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

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Jordan • Enhancing equity by referring insured patients to other sectors in order to provide access to the Ministry of Health services for poor and disadvantaged people who cannot afford treatment cost in private hospitals. • Taking into consideration the high unemployment rate (16%) and the high percentage (12%) of people below the poverty line, contracting out health services is becoming a social policy tool in Jordan. • Containing health costs by using underutilized hospital beds in private and other public sectors, instead of investing in building new hospitals. • Providing incentives for private hospitals to stay in the business and develop their services to attract more patients from other countries. This will have a positive impact on macroeconomic level and increase the national income from “medical tourism” which was about JD 400 million in 2002. • Relieving the Ministry of Health of the provision of some highly specialized medical services that require costly investment of capital and human resources. This will allow the Ministry of Health to divert resources, develop and extend primary health care services. • Changing the negative role of the government towards private hospitals to a more positive and supportive role. Instead of buying the bankrupt private hospitals (e.g. Queen Alia Hospital in Amman, Al-Nadim Hospital in Madaba, and the Specialty Hospital in Mafraq) the government policy now encourages purchasing services from private hospitals to help them prosper and stay in business. • Building partnership between the public and private sectors based on serving mutual interests of both parties. Reasons for the private sector to enter into contractual arrangements with the Ministry of Health include the following. • Fully utilizing the bed capacity (1905 beds) and the advanced diagnostic technology in private hospitals in order to achieve better return for investment and increase net profit. • Ensuring regular cashflow to meet recurrent hospital expenses. • Strengthening the competitive situation of the private hospital. It is considered as government accreditation. • Securing a stable and continuous revenue. Contracting with the public sector increases the revenue mix of the private hospitals and safeguards them against economic fluctuation. Political and legal environment Jordan began adopting a liberal economic policy as early as 1985 based on the redefinition of the roles of the government and the private sector. The primary responsibility is being assigned to the government for supervision, follow-up, regulation, safeguarding rights and ensuring equality of opportunities and competition. In 1996, the Jordanian privatization programme was officially announced. The main objectives of the programme were: attracting private investment; improving the efficiency of enterprise; and developing the local market to 118
Jordan attract foreign investment, technology and know-how. Strengthening public–private partnership is one of the major policy directions of his majesty King Abdullah to successive governments. Privatization and partnership policies in Jordan are not intended to replace the traditional role of the Ministry of Health in the provision of health services. Rather, they aim to complement this role by opening wide doors into the private sector to utilize its health resources in an effective and efficient way that reflects positively on both parties and on the overall economy of the country. Contracting out services with the private sector is used by the government, to extend highly subsidized and free the Ministry of Health services to the poor and the vulnerable. The increasing number of contracts between the Ministry of Health over the past three years (e.g. King Abdullah Hospital, Al-Hussein Cancer Centre, Lozmila Hospital, Al-Mowasah Hospital, Al-Hayah Hospital) is evidence of the high political commitment towards the execution of contractual agreements. The existing legal mandates and regulations give authority to the Ministry of Health to contract with private and autonomous public health providers. This legal authority is stated explicitly in Article 26 of the Civil Health Insurance law number 10, issued in 1983. This article reads: “The Minister of Health has the authority to contract out health services with private and autonomous public sectors (hospitals, doctors, laboratories, etc.) to provide health services for CHIP enrollees.” Article 4 of the high Health Council Law states that the Council should develop policies to strengthen the partnership between public and private health sectors and ensure that the two sectors complete and support each other. Policy number 6 in the Strategic Health Plan for 2004–2006 reflects high commitment of the government towards building robust relationships among the different health sectors to provide high quality, effective and efficient health services. The plan includes for the first time some projects related to the private sector. Jordan also has an advanced and independent judicial system. The Jordanian Constitution guarantees the independence of the judicatory authority. Thus, there are efficient and transparent mechanisms to recourse in the event of a dispute between the Ministry of Health and any contracting partner. Ministry of Health capabilities, strengths and weaknesses regarding contracting Due to its accumulated experience in contracting, the Ministry of Health has developed essential administrative and financial skills in contract management over time, especially within the Health Insurance Directorate (HID). The majority of the existing contractual arrangements are merely agreement protocols that lack competitive bidding procedures, performance evaluation or integrated computerized information systems. Therefore, most of the experience accumulated in the HID is limited to reviewing providers’ claims, processing reimbursement transactions and 119
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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
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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 and 116: Jordan Table 2. Summary of health e
Page 117: Jordan ASSESSMENT OF OVERALL CAPACI
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
Page 167 and 168: 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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