The role of contractual arrangements in improving health sector ...

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ACRONYMS Jordan GDP Gross Domestic Product JD Jordanian Dinar WHO World Health Organization MOH Ministry of Health RMS Royal Medical Services JUH Jordan University Hospital KAH King Abdullah Hospital CHIP Civil Health Insurance Plan JUST University of Science and Technology HID Health Insurance Directorate UNRWA United Nations Relief and Works Agency for Palestine Refugees in the Near East MCH Maternity and Child Health JNHA Jordan’s National Health Accounts NGO Nongovernmental organizations PHR Partners for Health Reform MOF Ministry of Finance MOP Ministry of Planning SWOT Strengths, Weaknesses, Opportunities, Threats MHIP Military Health Insurance Plan HCC Al-Hussein Cancer Center CH Crescent Hospital HIPP Health Insurance Pilot Project IU Implementation Unit 106
INTRODUCTION Jordan This study documents the experience of the Ministry of Health in Jordan in contracting out services with the private sector and the other autonomous public sectors such as the Royal Medical Services, Jordan University Hospital and King Abdullah University Hospital. The study also includes a general assessment of these contractual arrangements to identify areas of strengths, weakness and opportunities for improvement. The specific objectives of the study were to: • Acquire in-depth understanding of nature, extent and presence of enabling/disabling factors that promote/prevent public–private partnership in health in Jordan. • Develop a base for a national strategy on public–private partnership in health that would promote access, efficiency, equity and quality. A special data collection tool (Annex 1) was developed by the researcher to assess the contractual arrangements between the Ministry of Health and other health care providers. This tool covers the following areas: Type of service covered Selection mechanism and length of contract Regulation, who enforces and what level Payment mechanism Financial and other incentives for the purchaser and provider Level of performance based measures Purchasers level of effort in management and administration Providers level of effort in management and administration Geographical scope of contract Monitoring and evaluation characteristics. This report presents a brief analysis of the health care financing and delivery in Jordan, assessment of the overall capacity for contracting health services, and assessment of the contractual agreements between the Ministry of Health and other health care providers. Conclusions and recommendations are presented in the last section. OVERVIEW OF HEALTH CARE FINANCING AND DELIVERY IN JORDAN Socioeconomic background Jordan is low middle-income country, with a population of 5.3 million in 2002. It is a relatively small country of only 91 100 km 2, 90% of which is desert. Its Gross Domestic Product (GDP) amounted to JD 6259 (US$ 9308) billion in 2002 with per capita income of JD 1237 (US$ 1747). Approximately 40% of the population is under the age of 15 years, and the total fertility rate (TFR) is 3.7, one of the highest in the 107
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Morocco Draft The role of contractu
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CONTENTS FOREWORD..................
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The role of contractual arrangement
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Islamic Republic of Iran care (incr
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Afghanistan AFGHANISTAN 37
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Current health services delivery Af
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Afghanistan with the staff of the M
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Afghanistan 3) Greater emphasis cou
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Afghanistan Table 2. Implementation
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Provider Strengths Afghanistan •
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Bahrain BAHRAIN
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Bahrain services to be contracted-o
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Bahrain claiming under them respect
Page 55 and 56: Financing Bahrain There is a clear
Page 57 and 58: Bahrain receipt of the invoice. The
Page 59 and 60: Bahrain RESULTS AND DISCUSSION: CAS
Page 61 and 62: Bahrain The competitive bidding pro
Page 63 and 64: Bahrain 11. SMC Cleaning Services C
Page 65 and 66: INTRODUCTION Egypt The health secto
Page 67 and 68: Egypt are governed by their own set
Page 69 and 70: Egypt One of the key objectives of
Page 71 and 72: Egypt Is the legal framework robust
Page 73 and 74: Egypt The opportunity for the HSRP
Page 75 and 76: Egypt The Research Unit includes Fa
Page 77 and 78: Egypt How was the nongovernmental o
Page 79 and 80: Egypt How did the approved list of
Page 81 and 82: Egypt districts, where private and
Page 83 and 84: Egypt Annex 1 Contract copy between
Page 85 and 86: Egypt deposit the fees of opening n
Page 87 and 88: Islamic Republic of Iran ISLAMIC RE
Page 89 and 90: INTRODUCTION Islamic Republic of Ir
Page 91 and 92: Islamic Republic of Iran OVERVIEW O
Page 93 and 94: Delivery Facility Health House Sour
Page 95 and 96: Islamic Republic of Iran PBSC invol
Page 97 and 98: Islamic Republic of Iran authoritie
Page 99 and 100: Islamic Republic of Iran From an ad
Page 101 and 102: Islamic Republic of Iran 6. Shieber
Page 103 and 104: Medical Sciences University Islamic
Page 105: Jordan JORDAN
Page 109 and 110: Jordan hospital beds in Jordan. In
Page 111 and 112: Jordan health education programmes.
