Referral Procedures Manual for Palestinian Non-PMOH Referral Facilities

The manual aims to clarify PMOH referral facility accreditation requirements and provide basic information to private, civil, and charitable referral facilities regarding the referral system and procedures for accreditation to supply medical services purchased by the PMOH. The manual was developed in January 2016 by the SPU, represented by Dr. Amira Hindi and Dr. Abd Alnaser Daraghmeh, to establish a framework for the relationship between current and potential referral facilities and the SPU. The Palestinian Health Capacity Project (PHCP), funded by the United States Agency for International Development (USAID), provided technical support to review, refine, and endorse the manual in close consultation with the SPU and other stakeholders. The referral system was developed to overcome the shortfalls in public health services resulting from shortages in specialization, expertise, resources, equipment, and medical facilities and their capacity. The system aims to provide high-quality services to clients through the following steps: imposing controls on referrals abroad, auditing invoices from Israeli hospitals, minimizing referrals and giving preference to national hospitals, and conducting a comprehensive review of referrals and calling for tenders from Israeli and Jordanian hospitals. The manual defines the coordination and medical service delivery by accredited referral facilities, provision of various services nationwide, service quality assurance based on established protocols and services supplied at competitive prices, high levels of transparency by both beneficiaries and referral facilities, and basic information about key quality assurance standards for beneficiaries and accredited referral facilities that will be monitored by the PMOH. The PMOH and its various departments are responsible for the management of the referral system. The PMOH senior management is responsible for developing public policies, strategies, and regulations for the referral system in compliance with relevant laws and regulations, training and building the capacity of PMOH staff working in different stages of the referral process, providing the infrastructure, equipment, resources, and technology required to perform the relevant operations and activities, and monitoring referral facility performance to rectify any issues. The manual outlines the roles and responsibilities of the referring entity (PMOH hospitals), the service purchase unit, and the referral facilities at the patient admission stage, in the service delivery stage, and upon service delivery and patient discharge. The manual also provides information on medical coding, payment requests from the service purchase unit, special cases of deductions and stopping payments, quality criteria evaluation of accredited referral facilities, and the referral flow for non-emergency and emergency cases. The manual is designed to provide basic information to private, civil, and charitable referral facilities regarding the referral system and procedures for accreditation to supply medical services purchased by the PMOH. The manual will facilitate communication between referral facilities and the SPU, and will ensure that high-quality services are provided in a seamless manner. The manual also clarifies the model for communication through the E-Referral system, which will be introduced in the near future to replace the existing e-mail communication process.