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

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Table 5. Scorecard of contractual arrangements in Lebanon Lebanon Contractual arrangement What the arrangement achieves Challenges to meet MOPH 1) Primary care (primary care centres) 2) Hospitalization (private and public hospitals) 3) Social welfare (nongovernmental organizations) • Provide primary care services to uninsured Lebanese • When network is complete, it would cover all geographic areas • Provide nongovernmental organizations with needed support (e.g. essential drugs and vaccines) and help them improve performance • Provide hospitalization services to uninsured Lebanese, promoting equity • Cover all geographical areas • Beneficiary chooses provider • Accreditation system helps select the better hospitals • Flat rates for many surgical procedures decrease costs • Supervising physicians ensure indications, appropriates of care, and appropriate billing • Support work of nongovernmental organizations on heath and health determinants • Promote equity 4) Chronic drugs (YMCA) • Procure, store and distribute essential drugs for chronic conditions • Decrease cost of care • Improve access and thus promote equity 5) Immunization (UNICEF) • Secure immunization material • Decrease costs • Improve access and thus promote equity • Monitor and ensure quality • Assess impact • Impact the different agendas of primary care centre • Implement a true primary health care model (i.e. beyond primary care) • Prevent abuse • Monitor and ensure quality • Assess impact • Control escalating costs • Apply flat fees to all hospitalizations (surgical and medical) • Resist political pressures for inclusion of more hospitals • Hospitals have tremendous leverage • Monitor performance • Assess impact • Monitor and ensure quality of prescribing • Link to proper management of chronic conditions (e.g. algorithms) • Develop alternative mechanisms in case NGO withdraws • Find alternative sources if UNICEF withdraws
Lebanon Table 5. Scorecard of contractual arrangements in Lebanon (cont.) Contractual arrangement What the arrangement achieves Challenges to meet 6) Maternal services (Makassed) 7) Primary health expertise (consultants) 8) Programme management (WHO) Other public organizations 1) Ambulatory care (mostly private providers) 2) Hospitalization (Mostly private hospitals) • Provide community access to facilities for normal delivery • Link primary and maternal care • Link community maternal care and referral services • Secure public health expertise in needed areas • Avoid adding more regular staff • Ensures proper management of important programmes • Secures WHO expertise and intimate involvement • Retains primary health professionals (on WHO pay scale) • Provide ambulatory care for beneficiary • Cover all geographical areas • Beneficiary chooses provider • Provide hospitalization services to beneficiaries • Cover all geographical areas • Beneficiary chooses provider • Flat rates for many surgical procedures decrease costs • Supervising physicians ensure indications, appropriates of care, and appropriate billing 173 • Too early to assess performance and impact • Ensure quality of contributions • WHO overhead plus additional overhead when consultants are recruited • MOPH can independently manage programmes with support of WHO • Assess impact of programmes • Link programmes with other MOPH activities (e.g. primary care and hospitalizations) • Implement primary care model (including gate-keeping) • Prevent abuse • Monitor and ensure quality • Assess outcomes • Control escalating costs • Resist political pressures by strong provider groups. • Coordinate a common contracting mechanism with other financing agencies • Prevent abuse • Monitor and ensure quality • Assess outcomes • Apply flat fees to all hospitalizations (surgical and medical) • Resist political pressures by hospitals (e.g. for inclusion of more hospitals) • Coordinate a common contracting mechanism with other financing agencies
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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
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Medical Sciences University Islamic
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Jordan JORDAN
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INTRODUCTION Jordan This study docu
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Jordan hospital beds in Jordan. In
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Jordan health education programmes.
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Jordan Benefits by health subsystem
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Jordan Table 2. Summary of health e
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Jordan ASSESSMENT OF OVERALL CAPACI
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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 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: Lebanon could be a first step towar
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
Page 205 and 206: Pakistan the government grants a co
Page 207 and 208: Pakistan The relevant documents wer
Page 209 and 210: Pakistan Table 1. Examples of contr
Page 211 and 212: Pakistan Each contract generally sp
Page 213 and 214: Pakistan services. The specialized
Page 215 and 216: Pakistan Case study: contractual ar
Page 217 and 218: Pakistan used in the project to col
Page 219 and 220: Pakistan GFATM support, and a Natio
Page 221 and 222: 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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