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Can the information quality and flows be developed to support this more hands off arrangement for hospitals? What are the costs of the changes and can they be accommodated? Fiscal costs include payments for boards of directors; improved salaries for top management; more accountants required; staff with other skills required to meet the more sophisticated management and reporting demands; more workload for the POE Monitoring and Policy Unit; changes to capability in MOH; information requirements; annual external audit costs; etc. Alongside these fiscal costs on the budget the social and economic benefits needs to be considered. Amendments to chapter VIII Replace section 49 with the provisions below and add a new section 50. There are notes in italics on points to consider in refining these provisions. Once these provisions are refined then bring the rest of the Health Law into line with these provisions. For example the provision about the plans in section 56 will need to be aligned with the provision about the business plan below. This note has not extended to considering what provisions of the Health Law need to be changed as this is premature. It would be good to get clarity on how to apply the Public Enterprise Law before adapting the rest of the Health Law. As noted earlier, the suggestions below must be thoroughly tested including assessing if the new allocation of decision rights is appropriate (see table at the end of this note). Health sector publicly owned institutions Section 49 49.1 The institutions named in schedule * [of this law not the Public Enterprise Law] shall be Health Sector Public Enterprises owned by the Republic of Kosovo with the ownership responsibilities [define these] exercised on behalf of the government jointly by the Minister of Health and the Minister of Finance and the purchase (service provision) responsibilities exercised by the Minister of Health. [this joint allocation of responsibilities can only work if there is a culture of cooperation between ministers and ministries- if not then it may be better to allocate all the responsibilities to the Minister of Health BUT keep the role of the MOF monitoring unit for financial monitoring as it should develop expertise in the financial monitoring that the MOH is unlikely to be able to do] 49.2 The institutions named in schedule* [of this law not the Public Enterprise Law] shall be Health Sector Public Enterprises 50% owned by Republic of Kosovo and 50% owned by the specified municipality named in the schedule with the ownership responsibilities exercised on behalf of the central government jointly by the Minister of Health and Minister of Finance and ownership responsibilities of the municipality exercised by the municipality council. [need to think about how this joint ownership would work in practice] The purchase (service provision) responsibilities shall be exercised by the Minister of Health. [need to have this role exercised by the Minister of Health otherwise there will be issues with uneven access to and quality of secondary care services] 49.3 The Law on Public Enterprises shall apply to the Health Sector Public Enterprises except as specified in article 50. [check every provision of the Public Enterprise Law very carefully to see how applicable it is to the health sector and modify it where necessary. Some modifications have been suggested below but these are based on a limited knowledge of the Kosovo law and health system and refinements to these provisions are likely to be required] Special provisions for Health Sector Public Enterprises Section 50 50.1 The Law on Public Enterprises shall apply to the health sector institutions named in the schedules to the Health Law with the modifications specified in this section. 34
50.2 Section 1.2 of the Law on Pubic Enterprises shall not apply with respect to ... [must check all the laws referred to including the law on Business Organisations and exclude any provisions that would be inappropriate for Health Sector Public Enterprises- this is VERY important to do as it is highly likely there are some inappropriate provisions.] 50.3 The definitions in the Law on Public Enterprises shall apply with the following modifications... [go through the definitions and adjust any that are inappropriate and specifically include them in this change to the Health Law and say they apply and not the ones in the law on Public Enterprisers- for example see if the definition of board of directors is OK] 50.4 Sections 3 and 4 of the Law on Pubic Enterprises shall not apply and the Health Law shall prevail with regard to ownership of Health Sector Public Enterprises. [Need to review company law to see how relevant the provisions are to health sector institutions and use it if appropriate or exclude it and have replacement provisions if it is not] The government shall hold 100% of the shares in the Health Sector Public Enterprises or 50% of the shares as specified in schedule * for enterprises partially owned by municipalities. The government and municipalities shall not sell shares, use shares for security, or otherwise deal in the shares of Health Sector Public Enterprises as prohibited by section 41 of the Law on Public Enterprises except that the government may amalgamate enterprises, close enterprises and otherwise reorganise them. [must prevent dealing in shares- this has been a problem in some countries- but need scope to change the configuration of hospitals] 50.5 Section 5 of the Law on Public Enterprises shall apply with the modification that: (a) The Minister of Health and the Minister of Finance shall jointly exercise the ownership responsibilities on behalf of the Government and shall be the shareholders of Health Sector Public Enterprises. The Minister of Finance‟s role shall relate to the ownership interest [define this] and the Minister of Health‟s role shall relate to the ownership as well as they purchase (service provision) interest. Define this- the intention is for the Minister of Health to retain the role in policy on services while Minister of Finance is concerned about the assets, liabilities, fiscal risks from a general point of view in terms of oversight of these matters for the whole of the government. Another option to have the Minister of Health alone as the shareholding minister]. For Health Sector Enterprises partially owned by a municipality the Council of the Municipality shall be the shareholder for the municipality shares. The Minister of Health and the Minister of Finance shall jointly exercise the ownership responsibilities in respect of the central Government shares and the purchase (service provision) responsibilities shall be exercised by the Minister of Health. (b) The Select Committee shall include the Minister of Health and other ministers nominated by the Prime Minister but shall not necessarily include the ministers named in section 5. (c) The decisions of the government shall be implemented by the Minister of Health and other ministers nominated by the Prime Minister [check the implication of the Law on Business and exclude the explicit reference to it or modify the reference to it if it is inappropriate] (d) Section 5.2 shall apply to Health Sector Public Enterprises that are partially owned by municipalities [check the implication of the Law on Business and exclude the explicit reference to it or modify the reference to it if it is inappropriate] 