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

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Weaknesses and limitations Jordan • With the absence of an effective referral system and co-payment, eligible patients may abuse the services available in the two sectors. • The accounting systems in both sectors, especially at the Ministry of Health, are not sufficiently well developed to trace and document all services provided to patients and the due charges. Therefore, the reported claims do not represent the real bill that should be reimbursed. • Some terms and articles in the agreement are not well stated and may have different meanings and interpretations. Table 5. Admissions and outpatient visits for insured patients treated outside Ministry of health facilities and their cost, 2003 Organization/hospital Admissions Cost (JD) 128 Cost per admission (JD) Outpatient visits Cost (JD) Total costs (JD) RMS 8088 2 404 250 297 65 477 1 218 157 3 622 407 Prince Zeid Hospital/RMS 1832 203 526 111 27 717 508 300 711 826 JUH 14 349 6 166 458 429 245 923 4 806 258 10 972 716 KAH 7209 4 432 719 614 30 796 1 399 806 5 832 525 Al-Hussein Cancer Centre 745 1 407 305 1889 2602 259 855 1 667 160 Red Crescent Hospital 445 245 833 552 --- --- 245 833 Lozmila Hospital 627 419 600 669 --- --- 419 600 Al-Mowasah Hospital* 1450 480 000 331 --- --- 480 000 Al-Hayah Hospital* 547 292 500 535 --- --- 292 500 Other private hospitals (emergency cases) 2682 4 192 014 1563 --- --- 4 192 014 Total 37 974 20 244 205 533 372 515 8 192 376 28 436 581 Source: Directorate of Health Insurance. *The data for both hospitals cover the period from July–December, 2003 Jordan University Hospital and King Abdullah Hospital Jordan University Hospital (JUH) was built in 1973 by the Ministry of Health as a referral hospital. In 1975 it was handed over by the government to Jordan University to function as teaching hospital to the Faculty of Medicine. The law by which the hospital was handed over to the University stated that the JUH should continue to act as referral hospital to the Ministry of Health and that the government should finance 50% of the hospital budget. The financial arrangement between the government, represented by the Ministry of Health, and JUH has changed frequently. The existing agreement, which was signed in 1998, specifies the obligations and responsibilities of JUH as health care provider and the Ministry of Health as purchaser and payer.
Jordan King Abdullah Hospital (KAH) was opened in 2002 to function as a teaching hospital to the Faculty of Medicine at Jordan University for Science and Technology. It serves as a referral hospital for all health sectors in Irbid and Northern Region. The Ministry of Health and KAH signed an agreement in 2001, similar to the JUH agreement, to provide medical services to the beneficiaries who are referred to KAH by the Ministry of Health hospitals in the Northern Region. Main features • Emergency cases and patients referred by the Ministry of Health hospitals are treated without any co-payment. Self-referred patients pay 10%–30% of the hospital costs, depending on the category of their insurance plan. • The Ministry of Health pays each hospital according to its official charge scheme with 25% discount excluding medicines. • The Ministry of Health pays a monthly deposit to JUH and KAH (JD 400 000 and JD 200 000, respectively). • The two agreements contain some caps to rationalize the utilization of services and contain costs (e.g. the referral letter expires after three months, the Ministry of Health pays only for two outpatient visits per month for each patient). • The Ministry of Health appoints a full-time liaison committee in each hospital. The committee reviews and authorizes claims and acts as coordinator between the hospital and the Ministry of Health in all aspects related to the agreement. • A higher joint committee headed by the Minister of Health with senior members from both parties is formed for each hospital to resolve problems, settle disputes and suggest changes on the terms and conditions of the agreement. Strengths • Provide access for the Ministry of Health beneficiaries to tertiary and presumably higher quality patient care available in teaching hospitals. • Minimize pressure and over-utilization of the two major Ministry of Health hospitals located in Amman and Irbid (Al Bashir Hospital and Basma Hospital). This reflects positively on social equity by giving the poor and uninsured people a chance to be treated in highly subsidized public hospitals almost free of charge. • Improve the utilization rates in the two teaching hospitals and provide them with regular cashflow to meet their recurrent financial obligations. In 2002, 64% of the total admissions in JUH and KAH were the Ministry of Health beneficiaries (JUH and KAH Annual Reports, 2002). • Treating beneficiaries of the Ministry of Health in public teaching hospitals is more cost effective than treating them in private hospitals. The average cost of admission in private hospitals is almost three times higher than in JUH or KAH (Table 5). • It is more cost effective for the Ministry of Health to purchase tertiary care for its enrollees (beneficiaries) than to provide this service directly. In 2003, the Ministry of Health utilized 129
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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
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Egypt are governed by their own set
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Egypt One of the key objectives of
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Egypt Is the legal framework robust
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Egypt The opportunity for the HSRP
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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 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: Fee-for-service contracts Royal Med
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
Page 169 and 170: Lebanon Correcting this imbalance b
Page 171 and 172: Lebanon could be a first step towar
Page 173 and 174: Lebanon Table 5. Scorecard of contr
Page 175 and 176: Lebanon support for wide reform and
Page 177 and 178: 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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