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

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Contracting arrangements: An overview Lebanon Contractual arrangements in Lebanon cover a broad range of services. These include direct health care services, such as hospitalization and ambulatory care, indirect health care services, such as procurements of essential drugs and vaccines, and public health services, such as administration of programmes and supply of public health expertise. Table 1 summarizes contractual arrangements for direct health care services, the main form of services provided through contracting in Lebanon. The 5 major public financing schemes, supported by the Ministry of Public Health, NSSF, CSC, Ministry of Defence, and Ministry of Interior (note these reflect 3 separate funds), cover roughly 80% of the Lebanese population. The rest of the population is covered by private insurance and mutuality funds. Health care through these schemes is mostly based on contracting, which underscores the important role of contracting in Lebanon. The contractual arrangements cover a range of heath care services (Table 2). The largest three financing schemes, those of the Ministry of Public Health, NSSF and CSC, all include some level of co-payment by beneficiaries. All non-Ministry of Public Health funds include coverage for family members. For Lebanese eligible for the Ministry of Public Health scheme, application for coverage must be done on a personal basis. Therefore, family coverage is not applicable. The Ministry of Public Health coverage, a last resort for the uninsured and for services for catastrophic illness not covered by those insured under other schemes, is considered a temporary solution to improve equity until a more long-term financing scheme can be developed that includes the whole population. Unfortunately, this has proved difficult to accomplish despite several attempts at reform over the past decade. The costs of contractual arrangements in Lebanon are substantial (Table 3). Hospitalization receives the largest share of expenditures, when taking into account all schemes. For non- Ministry of Public Health contractual schemes, hospitalization services account for approximately 52%–55% and ambulatory care for 45%–48% of direct health care costs. What is most noticeable is the several-fold difference in the cost per beneficiary among the different funds. 154
Lebanon Table 1. Contractual arrangements involving direct health care services Responsible governmental party Ministry of Public Health Financing body (Fund) Ministry of Public Health Fund Ministry of Labour National Social Security Fund – Maternity and Sickness Fund Presidency of Council of Ministers Civil Servant Cooperative Health Fund Contracted party(ies) Type(s) of contracted party(ies) Public and public hospitals, primary care centres Private hospitals, private generalist and specialist physicians, midwifes, pharmacies Mix (governmental/for profit/non-profit/NGO) Mix (for profit/non-forprofit) Number of beneficiaries % of population covered 1 934 415 48 All regions 712 890 18 All regions Same Same 180 225 5 All regions Ministry of Defence Armed Forces Fund Same Same 260 000 7 All regions Ministry of the Interior Internal Security Fund General Services Fund Secret Services Fund Same Same 53 000 1 All regions Same Same 9000 0.2 All regions Same Same 2405 0.1 All regions Geographical coverage
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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
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Egypt Annex 1 Contract copy between
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Egypt deposit the fees of opening n
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Islamic Republic of Iran ISLAMIC RE
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INTRODUCTION Islamic Republic of Ir
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Islamic Republic of Iran OVERVIEW O
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Delivery Facility Health House Sour
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Islamic Republic of Iran PBSC invol
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Islamic Republic of Iran authoritie
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Islamic Republic of Iran From an ad
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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 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: Lebanon and local municipalities. E
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
Page 185 and 186: Morocco The programme budget is lik
Page 187 and 188: Morocco According to his Act, each
Page 189 and 190: Morocco The number of patients curr
Page 191 and 192: Morocco facilities and the technica
Page 193 and 194: Morocco Evaluation of the subcontra
Page 195 and 196: Morocco Annex 2 EVALUATION OF THE E
Page 197 and 198: Chefchaouen Reassignment of agents,
Page 199 and 200: Ain Seb. Hay Moh. S. B. Zenata El F
Page 201 and 202: Pakistan PAKISTAN
Page 203 and 204: 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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