Go­ing public, and pri­vate

Col­lab­o­ra­tion proves ef­fec­tive and can even lead to some lofty re­sults

Modern Healthcare - - OPINIONS EDITORIALS -

When it comes to ba­sic re­search and de­vel­op­ment, try­ing to get com­plex sci­ence-based projects off the ground, what’s the most ef­fec­tive and ef­fi­cient ap­proach to do­ing busi­ness—through the pri­vate sec­tor or the public sec­tor? It can be a po­lar­iz­ing ques­tion that for some will evoke an ide­o­log­i­cal re­sponse, es­pe­cially from those who be­lieve it’s al­ways best to get gov­ern­ment out of the way (no more Solyn­dras!) and let free en­ter­prise go to work.

The sim­plest an­swer is that “it de­pends.” But what has proved to be a suc­cess­ful for­mula, es­pe­cially in health­care, is a com­bi­na­tion of both sec­tors in the form of public-pri­vate col­lab­o­ra­tions. And it’s a model all in­dus­tries will need to em­ploy more of­ten as “public” re­sources get stretched ever thin­ner.

One arena for on­go­ing public-pri­vate part­ner­ship is the sub­ject of this week’s spe­cial re­port (p. 28) by re­porter Jaimy Lee. She dis­cusses pri­vate ef­forts by hos­pi­tals, health sys­tems, foun­da­tions, in­sur­ers and oth­ers to draw more at­ten­tion to preven­tion/well­ness ini­tia­tives and public health. They con­tinue to see prom­ise in these ef­forts to chip away at the health­care cost spi­ral, some­thing that seems re­sis­tant to re­me­di­a­tion.

But the providers cer­tainly aren’t do­ing all the work on their own. Yes, they are mak­ing siz­able in­vest­ments, re­al­iz­ing that their re­spon­si­bil­ity for pop­u­la­tion health is only go­ing to grow in this new era of ac­count­able care. Bos­ton-based Part­ners Health­care Sys­tem, for in­stance, has set a goal of com­mit­ting just un­der $1 mil­lion to sup­port pro­grams that pro­mote ex­er­cise and ac­cess to health­ier foods.

At the same time, the fed­eral Preven­tion and Public Health Fund, cre­ated un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act, has al­lo­cated more than $2 bil­lion to help fi­nance such ef­forts and is slated to pro­vide bil­lions in ad­di­tional funds over the next 10 years, ded­i­cated to com­mu­nity preven­tion, clin­i­cal preven­tion, in­fra­struc­ture im­prove­ment and ed­u­ca­tional pro­grams.

Also in this is­sue, Mod­ern Health­care Washington bureau chief Jes­sica Zig­mond re­ports on an­other public health chal­lenge where be­cause of di­min­ish­ing re­sources, public-pri­vate co­op­er­a­tion has be­come es­sen­tial: deal­ing with the in­creas­ing in­ci­dence of psy­chi­atric cases be­ing han­dled in the na­tion’s emer­gency rooms (p. 32).

As one ex­pert says, “In the men­tal health arena, we had the public men­tal health sys­tem and the pri­vate sys­tem—they used to op­er­ate in­di­vid­u­ally. But as the public sys­tem con­tracted, it put more pres­sure on the pri­vate sys­tem, which shows it­self” in the emer­gency depart­ment. Here again there’s an in­ter­de­pen­dent re­la­tion­ship that’s prov­ing cru­cial to en­sur­ing that pa­tients get proper treat­ment in the proper set­ting.

Fi­nally, last week brought an­other high-pro­file ex­am­ple of public-pri­vate part­ner­ship, this one quite far out­side of the health­care uni­verse—the suc­cess­ful launch of the first pri­vately built and op­er­ated rocket de­signed to ferry cargo to the In­ter­na­tional Space Sta­tion. And if all goes as scripted, the Spacex cap­sule could even­tu­ally trans­port as­tro­naut crews to the sta­tion.

While the achieve­ment was touted as a pri­vate-sec­tor mile­stone, the com­pany cer­tainly ben­e­fited from fed­eral seed money through Nasa—about $400 mil­lion so far—ac­cord­ing to pub­lished re­ports. The com­pany isn’t the only pri­vate contractor vy­ing to of­fer the next shut­tle ser­vice into space, and its tech­nol­ogy still faces plenty of rig­or­ous tests be­fore it’s on a clear tra­jec­tory to­ward com­mer­cial suc­cess. But the vic­tor in this race stands to land multi­bil­lion-dol­lar con­tracts. Then the feds can stop writ­ing checks to the Rus­sians ev­ery time this na­tion needs to hitch a ride into or­bit.

There should be lit­tle doubt that public-pri­vate part­ner­ships—by shar­ing ex­per­tise and fi­nan­cial re­sources, and with the proper fis­cal safe­guards—can be one of the best ways to achieve liftoff for many worth­while en­ter­prises.

DAVID MAY

As­sis­tant Man­ag­ing

Ed­i­tor/fea­tures

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