Health Financial Flows, Revenue, and Cost Optimization Efficiency Strategies to Support Financial Sustainability of the Health System in Jordan

The debt is attributed to various factors, including increasing demand for health services due to demographic changes and population growth, scaling costs to provide recurrent treatment for chronic conditions, poor performance of the health system, and outdated managerial practices. The Jordanian government must adopt a comprehensive strategy to promote a financially sustainable health system. A three-phased methodology was applied to analyze the financial flows into the public healthcare system, identifying 5 revenue drivers and 11 cost drivers. These drivers, if improved, would promote an optimized cost structure and enhanced revenue, resulting in a more resilient and sustainable public healthcare sector. The analysis of these drivers and identification of specific interventions defines a reform strategy that will benefit all health system users, with direct impact on alleviating hardships facing the most poor and vulnerable, including Syrian refugees. The reform strategy aims to optimize the health finance system and support improved quality and long-term sustainability. The approach calls for domestic resource mobilization to alleviate financing gaps and debt, along with improvements in the performance of the system for better use of public resources. The recommendation to mobilize additional resources must occur within the reality of the macro fiscal Jordanian context, ensuring that policy commitment is commensurate with the resource envelope. Jordan's burden of disease is dominated by non-communicable diseases (NCDs) and characterized by increasing prevalence of diabetes, hypertension, heart disease, and cancers. The Ministry of Health (MOH) unveiled a plan to reform the health sector for the period 2018-2022, which includes seven major aspects, including primary healthcare, secondary healthcare, health insurance, pharmaceuticals, medical tourism, reliability, quality control, and e-health. The plan includes the establishment of an independent health insurance body and entails 131 projects and initiatives worth JOD602.1 million (US$849 million). Health insurance coverage is estimated at 55 percent of the 9.5 million population in Jordan. The Government of Jordan (GOJ) operates two separate insurers, the MOH/Civil Insurance Program (CIP) and the Royal Medical Services/Military Insurance Fund (MIF), which cover 82.2 percent of insured Jordanians (approximately 45% of the population). Non-insured Jordanians must pay fees for health services during an event of sickness either in public facilities or by attending private providers. The GOJ is facing a severe financial crisis in attempting to meet the healthcare needs of the population. Due to inefficiencies in service delivery, fragmented financial (insurance) and delivery systems, inability to properly control utilization, and growing demand from refugees, the GOJ currently has a health services debt that exceeds 442 million JD as of the end of 2017. The major areas that contribute to this debt include the high cost of exemption treatment referred by the Royal Court and Cabinet, the cost of drugs purchased through the Joint Procurement Department, and the increasing costs to provide dialysis through the Renal Failure Fund. The GOJ is taking action to reduce arrears, including allocating additional resources to cover previous and projected future debt. This includes allocating in the Ministry of Finance 2018 budget under item 320 (payments for previous obligations) the sum of 360 million JD, and for years 2019 and 2020, allocating 429 million and 244 million JD respectively for that purpose. Furthermore, the Prime Minister has issued a memo requesting from the MOF and MOH to refer patients to the MOH hospitals and not to send them to private hospitals unless absolutely necessary.