Pub Date : 2017-04-03DOI: 10.1080/23288604.2017.1302902
A. Soucat, E. Dale, I. Mathauer, Joseph Kutzin
The Potential Health System Benefits of P4P Concerns Around the Current P4P Debate Moving Forward References Over the past 10 to 15 years, results-based financing (RBF) has gained increased prominence in global health. Though the term RBF encompasses a variety of demandand supplyside incentives to increase output or enhance access and quality, the focus of this special issue and our commentary is on incentives that target service providers. In high-income countries including the UK, France, and the United States these types of incentives are typically referred to as pay-for-performance (P4P), defined as financial incentives to hospitals, physicians, and other health care providers “aimed at improving the quality, efficiency, and overall value of health care.” The term performance-based financing (PBF) has acquired a wider use in lowand middle-income countries (LMICs) and refers to supply-side financial incentives where payment depends explicitly on quantity of services delivered and “on the degree to which services are of approved quality, as specified by protocols for processes and outcomes.” PBF may not only target health facilities but also include ministries of health, local governments, provincial and district health teams, and central medical stores. Though terminologies may differ, at their core, PBF or P4P is a provider payment mechanism, which uses information on provider activities and the health needs of the population they serve to drive resource allocation in order to maximize societal objectives. For purposes of this commentary, we will use the term P4P to refer to this mechanism. In this commentary, we argue that it is crucial to pay greater attention to the “forest”—that is, overall health system reforms and how provider payment arrangements interact with these to influence health outcomes, as opposed to looking almost solely and more narrowly at the “trees”—that is, the details and impact of a P4P mechanism divorced from the underlying health system. P4P is a category of strategic purchasing, the effectiveness of which depends critically on its connections with the wider environment of purchaser– provider relations. In the following paragraphs, we unpack the potential health system benefits of P4P. Next, we briefly Received 28 January 2017; revised 1 March 2017; accepted 2 March 2017. *Correspondence to: Elina Dale; Email: dalee@who.int 2017 World Health Organization. Published by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 IGO License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that the World Health Organization (WHO) endorses any sp
{"title":"Pay-for-Performance Debate: Not Seeing the Forest for the Trees","authors":"A. Soucat, E. Dale, I. Mathauer, Joseph Kutzin","doi":"10.1080/23288604.2017.1302902","DOIUrl":"https://doi.org/10.1080/23288604.2017.1302902","url":null,"abstract":"The Potential Health System Benefits of P4P Concerns Around the Current P4P Debate Moving Forward References Over the past 10 to 15 years, results-based financing (RBF) has gained increased prominence in global health. Though the term RBF encompasses a variety of demandand supplyside incentives to increase output or enhance access and quality, the focus of this special issue and our commentary is on incentives that target service providers. In high-income countries including the UK, France, and the United States these types of incentives are typically referred to as pay-for-performance (P4P), defined as financial incentives to hospitals, physicians, and other health care providers “aimed at improving the quality, efficiency, and overall value of health care.” The term performance-based financing (PBF) has acquired a wider use in lowand middle-income countries (LMICs) and refers to supply-side financial incentives where payment depends explicitly on quantity of services delivered and “on the degree to which services are of approved quality, as specified by protocols for processes and outcomes.” PBF may not only target health facilities but also include ministries of health, local governments, provincial and district health teams, and central medical stores. Though terminologies may differ, at their core, PBF or P4P is a provider payment mechanism, which uses information on provider activities and the health needs of the population they serve to drive resource allocation in order to maximize societal objectives. For purposes of this commentary, we will use the term P4P to refer to this mechanism. In this commentary, we argue that it is crucial to pay greater attention to the “forest”—that is, overall health system reforms and how provider payment arrangements interact with these to influence health outcomes, as opposed to looking almost solely and more narrowly at the “trees”—that is, the details and impact of a P4P mechanism divorced from the underlying health system. P4P is a category of strategic purchasing, the effectiveness of which depends critically on its connections with the wider environment of purchaser– provider relations. In the following paragraphs, we unpack the potential health system benefits of P4P. Next, we briefly Received 28 January 2017; revised 1 March 2017; accepted 2 March 2017. *Correspondence to: Elina Dale; Email: dalee@who.int 2017 World Health Organization. Published by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 IGO License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that the World Health Organization (WHO) endorses any sp","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"66 1","pages":"74 - 79"},"PeriodicalIF":4.1,"publicationDate":"2017-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82577034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-03DOI: 10.1080/23288604.2017.1291218