Page 113 and 114: Jordan Benefits by health subsystem
Page 115 and 116: Jordan Table 2. Summary of health e
Page 117 and 118: Jordan ASSESSMENT OF OVERALL CAPACI
Page 119 and 120: Jordan attract foreign investment,
Page 121 and 122: Jordan businesses efficiently. The
Page 123 and 124: Expected risks and incentives Minis
Page 125 and 126: Jordan Table 4. Profile of contract
Page 127 and 128: Fee-for-service contracts Royal Med
Page 129 and 130: Jordan King Abdullah Hospital (KAH)
Page 131 and 132: Strengths Jordan • Provides acces
Page 133 and 134: Jordan • The minimum charge scale
Page 135 and 136: Jordan The main reasons behind the
Page 137 and 138: Jordan • Interviews with the Mini
Page 139 and 140: Jordan • This type of contracting
Page 141 and 142: Jordan CONCLUSIONS AND RECOMMENDATI
Page 143 and 144: Jordan 3. Prospective payment mecha
Page 145 and 146: Jordan Annex 1 CONTRACT/AGREEMENT A
Page 147 and 148: Lebanon LEBANON
Page 149 and 150: Lebanon at their disposal for regul
Page 151 and 152: Research methods and data sources L
Page 153 and 154: Lebanon and local municipalities. E
Page 155 and 156: Lebanon Table 1. Contractual arrang
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Lebanon Table 3. Costs of contractu
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Lebanon performance or mechanisms f
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Lebanon Overall, the contracts allo
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Lebanon belong to the Ministry of S
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Lebanon Perhaps the more obvious di
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Lebanon quality of care in the cont
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Lebanon Correcting this imbalance b
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Lebanon could be a first step towar
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Lebanon Table 5. Scorecard of contr
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Lebanon support for wide reform and
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Lebanon Sabri B et al. Health secto
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INTRODUCTION Morocco During the pas
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Morocco A contractual arrangement i
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Morocco services, as the administra
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Morocco The programme budget is lik
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Morocco According to his Act, each
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Morocco The number of patients curr
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Morocco facilities and the technica
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Morocco Evaluation of the subcontra
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Morocco Annex 2 EVALUATION OF THE E
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Chefchaouen Reassignment of agents,
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Ain Seb. Hay Moh. S. B. Zenata El F
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Pakistan PAKISTAN
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Pakistan To improve the health stat
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Pakistan the government grants a co
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Pakistan The relevant documents wer
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Pakistan Table 1. Examples of contr
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Pakistan Each contract generally sp
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Pakistan services. The specialized
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Pakistan Case study: contractual ar
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Pakistan used in the project to col
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Pakistan GFATM support, and a Natio
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RECOMMENDATIONS Pakistan 1. Conduct
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Pakistan Annex 1 GUIDELINES FOR DIS
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Pakistan Question Discussion points
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INTRODUCTION Tunisia The health ins
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Tunisia hospital facilities may be
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Tunisia the regulations of the mutu
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Tunisia pocket household expenditur
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Tunisia The Tunisian health strateg
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Table 2. Distribution of agreements
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Tunisia Coverage of MRI procedures
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under the agreements, 1995-2004 Tun
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Tunisia Table 5. Beneficiaries (BEN
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Tunisia The National Pension and So
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Tunisia Table 8 shows an increase i
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Tunisia to the private sector. The
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CONCLUSIONS Tunisia Three closely i
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