THE URGENCY OF PUBLIC PRIVATE PARTNERSHIP
2. The Urgency of Public Private Partnership (PPP) in Public Healthcare Services
Public Private Partnership in heathcare services between BPJS Kesehatan and private healthcare providers are ‘working together to achieve the quality of public health. Both parties share risk and come up with new solutions to overcome the difficulties and limitation of public health services.
New ideas, knowledge, competencies and resources between partners, complementary each other.
In fact, the public private partnership of healthcare are changing their scope from an infrastructure oriented to a clinical service delivery where the public organization’s rule turns from provider to regulator; the payment and reimbursement mechanism are based on outcome, quality and cost savings. Many private healthcares providers, such as doctors, hospitals, clinic, pharmacy, conducting partnership to BPJS Kesehatan Semarang. The private sectors partners Positively able to access knowledge, having the opportunity create innovation, improve their capabilities and access capital and markets for expanding the marketing of their products and services.
Use of partnerships to address sustainability challenges has grown exponentially. There is a sense of hope that PPP is a long term and desirably longer than the temporary relationship achievable through traditional ‘contracting-out’ of services (Hodge and Greve, 2011). The sustainability makes improvement to the total quality of partnership, both now and in the future. It shows in the partnerships by BPJS Kesehatan and private health providers by regarding the commitment. The stakeholders in partnership realize to external drivers, partner motivations and characteristics, also process issues.
Globalization and technology development are being external drivers to public and private sectors, so they they need to concern by public private partnership to tackle the impact.
Partnership may boost the increase of quality performance for each institution because they are support each other in the same project. Serving and improving public heathcare are become the aims for both BPJS Kesehatan and private partners, so they motivated to reach it, even in such different characteristics. This makes process of public private partnership in healthcare need to well manage to share vision, building trust and handling conflict.
Partnering to different party takes many advantages, including to public private partnership.
Private sector partners may possess the ability to maximize value for money and thus deliver outcomes at lower cost to public sectors. Governments across the globe increasingly seek to reform public services in order to deliver better and more equitable outcomes at a lower cost.
Public administration scholars have recently begun to regard these as the most important dimensions of public service performance (Andrews & Entwistle, 2010). Efficiency in using value for money become an urgent things to do reminding the limitation of resources of government and public institution.
BPJS Kesehatan Semarang realizes that running the money in efficiency way is very important concerning to serving public health. The demand of public health excellent preferably conditioned by maximizing value for money and only private sectors have the abilities to conditioning the
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public demand. This situation encourages BPJS Kesehatan Semarang to make partnership with private healthcare service providers. The private healthcare service providers are professionals’
healthcare who works effectively and efficiently. Private hospitals, clinic, pharmacy and other private providers really understand to manage the funding wisely and valuable and its shown in the agreement contract that they have understood already.
Accountability is showing the willingness of responsibilities by each party in gaining the project aims. The partnership between BPJS Kesehatan Semarang and private heathcare provider takes some kind of accountability in their relationship. Financial accountability is the first accountability concerning the use of money in proper way. BPJS Kesehatan and partner are comparing the financial input to financial outcome (usage) in covering public health. BPJS Kesehatan takes evaluation in every semester checking the report of financial, while the private partners arranging the financial report and supporting with sufficient and significant data. Data consists of the name of health insurance user covered by BPJS Kesehatan and it’s signature as the legitimacy of the data.
Accountability for compliance with rules and processes in public private partnership of BPJS Kesehatan and private healthcare providers identified by regular report of partner performance.
BPJS Kesehatan have authorities in laws, regulations and fiscal rules to evaluate partners. The partnership will be reviewed if the evaluation of rules and processes by private partners were not implemented seriously. Access to reliable and useful information is essential to accountability mechanism. Transparency is required in the rules and procedures laid down by BPJS Kesehatan and partners in accountability for enforce compliance with rules and processes in public private partnership.
Perhaps the most obvious aspect that organisations are held to account for are the outcomes or results of their work, so accountability for results is required. BPJS Kesehatan focus on the quality of results. Of partners performer in serving public. Complaints from users are indicator for BPJS Health knowing the accountability of results from private partners. How the private partner serve to public demand in health sector, the quality of services, the improvement and innovation are related to accountability for results in public private partnership of healthcare.
It is undoubtable that the tendency between public and private parties is different. The public party’s goal is fulfilling public demand by public services and public funding. Their orientations are public fulfillment, public satisfaction, justice and equity among public, so the accountable is needed to exhibit responsibilities to public. The different orientation showing by private sectors which is profit became the most important goal to reach. Satisfying costumer is best approach through service excellent to run business successfully. Another effort to reach the goal in private sectors done by many efforts such as partnering to any institution (public and private), innovating product and services, technology aware, and so on.