I. Sieleunou, Anne-Marie Turcotte-Tremblay, H. Yumo, Estelle Kouokam, Jean-Claude Taptué Fotso, Denise Magne Tamga, V. Ridde
Abstract—The World Bank and the government of Cameroon launched a performance-based financing (PBF) program in Cameroon in 2011. To ensure its rapid implementation, the performance purchasing role was sub-contracted to a consultancy firm and a nongovernmental organization, both international. However, since the early stage, it was agreed upon that this role would later be transferred to a national entity. This explanatory case study aims at analyzing the process of this transfer using Dolowitz and Marsh's framework. We performed a document review and interviews with various stakeholders (n = 33) and then conducted thematic analysis of interview recordings. Sustainability, ownership, and integration of the PBF intervention into the health system emerged as the main reasons for the transfer. The different aspects of transfer from international entities to a national body consisted of (1) the decision-making power, (2) the “soft” elements (e.g., ideas, expertise), and (3) the “hard” elements (e.g., computers, vehicles). Factors facilitating the transfer included the fact that it was planned from the start and the modification of the legal status of the national organization that became responsible for strategic purchasing. Other factors hindered the transfer, such as the lack of a legal act clarifying the conditions of the transfer and the lack of posttransition support agreements. The Cameroonian experience suggests that key components of a successful transfer of PBF functions from international to national organizations may include clear guidelines, co-ownership and planning of the transition by all parties, and posttransition support to new actors.
{"title":"Transferring the Purchasing Role from International to National Organizations During the Scale-Up Phase of Performance-Based Financing in Cameroon","authors":"I. Sieleunou, Anne-Marie Turcotte-Tremblay, H. Yumo, Estelle Kouokam, Jean-Claude Taptué Fotso, Denise Magne Tamga, V. Ridde","doi":"10.1080/23288604.2017.1291218","DOIUrl":"https://doi.org/10.1080/23288604.2017.1291218","url":null,"abstract":"Abstract—The World Bank and the government of Cameroon launched a performance-based financing (PBF) program in Cameroon in 2011. To ensure its rapid implementation, the performance purchasing role was sub-contracted to a consultancy firm and a nongovernmental organization, both international. However, since the early stage, it was agreed upon that this role would later be transferred to a national entity. This explanatory case study aims at analyzing the process of this transfer using Dolowitz and Marsh's framework. We performed a document review and interviews with various stakeholders (n = 33) and then conducted thematic analysis of interview recordings. Sustainability, ownership, and integration of the PBF intervention into the health system emerged as the main reasons for the transfer. The different aspects of transfer from international entities to a national body consisted of (1) the decision-making power, (2) the “soft” elements (e.g., ideas, expertise), and (3) the “hard” elements (e.g., computers, vehicles). Factors facilitating the transfer included the fact that it was planned from the start and the modification of the legal status of the national organization that became responsible for strategic purchasing. Other factors hindered the transfer, such as the lack of a legal act clarifying the conditions of the transfer and the lack of posttransition support agreements. The Cameroonian experience suggests that key components of a successful transfer of PBF functions from international to national organizations may include clear guidelines, co-ownership and planning of the transition by all parties, and posttransition support to new actors.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"1 1","pages":"104 - 91"},"PeriodicalIF":4.1,"publicationDate":"2017-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73177635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-27DOI: 10.1080/23288604.2017.1303561
B. Meessen, Z. Shroff, P. Ir, M. Bigdeli
Abstract Abstract—This article presents conceptual and methodological developments made in analyzing the scale up of results-based financing (RBF) as part of a multicountry research program supported by the Alliance for Health Policy and Systems Research. Following a brief overview of the research process, the article proposes a new five-dimensional conceptualization of scale-up (population coverage, service coverage, health system integration, cross-sectoral diffusion, and knowledge expansion) to capture various facets of RBF scale-up. It also presents how Walt and Gilson's health policy triangle framework was modified to identify the enablers and barriers to scale-up in the country case studies included in this research program. The article then puts forth a four-phase model of scale-up, including phases of generation, adoption, institutionalization, and expansion, developed for the purpose of this research program. The article concludes by providing some lessons learned on the use of the methods and theoretical frameworks developed for this multicountry research program.
