Public Health & Hospital Services: A Model For Success

Transcription

1 Public-Private Partnerships Contracting for Health & Hospital Services: Lessons from Palestine Dr. Tawfiq Nasser, C.E.O August Victoria Hospital- East Jerusalem Coordinator: East Jerusalem Hospital Network

2 Palestinian Health Delivery Large governmental delivery system at all levels Large delivery systems in the nongovernmental and UNRWA sectors There is no consensus yet as to how the over all health system will be structured, how it will function, and funded Data mainly from MoH,PCBS,World Bank,

3 Role of the Ministry of Health Largest insurer Largest single sector provider Largest contractor Most hospitals depend of MoH and to a lesser degree UNRWA contracts for survival What is the future role of the MoH as a 1) provider 2)contractor 3) insurer 4)regulator?

4 Contracting Issues in 2000 (October 2000 MoH & World Bank) General policies of and commitment from the Palestinian Authority with respect to health systems planning and organization Laws and regulations directly and indirectly related to the health system Quality assurance/improvement mechanisms Economics and financing Contracting mechanisms

5 Statistics (MoH, PCBS) Health Sector over all 2004 (PCBS) Total MoH expenditure USD (in millions) Total on treatment outside MoH USD (in millions) paid by MoH Total MoH revenue USD (in millions) MoH expenditure per capita USD NA

6 Statistics-2006 (MoH) Number of contracts with nongovernmental hospital in the West Bank = 31 in Gaza = 11 in Jordan = 7 in Egypt = 3 No formal contracts with Israeli hospitals Total number of contracts administered by the MoH = 52 MoH Debt to nongovernmental hospitals close to 50 million dollars

7 Statistics-2006 Percent cost of treatment outside MoH for 2006 (by country) Jordan 23% West Bank 23% Israel 22% Egypt 1% 85% of case load within Palestine East Jerusalem 31%

8 Case load referred outside MoH hospitals (listed in descending order by cost) 1. Oncology = Ophthalmology = Neurosurgery = 494 (2 million dollars) 4. Cardiac surgery = Nephrology = Cardiac Catheterization = Orthopedic surgery = Hematology = Intensive care = Rehabilitation = General surgery = 299 Statistics-2006 (MoH)

9 Summary Points Increasing overall costs Increasing costs of treatment outside the MoH Most referrals inside Palestine Financial relevance versus Medical relevance Most emphasis on curative services-not screening and prevention No national economic reform plan to sustain health expenditure Still heavily dependent on donors

10 Contracting Environment Contracting is undertaken in an environment of Occupation Non-equity in access Physical mobility Socio-economy Technology restrictions The State is a nonsovereign entity under its own jurisdiction

11

12 Closures Update Number of closures by type ( 11 July 2007) km km Checkpoints A barrier manned by IDF and/or Border Police. Partial Checkpoints An established checkpoint operating periodically. Road Gates A metal gate, often manned by IDF, used to control movement along roads. Roadblocks A series of 1 metre high concrete blocks used to obstruct vehicle access. Earthmounds A mound of rubble, dirt and/or rocks used to obstruct vehicle access km Trenches A ditch used to prevent vehicle crossing. Road barriers Road barriers placed alongside major roads prevent movement across the roads. Earth Walls A continuous wall or series of earth mounds used to restrict access. 539 TOTAL (11 July 2007)

13 The Internal Politics of Partnerships Causes for political support: Respond to need & public demand Reduce cost Create a Win-Win situation Causes for political resistance: Interpretations: a Win for the non-governmental = Lose for the government A partner in success = a partner in jurisdiction Tendency to create large government without consideration of financial implications

14 Clinical Services Contracting Current status and benefits to the MoH: Shift costs of capital investments, training and development MoH contracts and sustainability Legal framework casual Financial feasibility unrealistic and skewed to MoH Quality monitoring casual Donors and philanthropy to the rescue (not-for-profit) Covers Development needs Covers Operational deficits Covers Training needs Covers Quality needs (not enough) Covers Emergency deficits (significant) Investors to the rescue (for-profit) Contracting model: non-sustainable and non-developmental

15 Contracting Pathology Service atrophy Levels Inclusions Quality Legally idiopathic Pricing anemia Operational Developmental Fiscal ischemia Precautions Mitigation Severed from national insurance system

16 Contracting Reform Contract preparation Base on strategic national objectives derived from community demands, MoH unmet needs, hospital plans Detail comprehensive services: levels, inclusions, and quality standards Reference a clear legal / medico-legal framework Establish a feasible pricing system that allows for operational success at least Document clear measures of risks mitigation that includes awareness of risks Establish clear quality standards, documentation, and monitoring system that allows for adjustments

17 Contracting Reform Contract preparation (cont.) Create centers of excellence (main strategy) Draft plans that take in political considerations. It must be transparent Monitoring plan with provisions for adjustments and rewards Improve MoH capacity in overall contracting mechanism (contracting unit or function)

18 Contracting Reform Contract Monitoring Programmatic performance Financial performance Quality performance Legal / medico-legal performance Outcomes research medical, financial Consumer education and access to contract outcomes (use external bodies)

19 Most Recent Initiative World Bank and MoH 2007 Established new contracting model Included all the stakeholders Initial establishment of the process and design Periodic review of the tenders ToR s Allowed for political sensitivities Draft document is promising to address most pathologic conditions Tender not issued yet Market confidence is still low due to prior experience Only effective and efficient implementation of this contract will push this reformed process to success

20 New MoH National Approach 12 th Government National Council for Health Policy and Planning Partnership through wide representation Strategic planning issues Health Reform Donor relations MoH policy and planning unit Operational and funded Erase culture of referral abroad Use & build district networks of similar hospitals