GE Healthcare Fostering Investment through PPP Africa Health Business Symposium 1
Why customer are looking at PPP/MES? Financial Transfer from CAPEX to OPEX Long term budget predictability & funding with flexibility, makes budget & capital planning easier. Guaranteed uptime & equipment refreshes takes complexity out of capital planning, Operational Saves time and effort of procurement / evaluation teams, a simplified purchase process Motivation and retention of clinical staff, providing support and Training Allows talented resources to drive productivity in other areas of the hospital Technological Contemporary equipment for clinicians improving patient diagnosis and enhancing safety / experience. Equipment refreshes ensure long-term technology predictability Minimize technology obsolescence Organizational Provides access to innovation and clinical research partnerships Single point of contact for managing multiple brands Availability guarantee and enhanced reporting Transfers risk from the authority to the providers Move from Total Cost of Ownership to 3 E s (Economy, Efficiency, Effectiveness) 2
Integrated Offering of PPP in Healthcare Market driving need for new solutions Infrastructure Construction and facilities management In hospitals, primary care or community care facilities Asset-heavy Services Clinical and non-clinical services At primary, secondary or tertiary level Asset-light Could include medical training/health insurance or vouchers Integrated Construction and facilities management and full range of clinical and non-clinical services At primary, secondary or tertiary level 3
Challenges within the Healthcare Market driving need for new solutions Clinical Operational Financial Access to state of the art capabilities Yesterday -> discreet priorities addressed individually Workflow consistency, productivity Capital budget, supply chain management Today > integrated solutions with clear economic value Lower dose leadership Upgradable technology Standardized care pathways Expanded service lines Improved Patient Outcomes Scalable, flexible deployment Streamlined workflows + + Redesigned patient care models Asset Availability guaranteed Risk Transfer Asset utilization, tech obso, ROI Long term capital capacity realignment, redeployment Long-term fiscal affordability Redeployment of Opex to Capex funding The best technology alone isn t enough anymore 4
What is a PPP? What is an MES? What are the differences between the two? Optimization Continuous training Upgrade Maintenance Delivery/ installation Managed Equipment Service (MES) Typically Standalone Brownfield; can also be Part of PPP/PFI greenfield hospital development Classical Today Managed Maintenance Public Private Partnership (PPP/PFI) Typically Greenfield Includes MES, in addition to Turnkey/Construction & Facilities Management A single product A medical department A new hospital/clinic PPP/MES are primarily public system procurements with long cycles to fin. close (24mths PPP 12mths MES) 5
GEHC Technology Partnership / MES references Growing Interest Across the Globe on Providing Customer Solutions US Canada Kenya India Temple Univ. Health Humber River Hospital Kenya Ministry of Health Gujarat UK University Hospital Coventry - MES Kings College Hospital, London - Operational 2016-7 Yr Contract - Radiology Outsourcing & Asset Optimization - Operational 2016-15 Yr Contract - MES covering Diagnostic Imaging & Project Management - Operational 2015-7 Yr Contract - MES covering Radiology for 98 hospitals across 47 counties - Operational 2009-7+5 Yr Contract - PPP covering radiology for 5 hospitals across the State - Operational 2003-39 Yr Contract - PFI covering Radiology, Cardiac, Neonatal, Critical Care & Other - Operational 2013-5 Yr Contract - MES - encompassing Cardiac Ultrasound Ireland Sweden Germany Austria Spain Beacon Hospital Karolinska Univ. Hospital Stockholm Gesundheit Nordhessen, Kassel Universitaetsklinikum Hamburg Eppendorf Vorarlberger KBmbH Hospital Universitari Son Espases - Operational 2016 - Yr 10 Contract Yr Contract - xxx MES covering Diagnostic Imaging - Operational Operational 2015 - Yr 14 Contract Yr Contract - xxx Care Pathway Optimization & PET-CT MES - Operational 2008-10 Yr Contract - Technology Partnership encompassing multiple sites, transition 05/10/2016 to digital solution across Radiology. - Operational 2009-10 Yr Contract -Technology Partnership mainly Ultrasound across all care areas incl HCIT - Operational 2016-12 Yr Contract - MES encompassing Radiology department. - Operational 2010-10 Yr Contract - MES encompassing Radiology
PPP Readiness Country Ranking Color Codes Nascent (0-29) Emerging (30-59) Mature (60-79) Developed (80-100) Russian Federation Morocco UK Es La Li Belarus PL Ukraine Sl H Ro Cr Bu Al Turkey Tunisia Armenia Kazakhstan Mongolia China S Korea Japan Mexico Honduras Guatemala Nicaragua Costa Rica Panama Colombia Equador Peru Dominican Rep Venezuela Brazil Ivory Coast Ghana Nigeria Egypt Cameroon Uganda Angola DR Congo Zambia Rwanda Kenya Tanzania India Bangladesh Thailand Vietnam Philippines Indonesia Papua New Guinea Paraguay Chile Uruguay South Africa Australia Argentina Source: Infascope Economist Intelligence Unit 7
PPP Units around the world Russian Federation Canada Ir UK B NL DE Es La Li PL United States Mexico Honduras Puerto Rico Senegal P S FR Cz I Cr Bu Al Turkey Gr Israel Egypt Nigeria Kuwait Kazakhstan China Nepal India Bangladesh S Korea Philippines Japan Costa Rica Peru Brazil Ghana Uganda Kenya Malawi Sri Lanka Malaysia Singapore Indonesia Papua New Guinea Chile Uruguay South Africa Australia New Zealand Source: http://ppp.worldbank.org/public-private-partnership/overview/international-ppp-units 8
Themes and key questions Theme Key Question Theme Key Question PPP Experience Stakeholder support and ownership Legislative and regulatory framework Access to finance Transparency and disclosure Does the government have any experience implementing PPPs? Does the government support PPPs? Do the general public and other key stakeholders support PPPs? Is the legal and regulatory environment sufficiently conducive to PPPs? Do legislation and regulations provide clarity on the management of unsolicited proposals? Do other legislation and regulations support the implementation of PPPs? Are legislation and regulations functioning well in practice? Are the necessary PPP project finance structures and sources available? re there oversight audit, and disclosure procedures and institutions in place? Institutional framework Funding and managing fiscal risk Are there institutions in place to support the preparation, procurement, and implementation of PPPs? Are there processes in place to guide the preparation, procurement, and implementation of PPPs? Are there standardized PPP documents and templates? Is there a government communication strategy and stakeholder engagement strategy on PPPs? Do the government and the industry have (access to) the skills and expertise to implement PPPs successfully? Does the budgetary system support PPPs? Is there funding available for robust PPP project preparation, procurement, and implementation? Is there a framework for government financial support to PPPs? Is there a framework for assessing and managing fiscal commitments and contingent liabilities? Source: Country Readiness Diagnostic for Public Private Partnerships by World Bank 2016 9