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Name of agency Suspend or cancel license Other enforcement (specify) Waive enforcement Waive other penalty due e.g. interest on debt Waive prosecution or laying of complaint Waive other type of enforcement (specify) National Assembly Regulations, rules, instruction making powers Make regulations, rules, instructions that bind other legal entities, public or groups Cabinet President (Office of President ) 46 Ministers (specify which ones) Ministry of Health (PS or other managers) Board of agency Head (CEO) of agency or other managers Others (specify such as MOF roles)
The issues raised at the start of this section can be reviewed to see if the provisions suggested above would resolve these issues. Notes are made on this below in italics. Increasing incentives for performance- budgets are not always the problem, for example cleaning is fully funded but the standards of cleanliness vary between hospitals with some being less satisfactory than others. Service quality can be poor in some hospitals. There would be greater transparency about the level and quality of service provided if there was a systematic approach to specifying services in the Statement of Service Performance, service agreements, and the reports on performance. The Minister of Health would have power to influence the business plan. The Ministry of Health would have power to set requirements for volumes and standards in the service agreements and to monitor their achievement. Payment could be tied to performance to incentivises hospitals to comply although this needs to be carefully implemented. Ensuring that services of an adequate quality are provided though-out the country and that there is reasonable even access to services within the constraints on the health system. See the comments above as the same tools can be used. How the MOH can exercise its regulatory, standard setting, policy, monitoring and other roles to provide a positive influence on hospital services, including its role in setting policies to deal with issues with referral patterns. As above- the service agreements can be used to create requirements, incentives and sanctions to change referral behaviours. For example hospital contracts in New Zealand were designed to create incentives for hospitals to refer patients who presented at accident and emergency services with minor complaints back to primary care by allowing hospitals to retain a portion of the savings and to apply these to agreed projects including staff education and improved equipment. How to deal with potential problems of uneven service levels and quality if some hospitals are under the control of municipalities. The changes to the Health Law suggested above retain key ownership and purchase roles for central government in hospitals where municipalities have a joint ownership interest in minority areas. Kosovo is a very small country in terms of geography and population and devolution to local government of hospitals would be likely to result in considerable efficiency and effectiveness issues. This is a particular risk given the possible capability issues with municipalities taking on this role given the complex nature of the ownership role for hospitals and the lack of skilled staff. A critical mass of staff with the required skills would be very difficult to develop at the municipality level. Another problem that can occur is that local governments can have interests in these hospitals that are aligned to their desire to retain jobs and expand services that are out of line with national interests and taxpayer interests in having an efficient and effective health service. It can be very hard to restructure and downsize hospital services once they are devolved to local government. These are some obvious points to consider and a fuller analysis should be undertaken to fully assess this matter. Kosovo Medicines Agency There is a suggestion that the Kosovo Medicines Agency should have set up as an independent body under the Constitution. There are reasons that this would not be appropriate as discussed below. Constitutional bodies that have special status are bodies that serve interests that are aligned to the Parliament and the public that it is inappropriate for government to influence. These are a narrow range of bodies including the courts which may have to rule against the government, the Ombudsmen who has to investigate government, the Auditor General who provides assurance to Parliament on the proposer use of resources by government, the Electoral Commission which must be free of government influence in undertaking its duties, the Central Bank which has to exercise its monetary policy role free of government influence, and in the case of Kosovo, the Independent Media Commission which has a role of protecting media freedom. The independence of these entities is reinforced by provisions in the Public Finance Act which restricts the ability of the government to interfere with these institutions by providing insufficient budget funds. While the Constitution provides for the creation of other independent institutions these should only be institutions in the same class as the other institutions, being institutions that can significantly affect the government and that may require protection from the government. The Kosovo Medicines Agency is not in this class of institutions. It is performing functions on behalf of government in regulating and licensing drugs and medical products as well as other functions. While it is performing regulatory functions, it is regulating the private sector and public sector providers, and not 47
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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
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Some issues raised by staff include
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main providers of services funded b
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Policy and planning unit A variatio
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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 49 and 50: Provides for a grant for minimum st
Page 51 and 52: V. Fourth goal - Functionalize, reo
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