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

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Jordan 60% of JUH beds (300 beds) with an average cost of JD 429 per admission, while the average cost of admission in all hospitals with which the Ministry of Health has formal and informal contracts was JD 533 (Table 5). • The agreements have some built-in mechanisms (utilization caps, liaison committees) to monitor overall performance, control costs and solve problems. Weaknesses and limitations • The liberal referring practice in the Ministry of Health hospitals is increasing the financial pressure on the Ministry of Health budget. In 2003, the cost of Ministry of Health beneficiaries treated at JUH and KAH was 58% of the total costs paid for all non-Ministry of Health hospitals (Table 5). • Teaching hospitals, especially in the absence of practice protocols, tend to provide more services than patients need. Thus, costs are more likely to increase. Al-Hussein Cancer Centre Al-Hussein Cancer Centre (HCC) was opened in 1997 as philanthropic, not-for-profit hospital. The centre has 131 beds. It provides diagnostic, treatment and rehabilitation services for cancer patients, including chemotherapy and radiotherapy. In 2001, the Ministry of Health and HCC signed an agreement for medical and scientific cooperation. Main features • HCC provides medical services for the enrollees of the CHIP and uninsured patients who are referred by the Ministry of Health. • The Ministry of Health pays the treatment cost of its beneficiaries and the Ministry of Finance pays the cost of the uninsured patients. • Charges are paid according to HCC official charge scheme with 20% discount excluding medicines. • The Ministry of Health has a liaison office at HCC. The office checks eligibility of referred patients, reviews and authorizes bills and coordinates all matters related to the implementation of the agreement. • HCC allocates 10% of its revenues from this agreement for the Cancer Research Fund. • A joint cancer research committee from the Ministry of Health and HCC develops the cancer research agenda, approves research projects and recommends the budget for each project. • A higher coordination committee, headed by the general secretary of the Ministry of Health with two senior members from each party, is formed to resolve problems and settle disputes that may arise. 130
Strengths Jordan • Provides access to integrated and highly specialized cancer services for insured and uninsured patients. This reflects positively on equity and quality of patient care. • Decreases pressure on and over-utilization of the two public cancer units at King Hussein Medical Centre and Al-Bashir Hospital. • Improves scientific cooperation between oncologists in the Ministry of Health and HCC and enhances cancer research in the country. • Improves the utilization rate at HCC and provides it with reasonable cashflow. The occupancy rate at HCC was 84% in 2003 (MOH Annual Report, 2002). Weaknesses and limitations • Reimbursement according to fee-for-service, the lack of co-payment and the absence of treatment protocols are incentives to increase the government bill of cancer patients. If this continues, it may force the government to reconsider its commitment regarding free treatment of cancer patients. • Scientific and research cooperation is not yet activated. • There are delays in reimbursement. Crescent Hospital Crescent Hospital is a 64-bed not-for-profit philanthropic general hospital situated in East Amman. According to the agreement which was signed in 1999, Al-Bashir Hospital, the largest Ministry of Health hospital, can referee beneficiaries to be treated at Crescent Hospital. Main features • Only Al-Bashir Hospital can refer patients. • Crescent Hospital should only provide patient services related to the medical diagnosis specified in the referral report. • Except delivery cases, hospital charges are calculated according to minimum official fees authorized by the Ministry of Health and other medical authorities • Except delivery cases and medicines, the hospital offers 30% discount on the total charges. • Normal delivery, caesarean section and complicated delivery are charged fixed fees on a per case basis (JD 80 and 100 respectively). • Medicines are priced according to the drug store prices plus 20% • The director of Al-Bashir Hospital should review and authorize all claims before sending them to the HID for payment. • The Ministry of Health has the right to review the medical and financial records for any patient. 131
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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
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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 and 128: Fee-for-service contracts Royal Med
Page 129: Jordan King Abdullah Hospital (KAH)
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
Page 179 and 180: 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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