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

Jordan
• A qualification process was completed, and the bidding contracts will be distributed to the
qualified hospitals (see Annex 2 for “Request for Qualification” form).
Assumptions of the pilot programme
• General programme assumptions
250 insured women, married, seeking to be pregnant.
2–3 hospitals contractors competitively selected, each accepting a fully bundled fee per
episode.
Episode includes all prenatal care, delivery, newborn care while in the hospital, and postnatal
care for the mother including family planning.
Hospital is paid the entire fee by the HID, and hospital is responsible for contracting with
physicians and other necessary services.
Protection from provider incentives to under-serve patients by imposing quality standards.
• Enrollment assumptions
Enrollees assigned to a hospital and a specific physician on enrollment (with enrollee
getting a choice).
Participation in pilot is in lieu of other HID benefits pertaining to the episode of pregnancy.
Woman may select to opt out of the pilot by appeal to HID at any time.
Enrollees and husbands will sign an agreement to establish terms and conditions of
participation.
• Pricing assumptions
Payment is a fixed price per episode, as set forth in a payment schedule by HID.
8–10 separate rates define the rate schedule, according to the difficulty of the pregnancy,
delivery, and neonatal care needs.
All hospitals will be paid the same rates.
Payment will be paid in three sums, after first ante natal visit, after delivery, and after the
episode is complete.
Payment is contingent on proper HIS data submission, and proper documentation of quality
care.
Special provisions need to be made for equitable risk sharing between HID and the
contracting hospitals: outlier supplementary payments, and exclusions for
catastrophic cases.
• MIS assumptions
All encounter forms and enrollment forms will come to the IU in hard copy, and will be
entered into the MIS at the IU offices by IU staff.
Medical coding will be done by IU based upon narrative descriptions provided on
encounter forms, verification may require phone call to provider.
IU will prepare monthly reports for delivery to each contract provider: received bills not
yet paid; total programme activity and payments to date; and enrollees by status.
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