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

Jordan
• The minimum charge scale, in addition to the discount rate and the co-payment mechanism,
provide the Ministry of Health with relatively low cost health care services at (presumably)
accepted quality.
• The agreement has some caps on services ordered by the provider (e.g. approval of payer if
the patient stay exceeds 5 days).
Weakness and limitations
• As other agreements, it lacks performance measures to assure quality of services.
• Dependence on a committee to monitor performance does not guarantee always good results,
as members of the committee change frequently and may lose interest if they do not have
incentives or are not exposed to close supervision from higher authorities.
• There are delays in reimbursement procedures.
Other private hospitals
All private hospitals including those who have formal contracts with Ministry of Health
may admit emergency patients enrolled in the Civil Health Insurance Plan. For hospitals that do
not have formal contractual relationships with the Ministry of Health, the Ministry will provide
reimbursement only for those patients who are assessed as emergency cases. The burden of proof
is on the hospital that provides the treatment, as well as on the patient.
Specific and detailed procedures should be followed within 24 hours of any emergency
admission in order that the Ministry of Health provides reimbursement. In 2003, the cost of
beneficiaries treated in private hospitals as emergency cases was about JD 4 million (Table 5).
The cost of an emergency admission in a private none contracting hospital is about three
times as the cost of admission in a contracting hospital (Table 5). This provides evidence that
contracting has significant effect on cost containment and thus increases efficiency.
Bed leasing contracts
Introduction
The Ministry of Health has recently begun contracting out services with two private
hospitals in East Amman on the basis of fixed payment against leasing a specified number of
beds. In March 2003, the Ministry of Health signed a contract with Al-Mowasah Hospital to
lease 40 beds, and in July 2003 the Ministry signed another contract with Al-Hayah hospital to
lease 30 beds. The two contracts have been effective since July 2003. Because both contracts
have the same conditions, the Ministry of Health contract with Al-Mowasah hospital will be
presented here as example for this type of contracting.
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