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Salwa Lecture

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									               Overview of PHRplus Activities
                         In Jordan


                          Dr. Salwa Bitar




Partnerships
for Health
Reform
         Summary of Activities

   Health Insurance Reform
   National Health Accounts (NHA)
   Hospital Decentralization
               Need for NHA

   Systematic analysis of total health care
    spending (public and private) not available
   Limited data on household use and spending
    on health care services
   Need for comprehensive data for policy
    analysis and decisions
   NHA - an integrated way of keeping track of
    resource flows in a health care system
                NHA Results
                 (In Brief)

   Total expenditures on health care: JD 454
    million
   Per capita expenditures on health care: JD 94
   Health care expenditures as a percent of GDP:
    9.1%
   Pharmaceuticals: JD158 (35% of total)
   61 percent of expenditures for curative
    treatment, and 25% for primary care services
          Additional Outcomes
                 of NHA
   Established team of NHA experts (RMS, MOH,
    JUH), that are committed to the
    institutionalization of their efforts
   Realization of the need to develop a public
    sector/private sector partnership, in future NHA
    activities
   Established strong support for the need to
    institutionalize NHA
        Health Insurance Reform
              Background
   Round table discussion to consider the issues (April 98)
   Assessment of Third Party Payers, such as private
    insurance companies and their role in the health
    economy (June 98)
   Survey of Shareholding Companies, these are
    companies that are listed on the Jordanian stock
    exchange (Aug 98)
   Workshop on Insuring the Uninsured (Nov 98)
   Focus Groups on health care needs of population (June
    99)
   Profile of the Uninsured in Jordan (July 99)
   Survey of 500 private companies in Jordan (Sep 99)
   Jordan Health Care Utilization and Expenditure Survey
    (Dec 2000)
      PHRplus Insurance Reform

   Take a more systematic, gradual approach to reform
   Focus on private sector contracting for hospital based
    services (system needs to be improved)
   Improve the contracting abilities of the Health Insurance
    Directorate (managerially and technically)
   Establish functioning Implementation Unit, and Advisory
    Board that will lead to subsequent National Health
    Insurance Board
   Distribute “cost-savings” such that services are
    expanded to uninsured Jordanians
    Advantages of Reform Efforts

   The MOH has identified the need to
    establish improved regulations concerning
    the distribution and consumption of
    pharmaceuticals (35% of health
    expenditures)
   The MOH is now realizes the need to
    redistribute funding from curative care to
    primary health care services (61% vs versus
    25%)
   The MOH can now accurately estimate the
    cost of producing hospital services (cost
      Advantages of Reform Efforts
              (continued)

   The MOH now realizes the need to include
    evidence based research into its policy
    design
   The MOH has gained an appreciation of the
    need to have personnel that are specialized
    and assigned to stable job assignments
    (e.g., the MOH PHRplus counterparts have
    been assigned to the project since 1998)
   The realization that effective and efficient
    reform requires the participation of all
    health care sectors, as well as coordination
    among donor organizations
         Challenges to Reform

   High turnover of senior level executives
    within the MOH (7 Ministers of Health since
    1998)
   Lack of coordination and dialogue across
    government agencies and ministries
   Lack of private sector participation in
    reform efforts

								
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