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British hospitals are jointly developed by government and enterprises

2019-03-22 来源: 51due教员组 类别: Essay范文

下面为大家整理一篇优秀的essay代写范文- British hospitals are jointly developed by government and enterprises,供大家参考学习,这篇论文讨论了英国医院政企合作开发。PPP即政企合作。英国是应用PPP较早也较为成熟的国家之一。英国医疗卫生领域的PPP具体实施模式主要分为PFILIFTPFI主要面向投资额超过2000万英镑的医院项目,而LIFT主要针对投资额较少的基层和社区医疗服务机构。由于PFI在实践中存在一些问题,受到了质疑,影响了项目的物有所值,因此,英国财政部提出了PFI的升级版本PF2,力图取代PFI

government and enterprises,英国政企合作开发,essay代写,作业代写,代写

PPP originated from abroad, and its concept and system was formally formed in the late 1990s. PPP refers to government-enterprise cooperation, which is also translated as public-private partnership. It means that enterprises obtain franchise rights from the government, provide construction and services of infrastructure and public utilities that are traditionally under the responsibility of the government, and recover investment and obtain reasonable income through operation. Upon expiration of franchise rights, facilities will be transferred to the government free or paid. PPP has the advantages of relieving the pressure of government funds, improving operation efficiency and service quality, transforming government management functions and reasonably sharing risks. It has been widely used in the domestic and foreign infrastructure construction and the development of public utilities, giving full play to its huge advantages.

Hospital construction is the key application field of PPP abroad, especially in the commonwealth countries, such as the United Kingdom, Australia, Canada, etc. Its development history and valuable experience have a strong reference significance for China to promote medical reform and strengthen hospital construction.

Britain is the application of the PPP earlier is also one of the relatively mature, through years of research and practice, formed a series of application guidelines, technical documentation, assessment and other guidance document, and in many fields successfully completed a large number of projects, in the year to March 2012, the British have implemented the PPP projects, has 717, private sector investment of over 54.7 billion pounds. Figure 1 shows the number of PPP projects implemented in the UK between 1990 and 2007. It can be seen that the number of PPP projects has been growing rapidly on the whole, but it has fluctuated slightly in recent years, with a wide range of fields. Especially, the application of hospitals is prominent, accounting for about 16.5% of all PPP projects, second only to education. According to statistics, as of April 2009, the UK has a total of 76 hospitals in the PPP mode, a total investment of about 6 billion pounds, but by March 2012, the hospital has increased to 118, the PPP project investment of up to 11.6 billion pounds, and the number is growing, the PPP has become the British government's main procurement in the field of medical and health care.

The specific implementation modes of PPP in the field of health care in the UK are mainly divided into PFI and LIFT. The difference between the two is mainly the difference in scale. PFI is mainly for the hospital projects with an investment of over 20 million pounds, and LIFT is mainly for the grassroots and community medical service institutions with less investment. In 2012, the UK Treasury proposed PF2, an upgraded version of PFI, to replace PFI due to some problems in practice, which were questioned and affected the value for money of the project.

PFI, namely "private financing", is one of the UK in 1992 the construction pattern of project financing, in the field of health care is the private sector is responsible for the construction of hospital financing, in the franchising period to provide logistical support services, the health sector to use hospital building core medical services, and pay fees to the private sector, its specific operating mode is DBFO, namely, design, construction, financing, operation. PFI can bring private sector funds, management, business and innovative technologies into public facilities and services, and reduce the financial expenditure and liabilities of government departments, transfer risks, and finally realize the value of the project. PFI is the mainstream financing mode for British hospitals. Since 1997, more than 90% of hospital projects have adopted PFI. Among all PFI projects, hospital projects account for the largest number, accounting for about 20.13% of the total number, and the number continues to grow. Under the guidance of the ministry of health, ministry of finance and other departments, PFI has formed a series of complete and rigorous operation systems and methods, and formulated clear and clear implementation guidelines with strong operability. See fig.2 for the PFI contract relationship and fig.3 for the operation process.

Does PPP have more advantages and save more money compared with traditional mode? How? This is the core issue of PPP. Therefore, it is necessary to make a quantitative evaluation and comparison of PPP efficiency, especially in the early decision-making and bidding stage. In response to this problem, the UK first put forward the VFM method in 1996, and then it was adopted by many countries and regions in the commonwealth, including Singapore, Canada, South Africa, Australia and so on. The core of VFM method is PSC, which is composed of initial PSC, competitive neutral adjustment, transfer risk and retention risk. The evaluation process of VFM is: in the bidding stage, according to the methods and conditions given in the bidding documents in advance, the bidder will put forward the quotation. Compared with PSC, the difference between the two is VFM, as shown in figure 4. When VFM is greater than 0, PPP mode is more valuable than traditional mode, and PPP mode should be adopted. However, when VFM is less than 0, it indicates that compared with traditional mode, PPP mode cannot improve efficiency and should not be adopted.

