Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience

Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provis...

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Main Authors:	Khalife, Jade, Rafeh, Nadwa, Makouk, Jihad, El-Jardali, Fadi, Ekman, Bjorn, Kronfol, Nabil, Hamadeh, Ghassan, Ammar, Walid
Format:	Journal Article
Language:	en_US
Published:	Taylor and Francis 2017
Subjects:	casemix contracting governance health reform private hospitals hospital accreditation participatory governance stakeholder engagement political clientelism
Online Access:	http://hdl.handle.net/10986/26008

id	okr-10986-26008
recordtype	oai_dc
spelling	okr-10986-260082021-05-25T10:54:40Z Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience Khalife, Jade Rafeh, Nadwa Makouk, Jihad El-Jardali, Fadi Ekman, Bjorn Kronfol, Nabil Hamadeh, Ghassan Ammar, Walid casemix contracting governance health reform private hospitals hospital accreditation participatory governance stakeholder engagement political clientelism Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system. 2017-02-07T19:04:33Z 2017-02-07T19:04:33Z 2017-01-31 Journal Article Health Systems & Reform 2328-8604 http://hdl.handle.net/10986/26008 en_US CC BY-NC-ND 3.0 IGO http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Taylor and Francis Publications & Research :: Journal Article Publications & Research Middle East and North Africa Lebanon
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	en_US
topic	casemix contracting governance health reform private hospitals hospital accreditation participatory governance stakeholder engagement political clientelism
spellingShingle	casemix contracting governance health reform private hospitals hospital accreditation participatory governance stakeholder engagement political clientelism Khalife, Jade Rafeh, Nadwa Makouk, Jihad El-Jardali, Fadi Ekman, Bjorn Kronfol, Nabil Hamadeh, Ghassan Ammar, Walid Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
geographic_facet	Middle East and North Africa Lebanon
description	Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.
format	Journal Article
author	Khalife, Jade Rafeh, Nadwa Makouk, Jihad El-Jardali, Fadi Ekman, Bjorn Kronfol, Nabil Hamadeh, Ghassan Ammar, Walid
author_facet	Khalife, Jade Rafeh, Nadwa Makouk, Jihad El-Jardali, Fadi Ekman, Bjorn Kronfol, Nabil Hamadeh, Ghassan Ammar, Walid
author_sort	Khalife, Jade
title	Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
title_short	Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
title_full	Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
title_fullStr	Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
title_full_unstemmed	Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience
title_sort	hospital contracting reforms : the lebanese ministry of public health experience
publisher	Taylor and Francis
publishDate	2017
url	http://hdl.handle.net/10986/26008
_version_	1764460714392551424

Hospital Contracting Reforms : The Lebanese Ministry of Public Health Experience

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