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

More documents

Recommendations

Info

ABBREVIATIONS Islamic Republic of Iran 1. MOH/MOHME: Ministry of Health/Ministry of Health and Medical Education 2. UHSR: Unit of Health Sector Reform 3. SSO: Social Security Organization 4. MSIO: Medical Services Insurance Organization 5. ICCU: Intensive/Cardiac Care Unit 6. GDP: Gross Domestic Product 7. PBO/MPO: Plan and Budget Organization/Management and Planning Organization 8. TQM: Total Quality Management 9. TUMS: Teheran Medical Sciences University 10. MUMS: Meshed Medical Sciences University 88
INTRODUCTION Islamic Republic of Iran Financing health care is a critical concern for rich and poor countries alike, as health care systems account for about 9% of global production. Developing countries face particularly serious challenges as they attempt to improve the well-being of their populations, achieve economic development objectives, and integrate themselves with the global economy. Health care financing is a particular concern for these developing countries, which account for about 84% of the world’s population and around 93% of its disease burden, but only 18% of its income and 11% of its health expenditure (Schieber, 1997). Rebuilding of financial resources is a major component of health sector reform policies. In this respect, the adoption of market-based performance approaches in health care service provision, in other words, marketization and privatization, were supposed to be a panacea. Arguments in favour of the use of market incentives in health care may be summarized as follows: Contracting/outsourcing may increase competition among health care providers; Increased provider competition may increase technical efficiency on the supply side and therefore allocative efficiency within the system; Contractual relationships enhance efficiency on the purchaser and provider sides via the incentive structure inherent in the contract; The contracting process itself may promote transparency in trading and decentralization of managerial responsibility, both of which may have beneficial effects on efficiency (Palmer N, 2000). Even where there is competition, there is no evidence that the private sector invariably provides greater efficiency or quality (Witter et al, 2000). For example, in the United States of America, competitive markets have been shown to have higher costs, more duplication of services, longer length of stay, and higher staff ratios than non-competitive markets. In the national health service, implementation of purchaser–provider split and quasi-market policies in the public sector have not yet been successfully evaluated. However, there are no generalized findings from studies conducted in health sector and health financing reform, therefore, the applicability of these assumptions to health care services, especially in developing countries, must be questioned. Indeed, attempts to translate such points of view into practice have highlighted several questionable assumptions, particularly that: Enough potential providers exist to enable the creation of provider competition; Provider competition, without any change on the purchasing side, can enhance efficiency; The benefits of introducing market incentives outweigh the costs of their implementation and maintenance; Government has adequate capacity to enter into and manage contractual relationships with the private sector (Palmer, N. 2000). Effective utilization of resources seems to be central in health sector reform. Internal market competition introduced in the United Kingdom and New Zealand, and managed care competition implemented in the United States of America, are known as two major strategies 89
Page 1 and 2:
Morocco Draft The role of contractu
Page 3 and 4:
CONTENTS FOREWORD..................
Page 5 and 6:
The role of contractual arrangement
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Islamic Republic of Iran care (incr
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38: Afghanistan AFGHANISTAN 37
Page 39 and 40: Current health services delivery Af
Page 41 and 42: Afghanistan with the staff of the M
Page 43 and 44: Afghanistan 3) Greater emphasis cou
Page 45 and 46: Afghanistan Table 2. Implementation
Page 47 and 48: Provider Strengths Afghanistan •
Page 49 and 50: Bahrain BAHRAIN
Page 51 and 52: Bahrain services to be contracted-o
Page 53 and 54: Bahrain claiming under them respect
Page 55 and 56: Financing Bahrain There is a clear
Page 57 and 58: Bahrain receipt of the invoice. The
Page 59 and 60: Bahrain RESULTS AND DISCUSSION: CAS
Page 61 and 62: Bahrain The competitive bidding pro
Page 63 and 64: Bahrain 11. SMC Cleaning Services C
Page 65 and 66: INTRODUCTION Egypt The health secto
Page 67 and 68: Egypt are governed by their own set
Page 69 and 70: Egypt One of the key objectives of
Page 71 and 72: Egypt Is the legal framework robust
Page 73 and 74: Egypt The opportunity for the HSRP
Page 75 and 76: Egypt The Research Unit includes Fa
Page 77 and 78: Egypt How was the nongovernmental o
Page 79 and 80: Egypt How did the approved list of
Page 81 and 82: Egypt districts, where private and
Page 83 and 84: Egypt Annex 1 Contract copy between
Page 85 and 86: Egypt deposit the fees of opening n
Page 87: Islamic Republic of Iran ISLAMIC RE
Page 91 and 92: Islamic Republic of Iran OVERVIEW O
Page 93 and 94: Delivery Facility Health House Sour
Page 95 and 96: Islamic Republic of Iran PBSC invol
Page 97 and 98: Islamic Republic of Iran authoritie
Page 99 and 100: Islamic Republic of Iran From an ad
Page 101 and 102: 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 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 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
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
Page 223 and 224:
Pakistan Annex 1 GUIDELINES FOR DIS
Page 225 and 226:
Pakistan Question Discussion points
Page 227 and 228:
INTRODUCTION Tunisia The health ins
Page 229 and 230:
Tunisia hospital facilities may be
Page 231 and 232:
Tunisia the regulations of the mutu
Page 233 and 234:
Tunisia pocket household expenditur
Page 235 and 236:
Tunisia The Tunisian health strateg
Page 237 and 238:
Table 2. Distribution of agreements
Page 239 and 240:
Tunisia Coverage of MRI procedures
Page 241 and 242:
under the agreements, 1995-2004 Tun
Page 243 and 244:
Tunisia Table 5. Beneficiaries (BEN
Page 245 and 246:
Tunisia The National Pension and So
Page 247 and 248:
Tunisia Table 8 shows an increase i
Page 249 and 250:
Tunisia to the private sector. The
Page 251:
CONCLUSIONS Tunisia Three closely i
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?