{"title":"From Scheme to System (Part 1): Notes on Conceptual and Methodological Innovations in the Multicountry Research Program on Scaling Up Results-Based Financing in Health Systems","authors":"B. Meessen, Z. Shroff, P. Ir, M. Bigdeli","doi":"10.1080/23288604.2017.1303561","DOIUrl":"https://doi.org/10.1080/23288604.2017.1303561","url":null,"abstract":"Abstract Abstract—This article presents conceptual and methodological developments made in analyzing the scale up of results-based financing (RBF) as part of a multicountry research program supported by the Alliance for Health Policy and Systems Research. Following a brief overview of the research process, the article proposes a new five-dimensional conceptualization of scale-up (population coverage, service coverage, health system integration, cross-sectoral diffusion, and knowledge expansion) to capture various facets of RBF scale-up. It also presents how Walt and Gilson's health policy triangle framework was modified to identify the enablers and barriers to scale-up in the country case studies included in this research program. The article then puts forth a four-phase model of scale-up, including phases of generation, adoption, institutionalization, and expansion, developed for the purpose of this research program. The article concludes by providing some lessons learned on the use of the methods and theoretical frameworks developed for this multicountry research program.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"65 1","pages":"129 - 136"},"PeriodicalIF":4.1,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77457094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-27DOI: 10.1080/23288604.2017.1291394
V. Petrosyan, Dzovinar Melkom Melkomian, Akaki Zoidze, Z. Shroff
Abstract—Results-based financing (RBF) has been integrated into the national health care financing system of Armenia covering all primary health care (PHC) facilities in the country. The RBF program contributed to a substantial increase in the utilization of PHC services and improved provider performance. Based on document and literature review and key informant interviews and focus group discussions, this article describes the successful scale-up and integration of RBF into Armenia's primary health care system throughout the period 2000–2015. The article shows how an interaction of contextual factors, actors, and processes contributed to the successful scale-up and integration of RBF into Armenia's primary health care system. Though international agencies, in this case the United States Agency for International Development (USAID), had a significant influence on the introduction and initial design of the RBF scheme, an important enabler was a well-sequenced reform process that included the most politically important stakeholders, including the State Health Agency. Embedding of RBF in national regulatory frameworks and the provision of funds from the national budget were also key contributors to success. Finally, an important enabler to the subsequent scale-up and integration of RBF into the PHC system was its introduction as part of a larger reform of the primary health care system.
{"title":"National Scale-Up of Results-Based Financing in Primary Health Care: The Case of Armenia","authors":"V. Petrosyan, Dzovinar Melkom Melkomian, Akaki Zoidze, Z. Shroff","doi":"10.1080/23288604.2017.1291394","DOIUrl":"https://doi.org/10.1080/23288604.2017.1291394","url":null,"abstract":"Abstract—Results-based financing (RBF) has been integrated into the national health care financing system of Armenia covering all primary health care (PHC) facilities in the country. The RBF program contributed to a substantial increase in the utilization of PHC services and improved provider performance. Based on document and literature review and key informant interviews and focus group discussions, this article describes the successful scale-up and integration of RBF into Armenia's primary health care system throughout the period 2000–2015. The article shows how an interaction of contextual factors, actors, and processes contributed to the successful scale-up and integration of RBF into Armenia's primary health care system. Though international agencies, in this case the United States Agency for International Development (USAID), had a significant influence on the introduction and initial design of the RBF scheme, an important enabler was a well-sequenced reform process that included the most politically important stakeholders, including the State Health Agency. Embedding of RBF in national regulatory frameworks and the provision of funds from the national budget were also key contributors to success. Finally, an important enabler to the subsequent scale-up and integration of RBF into the PHC system was its introduction as part of a larger reform of the primary health care system.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"83 1 Pt 2 1","pages":"117 - 128"},"PeriodicalIF":4.1,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74602799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-16DOI: 10.1080/23288604.2017.1302903
Z. Shroff, N. Tran, B. Meessen, M. Bigdeli, A. Ghaffar
Over the last 15 years, a growing number of low- and middle-income countries (LMICs) have adopted results-based financing (RBF) approaches for their health sectors. This special issue presents key ...
