Page 214 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

3. As the number of patients requiring additional expenses and the healthcare needs of
the target population changes in the future, yearly budgetary flexibility must
be ensured to account for the large-scale funding potentially incurred
to continue the operation of the Scheme in full. The Government and
purchaser should ensure that funding for the Scheme is based upon population health
needs and adjusted to fulfil the healthcare service demand on an annual basis.

4. Given that an integrated regulatory policy framework to monitor
programmes is key to developing effective strategic purchasing practice, the
Government should consider the development of an integrated regulatory framework of
purchasers and providers of primary care services that should include the identification
and specification of the roles of different sector actors, monitoring targets for PPPs, and
enforcement of fair rules, incentives, and sanctions for all participating providers.

Element 4:
Developing effective purchaser & provider organisations, as
indicated by ensuring alignment of stakeholders, and building and
sustaining partnerships

As part of a strategic purchasing effort, the Scheme should attempt to align the interests,
demands, and products of each stakeholder to improve organisational congruence–the
extent to which organisational arrangements minimise service duplication or fragmentation.
The Scheme must also ensure that the existing health system has the capacity to cater to
programme participants’ needs so that it is accountable for delivering quality services. As an
example of how to develop organisations that are congruent and accountable, Chapter 4.1
modelled a stakeholder interview methodology that would aid in eliciting the views of key
stakeholders and in identifying places where the fit between policy objectives and
organisations in the health system should be improved.

1. The Government should assess the capacity and capability of the
healthcare system to match new service demands generated by the
introduction of the Scheme.

a. The Government and purchaser must consider methods to ensure sufficient
private sector capacity for implementation of the Scheme to meet the health
needs of the target population. While screening capacity is likely less problematic,
the complex nature of chronic disease management necessitating follow-up
possibly by a team of more than a single primary care doctor may pose additional
demands on system capacity. Assessment of capacity may be achieved through a
rigorous pre-implementation assessment of private sector
capacity together with factors that affect participation in the Scheme. Such
consideration will inform the funding arrangements related to reimbursement levels
and incentives for participation. In addition, particularly where multiple healthcare
professionals are involved in care, clear and well-designed care guidelines and
clinical management protocols need to be in place. Referral protocols between
specialists and primary care providers are also necessary for integration of care
and coordination between providers.

b. Consideration should be made to promote primary care training for all healthcare
personnel. New training programmes and career structures could be considered.

212