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

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:
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