Dynamic Health systems RegulationExample from Bahrain

Dr. Bahaa Eldin Fateha, CEO, NHRA*

*National Health Regulatory AuthorityKingdom of Bahrain

National Health Regulatory Authority, NHRAEstablished by law in 2009.Became fully operational in September 2011.Responsible for regulation of healthcare

services, public and private: Facilities and professionals.

Registration, licensing and pricing of pharmaceuticals and health-related supplements.

Investigating medical errors and handling patient complaints.

Authorizing experimental medical research.

Bahrain experience, so farThe task is huge, and therefore there must be

a strategy to assure unified process of monitoring.

The main objective of NHRA is to improve the health system.

Therefore, we should have a common understanding of what we need to improve.

We will also illustrate the dilemma facing National Health Insurance and NHRA proposed solution.

ResourcesFacility;

ManpowerFinancial

Components of The Dynamic Health Systems

We put a lot of resources into the health systems: Buildings, equipment, all categories of manpower: Physicians, nurses, technicians, admin. In addition, financial resources to assure sustainability.

Is this sufficient to have a functioning Health System?

ResourcesFacility;

ManpowerFinancial

ProcessesDirection

Strategy & Planning

Management

Monitoring & Evaluation

+

The Dynamic Health Systems’ Model

How to use the resources: Strategy, plans and programs, management inclusive of monitoring and evaluation.

Is this sufficient? Probably – but something is missing!!

ResourcesFacility;

ManpowerFinancial

ProcessesDirection

Strategy & Planning

Management

Monitoring & Evaluation

OutcomeQuality,

EfficiencySafety

+ =

The Dynamic Health Systems’ Model

The third component is the outcome of the system. It needs something extra to call it DYNAMIC

ResourcesFacility;

ManpowerFinancial

ProcessesDirection

Strategy & Planning

Management

Monitoring & Evaluation

OutcomeQuality,

EfficiencySafety

+ =

The Dynamic Health Systems’ Model

Analysis

Analysis

Continuous Analysis to Improve the outcome through modifyingResources or the Process.

NHRA “wider” view of the Health Systems

ManagementOversight

Dept. Dept. Dept. Section

UnitDirectorate Dept.

Department

Leading systemOthers compare with

it

Excellent SystemCompare with others

Good SystemDecisions supported

by evidence

Weak SystemOperating butNo evaluation!

Unknown StatusFacility, Staffing, PPG

Outstanding Achievement

Extensive Achievement

Moderate Achievement

Some achievement

Low achievement

Performance Appraisal of healthcare organizations*

*Modified from ACHS

InputResources :

Facility;ManpowerFinancial

Failing Process1, Poor

monitoring2, Loss of control

3, Loss of direction4, Crisis

Management5, Dissociated

System

OutcomePoor Quality,

WastageHigher Risk

+ =

The Failing Health Systems’ – Phase I

Analysis

Analysis

Applies to individual department or to the hospital

as a whole.

InputResources :

Facility;ManpowerFinancial

ProcessIndividual-based

practicesNo evaluationNo direction

No integration

OutcomeWastageIll-healthUnsafe Practice

Dissociated from the

community

The Failed System – Phase II

? ?

“This is what we hope to have”

Community

PrimaryCare

System

Secondary Care

TertiaryCare

This is what we must avoid:“Dysfunctional” Health Systems

Community

PrimaryCare

System

Secondary Care

TertiaryCare

Repairing a failed systemOnce a system becomes dysfunctional, it is

extremely difficult and too costly to repair it. Patients’ and community confidence in the system may be damaged.

The best solution is prevention of failure.

Health Insurance Reimbursement DilemmaReimbursement is based on DRG- or DRG-Derived

system.The problem?If reimbursement is based on equal payment to all

facilities: It will kill future quality improvement, as high-expense facilities will cease investing in development.

If based on variable payment based on actual costing studies of each facility: Health insurance companies will channel patients to low-cost facilities, thus again killing future quality improvement.

NHRA Contribution to the Insurance DilemmaRanking of healthcare facilities based on a

unified system of appraisal.Reimbursement is based on DRG, but with an

approved scale based on the ranking.The system is binding, and enforced by a

strong governance. Insurance companies may use the system as

an add-on privileges to their subscribers.

Leading systemOthers compare with

it

Excellent SystemCompare with others

Good SystemDecisions supported

by evidence

Weak SystemOperating butNo evaluation!

Unknown StatusFacility, Staffing, PPG

Outstanding Achievement

Extensive Achievement

Moderate Achievement

Some achievement

Low achievement

NHRA interpretation of an Appraisal System(based on ACHS/ACHSI)

Leading SystemOthers compare with

it

Excellent SystemCompare with others

Good SystemDecisions supported

by evidence

Weak System:Operating butNo evaluation!

Passes Minimum Requirements

Outstanding Facility

Excellent Facility

Good Facility

Mediocre

Licensed - passable

NHRA Categorization of healthcare organizations

Thank You