50.6 Ownership policies shall be issued as required by section 6 of the Law on Public Enterprises with the modification that the Minister of Health and Minister of Finance shall jointly approve such policies for all Health Sector Public Enterprises and the policy shall reflect the special nature of the Health Sector Public Enterprises including the obligation to deliver public services while maintaining financial and clinical viability. Section 6.2 shall apply to Health Sector Public Enterprises partially owned by a municipality with the modification that the Minister of Health and Minister of Finance shall jointly approve the ownership policy in addition to approval by the Municipality Shareholding Committee. [note that ownership policy relates to the assets and liabilities of an organisation and the need to maintain capability- the purchase interest (service provision) can be dealt with in the business plan and service agreements and is much more in the domain of the Minister of Health while the ownership interests is commonly a concern of a Ministry of Finance as well as a Ministry of Health- this is a 35
- Page 21 and 22: Structural problems with excessive
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- 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
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- Page 35 and 36: The roles and functions of the boar
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- Page 39 and 40: Appendices Vertical Functional Revi
- Page 41 and 42: Valdet Hashani, Primary Health Care
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- Page 45 and 46: 56.2. Implementation of the health
- Page 47 and 48: This law regulates tobacco products
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- Page 51 and 52: V. Fourth goal - Functionalize, reo
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- Page 55 and 56: Two projects on Health and Environm
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- Page 61 and 62: Appendix E: Number of Staff and Bud
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- Page 75 and 76: [check if section 13 is OK or are t
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- Page 79 and 80: Template for examining decision rig
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- Page 89: fees. The proposal could exclude th
50.2 Section 1.2 of the Law on Pubic Enterprises shall not apply with respect to ... [must check all<br />
the laws referred to including the law on Business Organisations and exclude any provisions that<br />
would be inappropriate for Health Sector Public Enterprises- this is VERY important to do as it is<br />
highly likely there are some inappropriate provisions.]<br />
50.3 The definitions in the Law on Public Enterprises shall apply with the following modifications... [go<br />
through the definitions and adjust any that are inappropriate and specifically include them in this<br />
change to the Health Law and say they apply and not the ones in the law on Public Enterprisers- for<br />
example see if the definition of board of directors is OK]<br />
50.4 Sections 3 and 4 of the Law on Pubic Enterprises shall not apply and the Health Law shall<br />
prevail with regard to ownership of Health Sector Public Enterprises. [Need to review company law to<br />
see how relevant the provisions are to health sector institutions and use it if appropriate or exclude it<br />
and have replacement provisions if it is not] The government shall hold 100% of the shares in the<br />
Health Sector Public Enterprises or 50% of the shares as specified in schedule * for enterprises<br />
partially owned by municipalities. The government and municipalities shall not sell shares, use<br />
shares for security, or otherwise deal in the shares of Health Sector Public Enterprises as prohibited<br />
by section 41 of the Law on Public Enterprises except that the government may amalgamate<br />
enterprises, close enterprises and otherwise reorganise them. [must prevent dealing in shares- this<br />
has been a problem in some countries- but need scope to change the configuration of hospitals]<br />
50.5 Section 5 of the Law on Public Enterprises shall apply with the modification that:<br />
(a) The Minister of Health and the Minister of Finance shall jointly exercise the ownership<br />
responsibilities on behalf of the Government and shall be the shareholders of Health Sector Public<br />
Enterprises. The Minister of Finance‟s role shall relate to the ownership interest [define this] and the<br />
Minister of Health‟s role shall relate to the ownership as well as they purchase (service provision)<br />
interest. Define this- the intention is for the Minister of Health to retain the role in policy on services<br />
while Minister of Finance is concerned about the assets, liabilities, fiscal risks from a general point of<br />
view in terms of oversight of these matters for the whole of the government. Another option to have<br />
the Minister of Health alone as the shareholding minister]. For Health Sector Enterprises partially<br />
owned by a municipality the Council of the Municipality shall be the shareholder for the municipality<br />
shares. The Minister of Health and the Minister of Finance shall jointly exercise the ownership<br />
responsibilities in respect of the central Government shares and the purchase (service provision)<br />
responsibilities shall be exercised by the Minister of Health.<br />
(b) The Select Committee shall include the Minister of Health and other ministers nominated by the<br />
Prime Minister but shall not necessarily include the ministers named in section 5.<br />
(c) The decisions of the government shall be implemented by the Minister of Health and other<br />
ministers nominated by the Prime Minister [check the implication of the Law on Business and exclude<br />
the explicit reference to it or modify the reference to it if it is inappropriate]<br />
(d) Section 5.2 shall apply to Health Sector Public Enterprises that are partially owned by<br />
municipalities [check the implication of the Law on Business and exclude the explicit reference to it or<br />
modify the reference to it if it is inappropriate]<br />
50.6 Ownership policies shall be issued as required by section 6 of the Law on Public Enterprises with<br />
the modification that the Minister of Health and Minister of Finance shall jointly approve such policies<br />
for all Health Sector Public Enterprises and the policy shall reflect the special nature of the Health<br />
Sector Public Enterprises including the obligation to deliver public services while maintaining financial<br />
and clinical viability. Section 6.2 shall apply to Health Sector Public Enterprises partially owned by a<br />
municipality with the modification that the Minister of Health and Minister of Finance shall jointly<br />
approve the ownership policy in addition to approval by the Municipality Shareholding Committee.<br />
[note that ownership policy relates to the assets and liabilities of an organisation and the need to<br />
maintain capability- the purchase interest (service provision) can be dealt with in the business plan<br />
and service agreements and is much more in the domain of the Minister of Health while the ownership<br />
interests is commonly a concern of a Ministry of Finance as well as a Ministry of Health- this is a<br />
35
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