and analysis structure. Next, the following chapters introduce the current economic theories and research status related to health care PPP, providing theoretical background for reference. Chapter 3 is focused on the theoretical analysis of government responsibility in health care PPP. Different health care services have different natures which require different government roles. Making sure which areas of health care are suitable for the cooperation of government and market, also known as PPP, is fundamental for further government input analysis.The analysis of government input is based on health care PPP, therefore in chapter 4, the essay introduces the current condition of China's health care PPPs. Health care PPPs are highly related to the environment of the health care industry, which is why the policies, the issues and the reform actions are first talked about, and then follows the reason and background of adoption of health care PPPs in China. After that, through the analysis of current typical health care PPP cases,the chapter points out the difficulties of China's health care PPPs.With the fundamental analysis of the fourth chapter, the essay then makes a concrete analysis of government input mechanism from three aspects. Government input is a process of allocating and managing resources, and it is a contractual obligation as well as a management tool. Due to the scarcity of public resources, government input must act under certain rules and certain restrictions. Based on that, the essay dissects the input into three analyzing aspects,and these three chapters are the core of the dissertation. The fifth chapter introduces the types of government input methods, including holding shares in SPVs, direct payment and viability gap funding, and also the problems of China's method. The sixth chapter analyzes the government input size in health care PPPs, including the measurement, the limit and the disclosure of government input size, and also the problems facing China. The seventh chapter is focused on the efficiency of government input, including Value for Money and special concern on health care delivery outcomes for health care PPPs. In this chapter,China's current problems are again analyzed.As the origin country of modern PPP, UK has a lot of mature experiences on health care PPP and also a few issues surfacing with development. The research on foreign experiences can not only help Chinese government learn the advanced lesson, but also keep it from making the same mistakes. The study of foreign experiences must be combined with native culture and avoid mere copy, especially for the health care projects. Social background and local public wishes are critical for the life and death of the projects, for patients can choose not to go to the project hospitals, which is why health care projects are more complicated.Well-organized government input mechanism can straighten the government's work stream of PPP as well as control and guide the private sector, realizing health developing objectives through the effect of "visible hand". In the last chapter,the essay proposes suggestions on how to design a optimal government input system, including the publication of PPP laws and regulations on health care industry, clear definition of responsibilities among relevant authorities, appropriate risk and reward allocation, fine choice of input scope and multiple input methods to adjust the behaviors of private sectors, the use of Value for Money on a broader scope and fiscal constraint in health care more balanced. Aside from all those above, institutional environment and related policies are safety nets for the smooth operation of projects, which can include the removal of barriers to private sectors, the support on refinancing, etc. Scientific and systematic input system can optimize government resources and increase social and economic values, improving the government's input skills.The new findings and contributions are as follows:First, the government input mechanism for health care PPP is different from general input on health. The former is a new fiscal tool under a bilateral relationship, and it includes different parties, scope and principles than the latter. So this dissertation creates a new angle and provides a fresh eye for considering the government input mechanism under health care PPP. The dissertation divides the government input mechanism into five analyzing aspects,including input body, input scope, input method, input principle and input amount and does a comprehensive analysis based on the distinction of health care industry. Because of the special features of health care,China's current situation and relevant system are not mature,which is why health care PPP projects must be chosen very carefully.Second, the dissertation proposes that the public sector should use Value for Money in a broader term, considering health care delivery efficiency in the qualitative and quantitative analysis. Moreover, when the public sectors allocate the risks and calculate the returns against the costs, indirect returns such as entitlements and land rights should be included in the equation as well as direct returns. This cost-benefit analysis can help the government appraise whether the project has enough appeal to the private sector, and also keep the public sector from granting the private sector excessive profit.Third, the dissertation suggests that in order to avoid focusing on one industry and causing structural imbalance, fiscal commitment on health care PPP of all PPPs should be in line with health department's budget of total budget, leaving room for special adapations.