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

Islamic
Republic of
Iran
care (increase
clientele)
Decentralization of
services
MOH policy to
provide services for
segment of rural and
deprived population
contracting out
Jordan Optimize capital
investments by
private sector
Improve
accessibility and
efficiency
Decrease waiting
lists at government
hospitals
Lebanon More elaborate
infrastructure of
hospitals in the
private sector
Avoid duplication of
services already
available in private
sector
Morocco Decentralization of
services
Improve access to
The role of contractual arrangements in improving health sector performance
Access to
government
resources for
family
physicians
Utilize spare
capacity
Assurance of
regular source of
revenue
Increase
credibility in
population
through
affiliation with
MOH
Access to major
insurers of
population
Utilize capacity
in private sector
Enhanced
recognition of
private sector
Opportunity for
Political and legal
support through
3rd Socioeconomic
Development Plan
passed in 1999
Political
environment and
legal framework is
present
Health reforms to
improve equity
and access
Bureaucratic
framework is not
flexible
Legal framework
is adequate
Political will is
lacking for
improving
contracting
process
No clear policy on
contracting
clinical services
process MOH be difficult due to
improvements
required
Improve access,
quality and
efficiency of PHC
services, especially
to the deprived and
vulnerable
population
Experience of
contracting for the
past 3 decades
Cost and price
analysis for some
projects
MOH has
experience in
contracting
Contracting is
highly fragmented
Does not limit cost
of health care
MOH has
experience in
contracting
Loose partnership
23
Private sector in
health care
markets is not fully
developed and is
mainly involved
with hospitals in
cities
Lack of experience
with PHC services
Advanced
information
systems
Experience in
negotiating
contracts
Lack of skilled and
professional
managers
Major provider of
services
Oversupply of
specialists and
services
Advanced
diagnostic and
therapeutic
services
Health managers and
their private sector
counterparts lack
necessary skills for
contracting
Private sector
demonstrates
opportunistic
behaviour
Delay in payments
from the MOH
Concerns of quality
of care in private
sector
Number of providers
is above requirement
Contracts are not
performance based
Difficulty in ensuring
quality of services
Used at pilot centres
Performance based
service contracting
with measurable
standards and
negative incentives
for non-performance
Weak monitoring
mechanisms are a
challenge
Political
environment affects
monitoring of
contracts
Capacity to monitor
contracts is poor at
MOH
Monitoring
indicators not welldefined
Adequate