Challenges and Problems of Public Private Partnership in Health System: A Review Study

Background and Objective: Public private partnership (PPP) model has been recently introduced as an approach to improve functional efficiency and solving governments’ health care shortages in various aspects. The number of studies focused critically and explanatory on this model are scarce. Furthermore, lack of study organization and structural coherence for deducing practical consequences are still bold in this field. This review summarizes and categorizes these shortcommings. Materials and Methods: This study is designed in review manner: search was conducted in Pubmed, Google scholar, SID.ir and Scopus with all of the combinations of the two keyword groups with the time period search restriction of 2010 to 2017 published studies: group one included “Public private partnership”, “Public private cooperation”, “Privatization”, “Public private initiatives” and their abbreviations; and group two included “Health”, and “Hospital”. After stepwise evaluations and appropriate screening, of 145 assessed papers in the first place, 23 papers were finally selected for data extraction. After reading the full-text of included articles, all of the mentioned information about the problems and challenges of PPPs were extracted. Then, the drafted results for each study were evaluated and compared with each other and organized as main subgroups. Afterwards, the frequency of repeats and emphasis of each subgroup was calculated for all of the 23 studies. Finally, a description review was adapted and registered for each subgroup using related articles. Results: Analysis and assessment of the papers included in this study pointed to several discrete issues which were categorized and discussed in 12 main subgroups based on their conceptual coherence: complexity, low-quality evaluation and supervision, lack of transparency, inadequate coordination, neglecting justice and public interest, lack of flexibility, lack of experience and practical knowledge, insufficeient financial resources, lack of appropriate risk assessment, inadequate cooperation of stakeholders, partner choice restrictions, and paying insufficient attention to the staff. Conclusion: The most important problems and challenges currently confronting health care PPPs were assessed to be complexity, low-quality evaluation and supervision, lack of transparency, and inadequate coordination. All of the items highlight the need to enhance the comprehension of both agreement sides regarding the nature, structure, and complexity of these types of cooperation; as well as complete and precise clarifications for sides, community, and other stakeholders. DOI: http://doi.org/10.22037/ch.v5i4.1976

Additional file 1: Table S1. of Divergent pathway of lipid profile components for cardiovascular disease and mortality events: Results of over a decade follow-up among Iranian population

cardiovascular disease event incidence (per 1000 person-year) of different serum lipid markers and lipid indices among men, women and total participants (n=5054); Tehran Lipid and Glucose Study (TLGS) (2001-2012). Table S2 cardiovascular mortality rate (per 1000 person-year) of different serum lipid markers and lipid indices among total participants (n=5518); Tehran Lipid and Glucose Study (TLGS) (2001-2012). Table S3 Non-cardiovascular mortality rate (per 1000 person-year) of different serum lipid markers and lipid indices among total participants (n=5518); Tehran Lipid and Glucose Study (TLGS) (2001-2012). Table S4 Hazard ratios of lipid measures for predicting first cardiovascular disease events among participants without prevalent CVD in those with available data on HOMA-IR (n=1548); Tehran Lipid and Glucose Study (TLGS) (2001-2012)*. Table S5 Hazard ratios of lipid measures for predicting first cardiovascular disease events among participants without prevalent CVD based on lipid profile tertiles CVD in those with available data on HOMA-IR (n=1548); Tehran Lipid and Glucose Study (TLGS) (2001-2012). (DOCX 65 kb