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

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
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• 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