Table 5 Strengths and weaknesses in the SHP function of provider payment and monitoring
State budgetary allocation for health | State social health insurance scheme |
|---|---|
Strengths include - Use of all public health service providers - Approved state budget used for funds allocation - More coherent PPM - Generics only policy Weaknesses include - Lack of criteria for provider accreditation and periodic re-accreditation - Absence of list of pre-qualified wholesale suppliers of medicines, medical devices and supplies | Strengths include - Performance-based criteria for provider accreditation and periodic re-accreditation - Coordinated blended provider payment mechanisms - Generics-only policy for purchasing - Fixed official tariff applicable to all service providers Weaknesses include - Lack of coherence of the multiple PPMs - Absence of a list of pre-qualified wholesale suppliers of medicines, medical devices and supplies |
Opportunities | Opportunities |
Utilize more flexible PPMs e.g. global budget to increase provider autonomy and efficiency | Institutionalize the collection and review of data from providers for performance monitoring and to inform payment rate adjustments Upgrade IT systems to support claims management and data collection for performance management |
Threats | Threats |
Rigid line item budget with little opportunities for efficiencies Poor quality service delivery | Cost escalation due to incoherence of multiple PPMs Manual systems with data in difficult-to-analyze formats No budget for monitoring and evaluation |