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

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Al-Mowasah hospital Jordan Al-Mowasah hospital is a private for-profit 160-bed hospital. It was opened in 2000 in Marka Region, east of Amman. The hospital is located in a low- to middle-income, highly populated area that lacks public and private hospitals. It is well built and equipped to accommodate most medical and surgical specialties. The hospital economic feasibility study was based on the assumption that the people living in East Amman will not go to hospitals in west Amman if they have modern and well-equipped hospital near to their residency. Before signing the contract with the Ministry of Health, the hospital was operating 48 beds with 20% average occupancy. As a result of the low occupancy rate, the hospital faced financial problems. The monthly loss was about JD 50 000 (US$ 75 000), as shown in Figure 3. Figure 3. Net loss of Al-Mowasah hospital before contracting with the Ministry of Health 134
Jordan The main reasons behind the low utilization rate, as expressed by the hospital director and highlighted by the results of a recent unpublished study (Baniawad, M., 2004) are summarized as follows: • Large percentages of people living in the hospital area are insured by the Ministry of Health and RMS and they go to public hospitals. • Uninsured poor people also seek treatment in highly subsidized public hospitals, mainly in Al-Bashir Hospital. • People who are wealthy and willing to pay usually go to private hospitals in West Amman, for reasons of social prestige. • The hospital site is inconvenient (high traffic, overcrowded, near a sewage treatment plant and slaughterhouse) and does not attract patients from other areas in the region. Main features • The hospital provides the Ministry of Health with the full services of 40 beds (except medicines and services of attending physicians). • The Ministry of Health pays the hospital a flat rate of JD 1950 per bed per month (JD 65 per day). • The 40 leased beds are distributed by medical specialty as follows: 18 beds for medical cases. 18 beds for surgical cases. 4 beds for intensive care cases. • One of the hospital floors with 36 beds is designated for the Ministry of Health patients. Thus, the Ministry of Health patients do not mix with other private patients. • The beds on the Ministry of Health floor are distributed equally among private, semi-private and regular rooms to accommodate the different categories of Ministry of Health beneficiaries. • The hospital provides the following services for the leased beds: Nursing services. In-house doctors. Diagnostic investigations excluding hormone tests, histopathology, MRI and angiography. All services needed to perform surgical procedures including anesthesia agents and medical gases. Medical and non-medical supplies excluding artificial implants and limbs. Administrative facilities and services, such as reception area, offices for Ministry liaison staff, lounge and rest facilities for Ministry physicians, pharmacy, store, medical records area, telephone facilities, patient transportation among hospitals in Amman. • The Ministry of Health provides the following: Attending (specialized) physicians to provide medical and surgical care for the Ministry of Health patients. Medicines and pharmacists. 135
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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
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Egypt How did the approved list of
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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 and 130: Jordan King Abdullah Hospital (KAH)
Page 131 and 132: Strengths Jordan • Provides acces
Page 133: Jordan • The minimum charge scale
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
Page 181 and 182: Morocco A contractual arrangement i
Page 183 and 184: 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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