{"title":"Taking Results-Based Financing from Scheme to System","authors":"Z. Shroff, N. Tran, B. Meessen, M. Bigdeli, A. Ghaffar","doi":"10.1080/23288604.2017.1302903","DOIUrl":"https://doi.org/10.1080/23288604.2017.1302903","url":null,"abstract":"Over the last 15 years, a growing number of low- and middle-income countries (LMICs) have adopted results-based financing (RBF) approaches for their health sectors. This special issue presents key ...","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"29 1","pages":"69 - 73"},"PeriodicalIF":4.1,"publicationDate":"2017-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79975759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-16DOI: 10.1080/23288604.2017.1304190
Z. Shroff, M. Bigdeli, B. Meessen
Abstract Abstract— This article presents the enablers and barriers to the scaling-up of results-based financing (RBF) programs. It draws on the Alliance for Health Policy and Systems Research's multicountry program of research Taking Results Based Financing From Scheme to System, which compared the scale-up of RBF interventions over four phases—generation, adoption, institutionalization, and expansion—across ten countries. Comparing country experiences reveals broad lessons on scale up of RBF for each of the scale-up phases. Though the coming together of global, national, and regional contextual factors was key to the development of pilot projects, national factors were important to scale up these pilots to national programs, including a political context favoring results and transparency, the presence of enabling policies and institutions, and the presence of policy entrepreneurs at the national level. The third transition, from program to policy, was enabled by the availability of domestic financial resources, legislative and financing arrangements to enhance health facility autonomy, and technical and political leadership within and beyond the Ministry of Health. The article provides lessons learned on RBF policy evolution, emphasizing the importance of phase-specific groups of actors, the need to tailor advocacy messages to enable scale-up, the influence of political feasibility on policy content, and policy processes to build national ownership and enable health system strengthening.
{"title":"From Scheme to System (Part 2): Findings from Ten Countries on the Policy Evolution of Results-Based Financing in Health Systems","authors":"Z. Shroff, M. Bigdeli, B. Meessen","doi":"10.1080/23288604.2017.1304190","DOIUrl":"https://doi.org/10.1080/23288604.2017.1304190","url":null,"abstract":"Abstract Abstract— This article presents the enablers and barriers to the scaling-up of results-based financing (RBF) programs. It draws on the Alliance for Health Policy and Systems Research's multicountry program of research Taking Results Based Financing From Scheme to System, which compared the scale-up of RBF interventions over four phases—generation, adoption, institutionalization, and expansion—across ten countries. Comparing country experiences reveals broad lessons on scale up of RBF for each of the scale-up phases. Though the coming together of global, national, and regional contextual factors was key to the development of pilot projects, national factors were important to scale up these pilots to national programs, including a political context favoring results and transparency, the presence of enabling policies and institutions, and the presence of policy entrepreneurs at the national level. The third transition, from program to policy, was enabled by the availability of domestic financial resources, legislative and financing arrangements to enhance health facility autonomy, and technical and political leadership within and beyond the Ministry of Health. The article provides lessons learned on RBF policy evolution, emphasizing the importance of phase-specific groups of actors, the need to tailor advocacy messages to enable scale-up, the influence of political feasibility on policy content, and policy processes to build national ownership and enable health system strengthening.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"71 1","pages":"137 - 147"},"PeriodicalIF":4.1,"publicationDate":"2017-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83948367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1080/23288604.2017.1291217
K. Khim, P. Ir, P. Annear
Abstract—Contracting approaches have been used in various forms to improve the delivery of public health services in low- and middle-income countries. Cambodia has embarked on a public-sector reform that includes a model of internal contracting of health care through the Ministry of Health, supported by incentive payments for staff and facilities. Contracting for health care in Cambodia has evolved through three phases during 1997–2015, each with particular design features, arrangements, and structures; different levels of involvement of local and international stakeholders; and modifications based on evidence from operational research. Based on a review of published and gray literature and interviews with 29 local and international key informants, we identify national ownership, financial sustainability, and the need to strengthen service delivery institutions as the major forces that have shaped contracting in Cambodia, culminating in the move to internal contracting arrangements for public health care delivery. There remains a need to strengthen contracting governance arrangements.
