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

Jordan
The study also identified some challenges that may hinder public–private partnership and
should be jointly addressed. These challenges include:
• Shortage of national administrative and technical skills in contract design, monitoring and
management.
• Lack of inadequate computerized management information system in both sectors.
• Lack of treatment protocols and guidelines to control and monitor the quality of services.
Even in the presence of these protocols, several private hospitals stated that they would be
unwilling to participate in the HIPP if clinical guidelines were proposed (Banks D. and
Shahrouri M., PHRplus, 2003).
• Lack of cost analysis and proper pricing mechanisms.
• Creation of incentives for conducting multiple unnecessary procedures by the fee-for-service
system, which reflects negatively on cost and quality of contracted services.
• Lack of open and competitive procedures used for awarding contracts. Sole source
recruitment may result in “fat and happy contractors” who do not have to innovate or
improve their efficiency and have lucrative contracts.
• Delay in payment due to bureaucratic procedures or short budget allocations. This delay was
a main cause of poor levels of satisfaction with the Ministry of Health as a client (Banks, D.
and Shahrouri, M., PHRplus, 2003), (Fahmi Alaostah, 2004).
• Oversupply and duplication of expensive services caused by the uncontrolled growth of the
private sector. Aggravated by the inefficient role of the Private Hospital Association, this
situation is likely to weaken the bargaining position of the private hospitals and may lead to
severe discounted prices. This eventually may have a negative impact on the quality of
contracted services.
• The existing bureaucratic set-up and centralization of decision-making and budgetary
allocations that prevail in the Ministry of Health, as well as in other government
organizations, which could be an obstacle to develop innovative and business like
management in the Health Insurance Directorate.
• Mutual trust and confidence do not always dominate the relationship between the Ministry of
Health and the private sector.
Recommendations
The following recommendations are proposed to meet the above challenges and create an
environment conductive to public–private collaboration in Jordan.
1. A national programme for capacity building in contract design, monitoring and
management should be developed. This programme would help further strengthen the
capacity of the private providers to deliver services effectively and efficiently.
2. Treatment protocols and guidelines should be developed to control the quality and
appropriateness of the contracted services. The private sector should participate in the
development of these standards.
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