The PFI model is not a panacea. There are also some problems such as long bidding negotiation cycle, high cost, insufficient value for money, insufficient flexibility of franchise agreement, insufficient publicity of projects, improper risk allocation and too high investor returns. In practice, many people have raised questions and objections to the actual performance and role of PFI in the UK. According to the problems exposed in practice, the British Treasury proposed the PF2, an upgraded version of PFI, in the end of 2012.

Relative to PFI, the main modification contents of PF2 include: enriching capital and debt capital sources. The government, as a joint investor, provides part of the capital, and a certain proportion of the capital shall be invested through competition. To speed up the procurement process and reduce the procurement cost, improve the procurement capacity through centralized procurement and strengthened authorization, promise that the bidding phase will be no longer than 18 months, introduce standardized and efficient procurement process, and strengthen the project approval review; Improve flexibility, openness and efficiency of services, remove soft services from projects, give procurement departments greater discretion and discretion in service delivery, and conduct regular evaluation of service delivery; To improve transparency, investors are required to publish information on the return on capital, and projects in which the government holds equity are required to publish annual reports containing details of financing. Appropriate risk allocation to improve the government's risk management, including the additional risk of capital expenditure caused by various unforeseen reasons; Pay more attention to the connection with the capital market, especially long-term debt financing; Upgrade value for money guide.

As soon as PF2 is launched, it is confirmed that it will be used in PPP education programs, and the ministry of health has begun evaluating the suitability of PF2 in several hospital programs. PF2 represents the development trend of PPP. Although the national conditions and stages are different, it is still an important reference for the development and optimization of PPP in China.

In the UK, 90% of the initial medical diagnosis of the patients is carried out in primary medical institutions, but most of the government investment in the actual construction is only invested in hospitals, resulting in severe shortage and dilapidation of the construction facilities in primary medical institutions. To address this situation, the department of health (moh) of the UK launched LIFT mode specifically for grassroots medical institutions in 2001, and its support targets include community clinics and general practitioners. LIFT the implementation of the model is: according to the local government to choose the right project planning and the actual demand, investors through public bidding in the form of a selection, jointly by the public sector and private sector investment, obtaining a franchise, a group of grassroots medical institutions responsible for the project's financing, construction, renovation and maintenance, and give the corresponding building leasing grassroots medical institutions operate. Franchise period 20 ~ 25 years, every 5 years evaluation, franchise expires, the building can not be handed over free, but the medical service agencies have the right to buy the priority. Practice has proved that LIFT is an effective and flexible mode of hospital financing, which can effectively reduce costs, effectively promote the construction of grassroots medical institutions, introduce private sector funds and professional capabilities, indirectly promote and attract grassroots medical service personnel, and enrich the choice of medical treatment for the masses. According to statistics, as of 2008, there have been 47 LIFT project companies in the UK, providing primary care services covering half of the population in the UK and attracting more than 1.5 billion pounds of investment.

Through the above introduction and analysis of PPP in British hospitals, the following characteristics of PPP in British hospitals can be summarized

There is a set of standardized, modular implementation guidelines and standard contracts, conducive to the promotion of the project. The government department in charge of setting up multiple institutions, such as the national audit office, business office, the PUK, etc., to guide the development of the PPP, consultation, supervision, summarize and improve, in the field of medical and health, the ministry of health also according to the characteristics of the medical industry, formulate the corresponding guidelines, published reports, etc., these measures is convenient and effective, vigorously promote the development of PPP.

Be able to absorb the success or failure experience in time according to the change of environment and project and make improvement. Britain according to the type, size and properties of medical institutions, adopted different PPP models, such as hospital PFI and LIFT for grassroots medical institutions, a clear division of responsibilities, complement each other and learn from, form a complete structure, the coverage of the system, is advantageous to the health service level and reasonable layout, to promote the development of medical and health undertakings.

These systems and methods are conducive to the scientific decision-making of the government, the rationality of choosing investors for PPP projects, and the optimization of projects and the maximization of public interests.

The private sector is only responsible for the financing, construction and non-core services of hospital projects, with the NHS, which represents the government, providing the core or medical services. Such advantages are clear division of labor, complementary advantages, risk sharing, conducive to the full play of their respective advantages. Due to the strong professionalism of medical work, the general private sector does not have this strength and can only be responsible for the health sector with rich experience and strong technical force, while the health sector can get rid of the fetters of logistics services and concentrate on providing medical services.

The lower house of parliament, the national audit office, the ministry of health and other departments have the evaluation report on the application of PPP in hospitals. Through in-depth and comprehensive evaluation of the project operation, the experience is summarized to constantly optimize and improve the PPP model.

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