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

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Table 3.Sources of funds to financing agents, JD, 2001 Financing Agents MOF MOP Other Government entities Jordan 116 Primary sources of funds Private firms Household UNRWA Other donors Total MOH 134 543 792 1 195 784 1 000 000 21 799 453 8 934 422 167 473 451 RMS 53 917 300 393 700 23 996 600 1 180 000 5 601 360 85 088 960 JUH 185 000 3 067 259 350 000 95 000 431 000 4 128 259 Other Gov. Entities 2 478 000 2 478 000 Public Universities 2 852 300 1 429 700 4 282 000 Social Security 1 836 000 1 836 000 Private Insurance Enterprises 21 688 716 1 934 612 23 623 328 Household 241 940 021 241 940 021 NGOs 8 868 413 8 868 413 Private Firms 47 535 544 990 200 48,526,744 Private Universities 1 022 850 712 150 1 735 000 UNRWA 7 836 144 7 836 144 Total 188 461 092 1 774 484 30 916 159 73 613 110 273 512 296 7 836 144 21 721 035 597 834 320 Source: Jordan National Health Account, Draft Report, 2004.
Jordan ASSESSMENT OF OVERALL CAPACITY FOR CONTRACTING HEALTH SERVICES Introduction and rationale for contracting Since 1970, private for-profit hospitals and other autonomous public sector bodies, mainly the RMS, have witnessed remarkable expansion and development in secondary and tertiary medical care. In contrast, the Ministry of Health hospitals have been less advantaged, less developed and under-funded. The government health care facilities provide highly subsidized (80%–85%) services for the uninsured and free of charge services for the insured and the poor. As Ministry facilities clearly form the backbone of the Jordanian hospital “safety net”, they have been over-burdened and have concentrated on primary and secondary medical care. The hospital bed occupancy at the Ministry of Health hospitals in major cities (Amman, Zerqa, Irbid) ranged from 78% to 83% in 2002, while the occupancy rate in private hospitals was 44% (MOH Annual Report, 2002). Therefore, the Ministry of Health has been heavily involved during the past three decades in contracting with the private sector and other autonomous public sectors (i.e. RMS and JUH) to meet the health needs of its beneficiaries and uninsured poor people. This section assesses the overall capacity for contracting out health services in Jordan. The main topics covered include: the rationale for the Ministry of Health and other providers to contract; the political, legal, economic and social factors related to contracting; the strengths and weaknesses of purchasers and providers; and the administrative and technical capabilities of each party. The reasons behind the policy decision of the Ministry of Health in Jordan to contract out health services are related directly to the provision of health services or to health and social policy. Reasons related to the provision of services include: Unavailability of services (mostly tertiary level services as: cardiology and cardiovascular surgery, neurosurgery, plastic and constructive surgery, organ transplants, etc…) Shortage of beds, mainly in Amman, Zerqa and Irbid. Shortage of private rooms. Emergency cases. Patients’ preference (restricted for some private hospitals and usually involves copayment). Lack of the Ministry of Health hospitals (Aqaba, Taffilah, some areas in Amman). Shortage of diagnostic facilities. Shortage of medicine. Long waiting lists. With regard to health policy reasons for contracting out include: 117
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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
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Financing Bahrain There is a clear
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Bahrain receipt of the invoice. The
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Bahrain RESULTS AND DISCUSSION: CAS
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Bahrain The competitive bidding pro
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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 and 106: Jordan JORDAN
Page 107 and 108: INTRODUCTION Jordan This study docu
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: Jordan Table 2. Summary of health e
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
Page 157 and 158: Lebanon Table 3. Costs of contractu
Page 159 and 160: Lebanon performance or mechanisms f
Page 161 and 162: Lebanon Overall, the contracts allo
Page 163 and 164: Lebanon belong to the Ministry of S
Page 165 and 166: 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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