As private heathecare providers in Semarang, they have consideration to government’s policy in public healthcare policy. One of the policy is public private partnership between government institution and private heathecare providers. In the early implementation, the partnership between
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BPJS Kesehatan Semarang (as government institution) and private healthcare providers (private hospitals, optics, drugs stores) were not runs smoothly. The main reason was conflict over goal and objective from each partner because of its differences. The private healthcare providers need to gain an optimum profit, while BPJK Kesehatan must manage public funding efficiently. The orientation for both partners clearly different and it caused conflict beetween partners. The private partners think that it would not worth to partnering in with BPJS Kesehatan because the payment quite limited. Meanwhile, BPJS Kesehatan argued that they have policy to use INA CBGs (Indonesian - Case Based Groups) concerning to the payment of heath services. It is absolutely became the barrier because the goal and objective among partners are different.
Private parties need to manage their resources economically. It means that all resources have to be well managing effectively and efficiently to gain great profit, especially in funding. Private health care provider thought that every expense have to turn in significant income cost by proper time. ‚The sooner the better‛ is become ‚principal of work‛ for private sector running their funding. This kind of way clearly could not adapted by BPJS Kesehatan because they have different way to work. BPJS Kesehatan have their policy how to manage public finding to settle up the claim of private healthcare providers, it won’t pay sooner because it need certain time. This is why the private providers meet the difficulty in managing funding and staff. The staff of private providers has to give more attention in this business and of course their concern to another matter of business by their own is reduced.
As government institution, BPJS Kesehatan takes greater power relation between partners. This condition made because BPJS Kesehatan concern and take responsibilities to public health.
Meanwhile, private heatlhcare provider put contributions by part of society in supporting the assurance of public health. By the greater power relation, private providers must obey to the role and policy of partnership with BPJS Kesehatan. BPJS Kesehatan sets the system and private health providers following the system to keep the partnership, the one who un-accordance to the system, would not be able to make a partnership. The power relation is not balancing as partnership should do.
Organization behaviour and organization culture between public institutions and private parties make some organization difficulties. The way public institution works are different with the way of private parties. The public institution works in transparent, accountable and need much time to finish their works. Meanwhile, the private sectors need to work simple, tidy, fast, result orientation and not wasting time. This situation appears in public private partnership between BPJS Kesehatan Semarang and private healthcare providers. The private sectors works in simple and quickly way to get result and they don’t like to wait because it’s wasting time. ‚Time is money‛ becomes motto to private sectors and this is quite different to BPJS Kesehatan. BPJS Kesehatan works based on procedures, so it takes much time. The barrier shows up in these differences.
Public private partnership is complicated way when discussing about how to match the goals between partnership parties. In other way PPP is important to collaborate stakeholders concerning in public affairs. Strategy is required to keep and overcome the partnership. One of
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strategy in public private partnership between BPJS Kesehatan Semarang and health providers (hospital, optic, and clinic) is involve partners to share power and responsibility to enhance governance process of partnership genuinely. BPJS Kesehatan and private partners meet directly face to face without intermediaries. Other effort is build communication among partners and government to break dominance, aggression, and control of governance domains also become one strategy to strengthen partnership. BPJS Kesehatan invites the representatives of private healthcare provider regularly to discuss about difficulties, treats, and solutions above them.
Intensive communication becomes solution to overcome barrier wisely.
Another important strategy is support evaluation of public private partnership transparently between BPJS Kesehatan and private health providers. In the partnership, there is suspiciousness on both side mainly in funding and performance management. That is why the partnership must held in honest and open data to build transparent report. There are no data manipulation, the data must be valid and there is always real supporting data evidences. Private providers must shows up and legitimate the supporting data evidences. All implemented strategies in partnership between BPJS Kesehatan Semarang and private health providers is proactive strategies which are very effective if they are genuinely pursued for mutual interests and based on mutual respect and cooperation each other in public private partnership.
CONCLUSION
The progress of public demand, especially in healthcare service needs a serious attention from the government as its responsibilities. The limitation of government must be overcome by partnering to private sector. Public private partnerships in healthcare service are an urgent effort to fulfill the improvement of quality in public service delivery. The urgency of public private partnerships in healthcare service consider to innovation in public services; sustainable development by using valuable resources; efficiency in using value for money and accountable as public governance.
Meanwhile there are some barriers among partners, such as conflict over goal and objective from each partner because of its differences by public sectors and private sector. Another barriers are resources cost such as funding and staff; power relation between partners and organization difficulties (whether internal or external organization) in each partners.
The strategy to assist in building and sustaining effective public private partnerships in health sectors, between the BPJS Kesehatan Semarang and private health service providers, is proactive strategies. Proactive strategies gain by (1) genuinely involve partners (private health service providers) to share power and responsibility to enhance governance process of partnership; (b) build communication among partners and government to break dominance, aggression, and control of governance domains and (c) support evaluation of public private partnership transparently.
The urgency of public private partnership (PPP) in public healthcare services is truly important.
However, the barriers need to overcome, so strategies are implemented to strengthening partnerships. The sustainable partnership partnership among partners had to created, specially for
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public private partnership (PPP) in public healthcare service between BPJS Kesehatan and private health service providers in Semarang City, Central Java, Indonesia.
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