Provider Restructuring




Sanigest provides expert technical and administrative analysis for the development and implementation of national health systems



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Provider network reconfiguration is one of the most complex services Sanigest provides to its clients. Sanigest is more than adept in actively assisting clients to systematically reform health care networks in order to curb the immediate problem of growing arrears and ensure long-term sustainability.

Sanigest has extensive experience with situations where there is need to redefine and properly structure the network/chain of primary care/ambulatory services with inpatient care.  No reform of the hospital sector will be successful without a functional primary health care system with a broad scope of work, capable of handling most situations and publicizing to hospitals what is needed in terms of specialization and more complex care. Usually the general objective of reforming any provider network involves enhancing overall efficiency, effectiveness, quality, and equity in the health sector, to ultimately improve the health status of the population.  We provide our clients with a comprehensive set of measures to address these issues, and attain the following goals:

  • Achieve equal conditions between public and private providers
  • Establish an economic relationship between the health care provider and the patient
  • Diversify the sources of financing in the different entities
  • Reinforce the interdependence of health and economic management
  • Improve curative and preventive care and its material and technical basis
  • Renew the positive attitude of citizens toward their own health
  • Improve the social status of health professionals through the introduction of a performance-based reward system
  • Strengthen the control process in the delivery of health care services
  • Standardize the processes of diagnoses and treatment

Moreover, provider network reconfiguration is a sensitive topic significantly influenced by legislation.  Sanigest can also assist its client in this field by providing the following services, all in need of proper legislative and regulatory development:

  • Define health care providers, types of providers, licensing, certification, and accreditation
  • Provide sound networking and management
  • Assist with price setting and contracting
  • Control and supervise licensing, certification, and accreditation
  • Define the role and status of chambers or associations of health care professionals
  • Offer support with accounting, reporting, auditing, and governance
  • Provide clinical and managerial information and support with data gathering
  • Define professional and ethical standards

For example, in Slovakia, an ambitious health reform program was launched which included, among other efforts, restructuring and changing the ownership status of hospitals, strengthening the health insurance companies, and introducing complementary private insurance.  Sanigest held a fundamental role in assisting the Slovak government to systematically reform the health care financing and delivery system.

Kazakhstan: Twinning Arrangements for Investment Planning in the Health Sector.

The project aims to improve health sector capacity in investment planning on the basis of the norms upgraded to international standards, considering population needs and to foster hospital autonomy and public-private partnerships in the health sector. During the project, Sanigest prepared Master Plans for 16 regional authorities, including the assessment, planning and restructuring of more than 1,000 hospitals throughout Kazakhstan. The project introduced innovative mechanisms to share knowledge, including a clearinghouse on hospital planning, benchmarking and e-learning tools to enhance change management during the reforms, as well as providing new standards for hospital design, construction and management.

Serbia: Designing a Health Sector Reconfiguration Strategy.

On behalf of the Serbian Ministry of Health, Sanigest has been contracted to develop and implement in collaboration with the MOH and other donors, and as suggested in the recently revised Health Care Law, a national strategy for restructuring Health Care Institutions (HCIs). This national strategy will provide a long-term vision for a sustainable and equitable health sector and will encompass networks and development plans in all regions and business plans for hospitals to guide investment and restructuring of HCIs. Likewise, the Sanigest team will develop, in collaboration with the MOH, a detailed annual “roadmap” to implement the above mentioned MOH Action Plan in accordance with the overall HCI reconfiguration strategy. This implementation plan describes on a facility level how the suggested measures shall be implemented and proposes activities, responsible parties, and timelines to ensure the newly defined targets are met without having a negative impact on the quality of care; the plan will indicate the financial and Human Resource consequences at various levels (facility, region, and national), as well as conditions to free up fixed costs. Lastly, the Sanigest professionals will train staff at the MOH and in health facilities on the development and implementation of the HCI reconfiguration strategy and MOH Action Plan.

Slovakia: Technical Assistance to the Provider Payment Mechanism

A team of Sanigest experts successfully mapped out a master plan of hospitals for the three larger cities containing facilities: Bratislava, Kosice, and Banska Bystrica, based on results from assessments of the individual hospitals capabilities. Moreover, Sanigest prepared guidelines for the implementation of the hospital governance, encompassing the internal procedures and relationships vital for effective operation, which in turn will lead to higher accountability of health care providers. Team members also assisted the Health Care Surveillance Authority to formulate the start-up system for the HICs enhanced autonomy system, along with designed the optimization plans for hospitals in Bratislava, Kosice, and Banska Bystrica to evaluate medium and long-term needs necessary to cultivate new population norms and standards for the future. Ultimately, based on the hospital analyses, Sanigest devised the hospital master plan, as well as the operational manual for the Health Restructuring Fund.

Moldova: Health System Restructuring.

Sanigest completed their mission of providing technical assistance to the Ministry of Health by designing a restructuring strategy for the health care system of Moldova, which included the launch of a national health insurance system as well. Thorough analyses of the prior situation in Moldova’s hospital sector allowed Sanigest to craft a new health delivery model, in order to implement valuable purchasing strategies and evaluation mechanisms. During the preparation of the detailed hospital restructuring plan, Sanigest offered their qualified assistance in areas such as hospital closures, consolidations and investments, as well as in the introduction of health services contracting. Moreover, Sanigest extended their support to Moldova in negotiations involving primary care and hospital providers, regarding health service contracts and payment methods for the re-imbursement to these providers. Lastly, Sanigest conducted and reviewed distributional analyses concerning the impact of out-of-pocket payments and informal payments of health care services utilized by households.

Moldava: Hospital Restructuring Plan Chisinau.

Sanigest engaged in a project to assist the Government of Moldova develop a comprehensive restructuring plan for the municipality of Chisinau. The overall goal entailed creating a plan to allow for the most cost-effective allocation of the limited amount of budgetary resources available, while at the same time improve the population’s health standards. Based on this objective, the team reviewed the existing feasibility report and any other information held by the MOH relating to the buildings and facilities, including details of existing water supply systems and sanitation. Next, Sanigest reviewed local contractors’ capabilities to carry out the work effectively, and made appropriate recommendations on procurement to the MOHMI. In addition, the team compiled bid documents for the agreed bid packages, comprising instructions to bidders, conditions of contract, drawings, specifications, schedules, and detailed cost estimates. Likewise, Sanigest helped the Moldovan government disseminate this plan, so as to gain the necessary political and popular support for its implementation.

Area Expert

Etoile Pinder
Consultant, Survey Expert

Michal Pothuis

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