{"title":"Factors Driving Changes in the Design, Implementation, and Scaling-Up of the Contracting of Health Services in Rural Cambodia, 1997–2015","authors":"K. Khim, P. Ir, P. Annear","doi":"10.1080/23288604.2017.1291217","DOIUrl":"https://doi.org/10.1080/23288604.2017.1291217","url":null,"abstract":"Abstract—Contracting approaches have been used in various forms to improve the delivery of public health services in low- and middle-income countries. Cambodia has embarked on a public-sector reform that includes a model of internal contracting of health care through the Ministry of Health, supported by incentive payments for staff and facilities. Contracting for health care in Cambodia has evolved through three phases during 1997–2015, each with particular design features, arrangements, and structures; different levels of involvement of local and international stakeholders; and modifications based on evidence from operational research. Based on a review of published and gray literature and interviews with 29 local and international key informants, we identify national ownership, financial sustainability, and the need to strengthen service delivery institutions as the major forces that have shaped contracting in Cambodia, culminating in the move to internal contracting arrangements for public health care delivery. There remains a need to strengthen contracting governance arrangements.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"6 1","pages":"105 - 116"},"PeriodicalIF":4.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83973230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-08DOI: 10.1080/23288604.2017.1280115
J. Kiendrébéogo, Z. Shroff, A. Berthé, Lamoudi Yonli, M. Béchir, B. Meessen
Abstract—Supported by the World Bank (WB), Chad implemented a performance-based financing (PBF) scheme as a pilot, from October 2011 to May 2013. However, despite promising results and the government's stated commitment to ensure its continuation after the World Bank's departure, PBF failed to come onto the national policy agenda. This article aims to explain why this was the case, an especially interesting question given that several factors were favorable for project continuation. Data for this case study were collected through literature review and key informant interviews. We applied Kingdon's agenda setting theory to explain this failure. We found that though the potential of PBF to address challenges facing the Chadian health system was confirmed by internal and external evaluations of the pilot, it failed to move from the governmental agenda to the decision agenda. The main reason was a lack of dedicated policy entrepreneurs, resulting in a weak actual ownership of the policy by national authorities and key stakeholders. We tried to understand why such policy entrepreneurs failed to emerge.
