When the Private Sector serves the Public Sector

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Public and private, good and bad. In Italy, when it comes to healthcare, the debate surrounding healthcare remains simplistic and, at times, unhelpful, presenting these two worlds in a binary manner. On one side is the defence of public health, on the other, the profit-driven logic which is seen as creating inequalities.

There is a widespread prejudice, not only among the general public but sometimes even among professionals, that the involvement of private operators represents a threat to the healthcare system and the country. Private healthcare providers, but also suppliers of services, materials and technologies that enter into the dynamics of public healthcare institutions would, according to this vision, be an obstacle to the public good.

As often happens, the reality is much more complex.

Deep-rooted prejudices

But where do these prejudices come from? First of all, “private healthcare” is confused with “paid healthcare”. In our country, we are fortunately used to considering health a universal right available free of charge. The fundamental principles on which the National Health Service is based since its establishment, with law no. 833 of 1978, are universality, equality and equity. And we are rightly opposed to the idea that this should become accessible only to those who can afford to pay out of their own pockets.

What the general public ignores, or does not consider, however, is that the private sector is already widely involved in the provision of services on behalf of the National Health Service, and therefore free of charge for the patient. Not only that: most citizens tend not to consider that without the private partner it would be impossible for the National Health Service itself to ensure the current levels of assistance and care, which are already under great pressure, for example with regards to the growing waiting lists. In short, accredited private healthcare constitutes a consolidated and essential reality, which remains, however, free for the patient, within the
spending budget defined and distributed by political decisions and logic first, and then by public law. This is quite different from the pure private market segment, which in any case often also absorbs delays in introducing fee profiles appropriate to innovative methods and practices.

When the Private Sector Supports Public Healthcare

But this is not the only type of private involvement. Less widespread, but growing, is another type of collaboration between these two worlds: one that takes shape within public structures where specialised private companies provide their expertise and resources to help the public sector achieve its healthcare objectives “from within.”

In other words, we are talking about highly qualified partners who operate within public hospitals, providing services and technologies to enable them to better manage their healthcare mission, without replacing them. Private companies whose purpose is not to provide an alternative – for a fee – to the public service, but rather to serve the public sector to enable development plans and efficiency improvements in the provision of services due to their catchment area.

This is precisely the mission of Medipass: in the specific context of cancer diagnosis and treatment, we operate in the market through the “integrated clinical services” model, based on the sharing and pursuit of the healthcare objectives of the public structure. Our role is to provide the client facility with all the resources necessary to establish, renew, and manage imaging diagnostics, nuclear medicine, and radiotherapy departments over the medium to long term.

Cultural Obstacles

It is clear that convincing public entities of the benefits of partnering with companies like ours is, at least in part, still a challenge. In a general context of distrust towards private healthcare providers, the idea of bringing a private partner into the public sector is often difficult to accept. Among the fears are the risk of sacrificing the quality of services in favour of profit,

losing autonomy in strategic decision making, and weakening clinical governance. Furthermore, there is little awareness of the existence of well-defined legal and administrative pathways which allow for this collaboration, despite the fact that the latest regulations on public-private partnerships provide a clear framework also in relation to core services. A natural resistance to change that also deserves to be removed through professional development interventions that to date have been too sporadic and inconsistent. Even in the economic sphere, there is a huge gap between evaluation systems based on skills for customised tenders, perhaps regarding the lowest price, and the need to evaluate economic plans which intend to propose performance measurement and value-based logic, even before weighing up induced benefits, both at a healthcare and social level.

A Partner who Shares Objectives, Risks, and Benefits

Public healthcare today faces a dilemma: how do we ensure increasingly costly and complex services in greater quantities in a context of limited economic and professional resources? Our model, through highly

results-oriented management, can be one of the answers:

  • Ensuring the necessary investments for acquiring new technologies or methods,
  • Guaranteeing their full functionality and availability in the long term,
  • Making the necessary incremental professional resources available,
  • Contributing daily, with our experience and expertise (gained in dozens of facilities in Italy and abroad), to improving the quality and efficiency of the services delivered.

All this while keeping clinical governance firmly in the hands of the public partner and sharing, through flexible remuneration, the risk of potentially not achieving shared objectives.

An Innovative Model that Restores Centrality to the Public Sector

Innovation has always been at the heart of what Medipass offers. Technological innovation, first and foremost, linked to the introduction of state-of-the-art methods and equipment, and process innovation, which allows for a department organisation designed to be efficient. But the real innovation perhaps lies in the proposed service model, which goes beyond the normal customer-supplier paradigm, replacing it with true partnerships based on shared risks and benefits. We believe that this model, already widely used successfully in other contexts (energy management, telecommunications, natural resources, etc.), if explored with experienced operators, can also be applied in highly complex sectors, such as clinical settings, where significant resources and highly specialised skills are required, such as in cancer diagnosis and therapy. However, we are talking about a new procurement model and it is therefore quite natural to have an adjustment period during which public decision-makers become familiar with this proposal. Moreover, our feeling is that there is a growing awareness of the validity of what we are proposing. It goes without saying that to seize these opportunities, in addition to the efforts already made by the Ministry of Economy and Finance (MEF) and the National Anti-Corruption Authority (ANAC), regional political decision-makers must also play their part.

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