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Forecast financial statements including the balance sheet; an income and expense statement (operating statement); and cash flow statement for the forthcoming year and two further years A statement of the fiscal risks and risk management strategies A statement of accounting policies to be used Other information necessary to fairly reflect the financial operations of the Budgetary Body for that year and its financial position at the end of the financial year [phase this in as it will take time for hospitals to be able to do this] Section 30.1 (e) shall be modified to add the requirement for Health Sector Public Enterprises to provide a forecast statement of service performance in the form specified by the Ministry of Health. Section 30.2 shall be modified to add the requirement that Health Sector Public Enterprises shall have the obligation to disclose information and shall not be permitted to with-hold information on the basis of commercial confidentiality except for information directly related to an actual competitive service tender. The Health Sector Public Enterprise shall publish the Business Plan on its website by [date] and the Ministry of Health shall publish the business plans for all Health Sector Public Enterprises on the Ministry of Health website by [date]. [New Zealand health sector experienced many problems with hospitals trying to make core service performance information confidential on the grounds they were competing when in reality most hospitals are monopolies or near monopolies for the bulk of their services and they use their dominant market power to prevent competition] 50.20 Section 31 (1) b shall be modified to add the requirement to report service performance in the format specified by the Ministry of Health and financial performance in the format required by the Ministry of Finance. [financial reporting should eventually be against the set of forecast financial statements but this takes time to develop- should show these results compared to the previous 2 years] Section 31 (2) shall be modified to add the requirement to provide the report to the Minister of Health and Ministry of Health. Section 31 (3) shall be modified to add the requirement to report on the statement of service performance comparing the forecast service performance in the annual business plan to the performance achieved in the format specified by the Ministry of Health. Section 31 (3) shall be modified to add the requirement to submit the annual report to the Minister of Health and the Ministry of Health. The Health Sector Public Enterprise shall publish the Annual Report Plan on its website by [date] and the Ministry of Health shall publish the annual reports for all Health Sector Public Enterprises on the Ministry of Health website by [date]. Section 31 (4) shall be modified to add that this requirement includes providing information as required by the Ministry of Health. [align these provisions to the earlier one about reporting. Cover the reporting to municipalities when they partly own an entity] 50.21 Section 33 (2) shall be modified to include a requirement to audit service performance as specified by the Ministry of Health. [service performance auditing can be gradually introduced as capability for specifying the requirements and doing the work develops- it takes time for auditors to learn these skills] 50.22 Section 37 (2) shall be modified to include a requirement to provide information to the Minister of Health and Ministry of Health on the performance of Health Sector Public Enterprises. 50.23 Section 41 shall be modified by adding the requirement that a Health Sector Public Enterprise shall not create liabilities in the nature of debt without the express written approval of the shareholding ministers. Such written approval shall be tabled in the Kosovo Assembly for information.[check how this lines up with restrictions on debt] 50.24 The shareholding ministers shall have the power to suspend the Board of Directors in the case of a service, financial or other failure that the ministers consider requires immediate intervention and in such case the Ministry of Health shall take over the governance role of the Board of Directors for a period determined by the shareholding ministers. The shareholding ministers shall replace some or 38
all of the directors as soon as practicable and return the governance functions to the board of directors. The exercise of powers under this section shall be by notice in writing to the board of directors and the notice shall be tabled in the Kosovo Assembly for information. 50.25 The Ministry of Health shall publish on its website all service agreements and contracts in their entirety, with all health service providers, within 10 days of concluding the service agreements and contracts. The transition provisions need to allow of gradual implementation of new structures and requirements. Consequential amendments There will be consequential amendments required including the Public Finance Act to deal with the new class of Health Sector Public Enterprises. Other changes to the Health Law Suitable transition provisions should be put in the Health Law. Some of the suggestions above take time to implement and require capability to be developed. The provisions drafted above do not provide for the role of the Health Insurance Fund at this stage as that can be provided for later when its role is clearer. This note has focused on the provisions relating to setting up Health Sector Public Enterprises and has not considered other aspects of the Health Law that may need to be refined. Some areas include: The intention of the Working Committee to split the Kosovo Clinical Centre into three separate autonomous clinics (section 75). They would need a clear organisational status with a governance and accountability framework with clear roles and responsibilities which is unclear from the current draft. The Health Law is not clear enough about the role of the Ministry of Health in policy, strategy, and monitoring in primary care and other sectors and the proposed changes to the law does not improve this situation. Primary health care centres appear to be expanding into secondary care under the proposed changes to section 29. Has this been carefully assessed to ensure it is likely to improve the efficiency and effectiveness of service? The Working Group discussed the issues relating to public and private practice including various proposals to deal with the current conflicts of interest. It is suggested that the conflicts of interest be assessed in detail and various possible solutions to dealing with them be considered. Some may require changes to laws but some will have contract, managerial, information provision, monitoring, auditing and other solutions. The Working Group has suggested a 2010 date for commencing the Health Insurance Fund‟s operations. This appears a highly unlikely target date. A suggested change to the Health Law involves exempting a large group of people from copayments. Co-payments can be very useful in modifying behaviour and should not be excluded in such a broad way. For example higher copayments for casual visits for treatments in secondary care can be set at a higher level than copayments for the treatment in primary care. There is a proposed provision that uninsured people will pay for services at “economic prices.” What does this mean? It would be better to simply say they will pay and not to put other requirements in the law (like economic price). The Ministry of Health and providers will 39
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Functional Review and Institutional
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Executive Summary 1. The process fo
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5. There are many constraints on ma
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9. Once the structure is decided th
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SECTION I: Legal, policy and medium
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Centre of Telemedicine reports to P
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other functions it could work along
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The whole-of-government budget proc
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Lack of planning and policy functio
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improve their planning and policy m
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Structural problems with excessive
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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 and 70: 3. Accountability. Incentives and s
Page 71 and 72: While there is clarity of central g
Page 73 and 74: 50.2 Section 1.2 of the Law on Pubi
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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
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