1. Purchasing Mechanisms
Costing, Tariffs, Reimbursements, Timeliness
How to decide what to pay for, how to split it up, how to decide on the rates, manage claims and make payments. Not separate topics – all interlinked.
Discussion to try to focus on the payments from HI to providers, on tariffs. Sharing ideas and examples, discussing.
But accept that this will lead us in to many wider issues!
Matt Boxshall

2. Tariff Strategy? Other priorities? Control Costs Public Health Impact
Kenya FMS
Public Health Impact
India
Health Market Strengthening
Philippines
Other priorities?
Egs.
PhilHealth Health System – pay generously – invest to decentralize services, defend Hospitals, gain efficiency long term
India - public health priority – prioritize best buys eg FP Cost of service vs Societal Benefit
Kenya – ? minimize costs – Jacaranda 9000ksh vs 6000ksh FMS

3. 1) Public vs Private Tariffs?
Do we want a “Level Playing Field”?
Offset public support, but
Political will? “Profiteering”?
Mechanism?
Integrated in NHI?
Separate agency model - eg India JSK
Public vs Private rates. How to account for public subsidy already in the public sector to make a level playing field.
eg JSK example from India – a separate agency to top up private providers?
Or different rates?
Political will – perceptions of private sector profiteering?

4. 2) On-Boarding Providers?
Chicken and Egg
eg Informal sector Kenya evidence
Pitching the HV – LM business model
Teaser rates?
Location-based incentives
India? Capital vs tariff increases?
Minimum capitation cover
Indonesia, Kenya?
Getting providers into the system
Chicken and Egg – how to catalyse change? Lack of availability of services key to driving down demand in for informal scheme in Kenya. If people enrol, providers will set up. But possibility of using general schemes (eg FMS) to catalyse
Minimum enrolment levels for capitation?
Eg Indonesia (old scheme) 1000 households per PHC.
Incentives to join – teaser rates? Eg?
Location based incentives? How to drive services to remote locations? Capital or Tariffs
Eg India
Business models for High Volume – Low Margin operations in health

5. 3) Who decides and how?
Level of engagement with (private) providers in setting rates?
Role of third parties
Professional bodies, Associations, SF, others?
Frequency of revision - dialog?
UK?
Philippines?
Ghana (capitation?)
Rolls of different actors in agreeing tariffs?
eg PhilHealth – engagement with private providers?
UK? Annual negotiations, consensus? Where to start?
Ghana – Capitation rates challenges
Engagement and communications – role of SF?

6. 4)Tariffs for Quality? Accreditation for Higher Tariffs?
Separate incentives for Quality?
eg UK
Prioritized Reimbursement for trusted providers?
Risks?
Objectivity, transparency?
Perverse incentives, gaming?
Incentives for Higher Quality – links to accreditation. Higher tariffs? Prioritized reimbursement? If incentives are there, also opens up market forces for providers to pay for accreditation process.
Examples - UK? Objectivity, transparency? Risk of perverse incentives, gaming

7. 5) Timeliness? Capitation vs F4S
Technology - ICT claims, mobile money etc
eg Ghana, Kenya
Feedback loops
Third Party roles
Dutch model CMAs
SF networks?
Timeliness
Capitation vs F4S.
ICT opportunities? Mobile money?
How to manage (and improve) poor quality claims – feedback loops.
Role 3rd parties – SF? Eg Dutch model
Cash flow – eg factoring in Ghana?

8. Public vs Private Tariffs? On-Boarding Providers? Who decides and how?
4) Tariffs for Quality?
5) Timeliness?
Incentives for Higher Quality – links to accreditation. Higher tariffs? Prioritized reimbursement? If incentives are there, also opens up market forces for providers to pay for accreditation process.
Examples - UK? Objectivity, transparency? Risk of perverse incentives, gaming

9. Packages? PHC vs Catastrophe? Minimum vs comprehensive?
Capitation vs F4S?
Specialist Services with capitation?
Eg Philippines
Meds – integrated or separate?
Co-payment? Controls?
Possibility of providing specialist services within capitation approach – public health priorities – methadone UK, LTMs in Philippines,
Meds. Separate system? How to benefit from Capitation if meds are managed separately? Examples? PhilHealth volume guarantees to negotiate process with suppliers.
Co-payment mechanisms? Do they have a place in PHC? How to control informal co-payment? Do we tacitly allow them?