Realist evaluation of public private partnerships in the Kuwait health care system

The aim of this study is to evaluate the Public Private Partnership (PPP) implementation in Yiaco Adan Diagnostic Centre (YADC), part of the Kuwaiti health care system, by critically examining its effect on the health care system objectives. The literature review describes the health care system structures, functions, objectives and goals. Public health care systems are often recognised for being effective and equitable, while private health systems are recognised for their efficiency and choice (responsiveness). The Kuwaiti health care system is then reviewed, and the challenges facing the system discussed. The origin of PPP, its objectives, and its place in the health sector, are subsequently examined. The research critically appraises, using a realist perspective, whether the introduction of PPP in the Kuwaiti health care system has enhanced health system objectives: efficiency, effectiveness, equity and choice. The thesis includes a preliminary study and a main study. The realist evaluation approach was adopted to explore how PPR, as a programme, introduces mechanisms to improve health system objectives, in the Kuwait context, with the aim of producing detailed answers to the questions of what makes PPP work, for whom, and in what circumstances. The preliminary study tested the practicality of the concepts identified in the literature and ensured that the PPP concept is readily understood among the research sample. The main study consisted largely of semi-structured interviews with 4 key stakeholder groups (public, private, financial and regulatory/advisory bodies). A customer experience questionnaire with a 5th stakeholder (patients) was also undertaken to determine the overall level of service provided at YADC. A document review was provided where appropriate to triangulate the findings. The research findings are significant in that they have shown that the recent PPP experience in the Kuwaiti health sector has a significant impact on the health care system levers (resource allocation, organisation, service provision and finance) by introducing various mechanisms (processes) that facilitate improved achievement of health care system objectives. These mechanisms reflect maximum utilisation and streamlining of resources, decentralisation of organisations, a customer-centred approach in service provision, and introducing incentives into the financial structure. All in all, it seems that PPP has the potential to achieve the health care system objectives better and create better value if implemented well and in the right context. The impact of PPP on health care has been to maintain its effectiveness and equity (public sector values) while significantly introducing efficiency and choice (private sector values). However, the research has highlighted barriers to the PPP process, including an unstable political environment, insufficient legal and financial frameworks, inexperienced government bodies and health care managers with limited knowledge of the PPP. Additionally, there has been a lack of clearly documented goals and deficiencies in the detail of the PPP contract. The research found that despite the government's long-term commitment the PPP model left many issues unclear, providing no allowance for population growth, scientific development, the need for continually updating technology and technical equipment. This indicates that there is scope for considerable improvement in the drafting of the initial contract including a degree of flexibility to allow for future health needs. This research recommends health care policy makers and managers to ensure PPP objectives such as reduced cost, elimination of bureaucracy, private sector involvement and profitability are maintained, while protecting the key health care system objectives of efficiency, effectiveness, equity and choice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo