Download

More documents

Recommendations

Info

In the absence of this analysis, some suggestions have been made below, but they must be tested to ensure that they are likely to provide better arrangements for hospitals with a stronger incentive environment for lifting performance. This work usually takes several weeks, rather than a day or two, so it is critical that the draft provisions below are thoroughly tested. The provisions for the Health Law suggested in this note have been designed with hospitals in mind. Consideration should be given to whether they can be applied (possibly refined) to cover other agencies in the health sector such as the NIPH, KMA and others. There has not been sufficient time to consider this in preparing this note. The framework The Public Enterprise Law provides a potentially robust governance and accountability framework that can be adapted to suit the situation for hospitals. Some key features include: Clear roles and responsibilities for ministers and local government exercising ownership responsibilities; monitoring unit for monitoring ownership performance including capability; and board of directors for overseeing performance. Mechanisms for specifying performance (business plan) and reporting on this, providing ministers with a way to influence the performance ex ante via the business plan and to monitor progress via the reports. Incentives for performance through clarity of specification of intended performance and the reporting including publication of these documents; through the influence of the role of the board of directors monitoring progress and exercising governance functions; through the influence of internal audit and external audit; through the monitoring of the POE Policy and Monitoring Unit; and through the increased flexibility to manage resources- note that these arrangements for hospitals potentially remove many of the issues about the detailed budget controls and inflexibilities that are impeding hospital management but these freedoms need to be matched with increased accountability for performance expectations (financial forecast and statement of service performance expectations), reporting, and good internal financial controls including internal audit. While these steps involve modern accounting standards, good quality performance specification and reporting and service auditing, it is possible to take simple and valuable steps to develop better information in all these areas, matched to the evolving capability in the health sector institutions. Very transparent appointment process for boards of directors designed to avoid conflicts of interest and to result in the appointment of qualified people. Requirements to use an accounting approach that would raise the level of transparency about the finances (full accounts with a balance sheet and P&L rather than the current cash budgeting- but should still have a cash flow statement) and potentially provide the hospitals with flexibility to manage resources. Subjects public sector health entities to the same standards as private sector ones so helps create a more level playing field for the public and private sector should the health insurance model be implemented. Has potentially robust provisions if implemented well that are designed to limit conflicts of interest which will become increasingly important if Health Sector Public Enterprises develop service for paying clients (private health insurance companies, Health Insurance Fund, consumers not covered by insurance, others). The adjustments that can be made to this framework include the following: 32
While there is clarity of central government ownership of most hospitals, for the minority regions where the municipalities are intended to have an ownership role, the draft law below suggests joint ownership given the reality that the central government should have an ownership responsibility for these hospitals as it ultimately carries the performance and financial risks (if this is not what is intended then amend this section to give full ownership to these municipalities). Addition of role of Minister of Health and roles for MOH in monitoring and other areas. Addition of requirement to have a statement of service performance and to report on this- also provision for service agreements with clarity on services to be provided (quantities and standards) and reporting on these with access to the reports by the public and interest groups. Other modifications to broaden the principally commercial focus of the Public Enterprise Law including addition of requirements to comply with service requirements from the MOH and a provision for the MOH to act if there is significant service or financial failures. Matters to consider In assessing the potential use of the modified framework for Public Sector Enterprises the following matters should be considered: How well is this framework working now for Public Enterprises? Are there problems that could be addressed in the provisions specially tailored for the Health Sector Public Enterprises? Will there be a large enough pool of qualified people to fulfil the role of directors on boards? Do the provisions below appropriately allocate the roles and responsibilities of the Minister of Finance and the Minister of Health and their ministries? The Minister of Finance‟s role relates to the ownership interests and the Minister of Health‟s role to ownership and purchase (service provision) interests. In some countries these ministers can operate effectively but will this be less likely in Kosovo if these portfolios are allocated to ministers from different parties? If this is an issue then the provisions below could be much more detailed about the respective roles. The allocation of roles and responsibilities to municipalities needs to be carefully considered. Some provisions have been included as examples below but these need further development. The law is designed so that the municipalities are specially named and presumably they are the ones relating to the minority areas where some transfer of responsibility is required by obligations on the government. This note does not discuss the suitability of these roles and responsibilities and they need to be designed carefully as this is a very difficult area of policy development. Are the arrangements proposed below suitable for the minority areas and compliant with the government‟s obligations in relation to these areas? Will hospitals be able to manage the increased freedoms and requirements; are there sufficient controls under law on asset and debt management and sufficient controls potentially in practice; what capabilities have to be developed; how long will it take to develop these capabilities? Related to this, what are the risks of the changes and how can they be managed? Can the MOH develop its service specification and monitoring role which is a different sort role to the one it has now? How long will this take? The draft provisions focus on the MOH role rather than trying to anticipate the role of the Health Insurance Fund as this is not entirely clear, some years away and the law can be amended later on to accommodate this. 33
Page 1 and 2:
Functional Review and Institutional
Page 3 and 4:
Executive Summary 1. The process fo
Page 5 and 6:
5. There are many constraints on ma
Page 7 and 8:
9. Once the structure is decided th
Page 9 and 10:
SECTION I: Legal, policy and medium
Page 11 and 12:
Centre of Telemedicine reports to P
Page 13 and 14:
other functions it could work along
Page 15 and 16:
The whole-of-government budget proc
Page 17 and 18:
Lack of planning and policy functio
Page 19 and 20: improve their planning and policy m
Page 21 and 22: Structural problems with excessive
Page 23 and 24: One option for the organisation of
Page 25 and 26: Some issues raised by staff include
Page 27 and 28: main providers of services funded b
Page 29 and 30: Policy and planning unit A variatio
Page 31 and 32: Health information is part of the D
Page 33 and 34: Issues raised by staff and others O
Page 35 and 36: The roles and functions of the boar
Page 37 and 38: Some countries have combined health
Page 39 and 40: Appendices Vertical Functional Revi
Page 41 and 42: Valdet Hashani, Primary Health Care
Page 43 and 44: split proposed in the World Bank re
Page 45 and 46: 56.2. Implementation of the health
Page 47 and 48: This law regulates tobacco products
Page 49 and 50: Provides for a grant for minimum st
Page 51 and 52: V. Fourth goal - Functionalize, reo
Page 53 and 54: Health information Develop effectiv
Page 55 and 56: Two projects on Health and Environm
Page 57 and 58: local government in relation to the
Page 59 and 60: Hospital prepares its own budget an
Page 61 and 62: Appendix E: Number of Staff and Bud
Page 63 and 64: Agency for the control of health ca
Page 65 and 66: Appendix G Additional advice provid
Page 67 and 68: Improving the health status analysi
Page 69: 3. Accountability. Incentives and s
Page 73 and 74: 50.2 Section 1.2 of the Law on Pubi
Page 75 and 76: [check if section 13 is OK or are t
Page 77 and 78: all of the directors as soon as pra
Page 79 and 80: Template for examining decision rig
Page 81 and 82: Name of agency Invest Give loans bu
Page 83 and 84: Name of agency Modify a license Can
Page 85 and 86: The issues raised at the start of t
Page 87 and 88: Figure 2: Integrated management cyc
Page 89: fees. The proposal could exclude th
show all

Download

Create successful ePaper yourself

Delete template?

Save as template?