{"title":"Why Performance-Based Financing in Chad Failed to Emerge on the National Policy Agenda","authors":"J. Kiendrébéogo, Z. Shroff, A. Berthé, Lamoudi Yonli, M. Béchir, B. Meessen","doi":"10.1080/23288604.2017.1280115","DOIUrl":"https://doi.org/10.1080/23288604.2017.1280115","url":null,"abstract":"Abstract—Supported by the World Bank (WB), Chad implemented a performance-based financing (PBF) scheme as a pilot, from October 2011 to May 2013. However, despite promising results and the government's stated commitment to ensure its continuation after the World Bank's departure, PBF failed to come onto the national policy agenda. This article aims to explain why this was the case, an especially interesting question given that several factors were favorable for project continuation. Data for this case study were collected through literature review and key informant interviews. We applied Kingdon's agenda setting theory to explain this failure. We found that though the potential of PBF to address challenges facing the Chadian health system was confirmed by internal and external evaluations of the pilot, it failed to move from the governmental agenda to the decision agenda. The main reason was a lack of dedicated policy entrepreneurs, resulting in a weak actual ownership of the policy by national authorities and key stakeholders. We tried to understand why such policy entrepreneurs failed to emerge.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"33 1","pages":"80 - 90"},"PeriodicalIF":4.1,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76307376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272982
Yagoub Al-Mazrou, Taghreed Al-Ghaith, A. Yazbeck, T. Rabie
Abstract—In 1999, the Kingdom of Saudi Arabia enacted a law that compels private employers to cover non-Saudi employees with health insurance. In the 16 years that followed, the health sector in the Kingdom has seen a dramatic shift in how services are provided and paid for, and the change continues at an accelerated speed. Based on interviews with 12 large private sector providers in Riyadh, Jeddah, and Khobar, we found that a labor law enacted in 1999 led to rapid expansion of the insured population, both expatriates and Saudis, which led to a drastic change in how hospitals and other facilities are paid, and considerable more consistency in revenue stream. This article describes how the 1999 labor law, combined with other market conditions and public incentives, led to unprecedented growth in private sector capacity and how the insurance system changed the labor market for health care providers and put more pressure on physicians to engage in dual job holding in both the public and private sectors. The Kingdom later introduced another labor program, known as Nitaqat, designed to implement the Saudization initiative that started in 2011, which put pressure on all private companies to hire Saudi nationals. The interviews with large private health providers found the Nitaqat program to be the largest barrier to the growth of the sector. The Kingdom presents a striking case of how the health sector can be drastically impacted by laws and policies outside the sector and how health systems and reforms can, and should, take into account the whole range of policy instruments available to a country.
{"title":"How Labor Laws Can Transform Health Systems: The Case of Saudi Arabia","authors":"Yagoub Al-Mazrou, Taghreed Al-Ghaith, A. Yazbeck, T. Rabie","doi":"10.1080/23288604.2016.1272982","DOIUrl":"https://doi.org/10.1080/23288604.2016.1272982","url":null,"abstract":"Abstract—In 1999, the Kingdom of Saudi Arabia enacted a law that compels private employers to cover non-Saudi employees with health insurance. In the 16 years that followed, the health sector in the Kingdom has seen a dramatic shift in how services are provided and paid for, and the change continues at an accelerated speed. Based on interviews with 12 large private sector providers in Riyadh, Jeddah, and Khobar, we found that a labor law enacted in 1999 led to rapid expansion of the insured population, both expatriates and Saudis, which led to a drastic change in how hospitals and other facilities are paid, and considerable more consistency in revenue stream. This article describes how the 1999 labor law, combined with other market conditions and public incentives, led to unprecedented growth in private sector capacity and how the insurance system changed the labor market for health care providers and put more pressure on physicians to engage in dual job holding in both the public and private sectors. The Kingdom later introduced another labor program, known as Nitaqat, designed to implement the Saudization initiative that started in 2011, which put pressure on all private companies to hire Saudi nationals. The interviews with large private health providers found the Nitaqat program to be the largest barrier to the growth of the sector. The Kingdom presents a striking case of how the health sector can be drastically impacted by laws and policies outside the sector and how health systems and reforms can, and should, take into account the whole range of policy instruments available to a country.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"38 1","pages":"26 - 33"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91179461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272984
A. Yazbeck, T. Rabie, Aaka Pande
This special issue examines government efforts that have been adopted since 2011 to address imminent health system challenges in the Middle East and North Africa (MENA) region. It attempts to capture some of the fundamental health sector reforms that have been adopted by MENA countries to address their population’s demands for better health care service delivery, access, and equity. The articles included in this special issue relate to projects that have been financed by the World Bank in the last six years, or where technical assistance was provided by the World Bank to MENA governments. Therefore, it does not constitute a comprehensive assessment of health system performance across all MENA countries, but focuses on a select group of country experiences where the World Bank was involved in this time period.
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