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Procurement Number
0002010436
Title
Strengthening the Capacity of the Service Purchasing Unit (SPU) at the Palestinian Ministry of Healt
Description
Background
Due to insufficient hospital capacity, treatment for most non-communicable diseases (NCD) are referred to non-governmental hospitals, imposing an important financial burden for the Palestinian Authority (PA). NCD often require sustained treatment and continuous access to preventive, curative, and palliative care. Since 2015, almost 90,000 cases per year (23 percent from Gaza and 73 percent from the West Bank) have been referred from public health facilities to private or NGO-run hospitals in the east Jerusalem Hospital Network (EJHN) , the West Bank, Gaza, or Israel, resulting in an average annual financial expenditures of about ILS 850 million (almost US $250 million), equivalent to one-third of annual Palestinian Ministry of Health (PMOH) health expenditures or roughly 1.3 percent of GDP (2022). This is in addition to over US $345 million in cumulative arrears to hospitals for services provided, constituting one of the largest drivers of public sector arrears. Between 2020 and 2022, the top three conditions for these outside medical referrals (OMR) were cancer, cardiovascular conditions, and urological conditions, representing a combined 60 percent of all referral expenditures.
The PMOH, through its Services Purchasing Unit (SPU), oversees the medical and financial aspects of the referral process. Claims for OMR are fully managed by the SPU, with the submission of claims by the referral receiving hospitals to the SPU, which conducts a medical and financial audit prior to the reimbursement of hospitals. Despite recent improvements in the digitalization and automation of the claims management process, including the introduction of an OMR-specific information system called eReferrals which allows for electronic submission of referral requests from public hospitals to SPU, the administrative burden associated with the process remains heavy.
The current claims auditing process is inadequate as it primarily focuses on the medical referral process without effectively evaluating intervention efficacy. Auditing results are not integrated into decision-making, highlighting a need for audits that improve efficiency and effectiveness. There's a shortage of human resources for evidence-based decision-making in both the Ministry of Health (MOH) and OMR receiving hospitals. The auditing process suggests a lack of coordination, with concerns about referral standardization and transparency. There is a need for stricter auditing policies to prevent abuse, especially in financial and medical practices. Overall, there's a call for enhancing auditing practices to monitor patient care and improve service delivery.
Purchasing of services from private hospitals for OMR relies on a mix of fee-for-service and case-based payments; and there are substantial challenges with price standardization. Specialized health services from private hospitals are purchased based on memorandums of understanding (MOU) that are signed with individual referral receiving private hospitals in East Jerusalem, West Bank, and Gaza. No MOU is signed with hospitals outside of these geographies, with the prices determined unilaterally by the private hospitals in these jurisdictions. Notably, there is no price transparency for OMR to Israeli hospitals, which deducts payments automatically from the customs revenue for the Palestinian Authority. Other than the financial and medical audit system, as well as various quality considerations included in the MOU, there are no modalities to ensure the efficiency and effectiveness of services purchased through OMR arrangements. This prohibits a potential transition towards a strategic purchasing system for OMR, which would contribute to improved sustainability and quality for these services.
As a result, large variations in unit cost of OMR exist across disease categories, referral destination and referral hospitals, highlighting the high level of inefficiency in purchasing services outside MoH and the lack of predictability in OMR spending. Analysis of OMR data suggests that cardiovascular conditions and neoplasms, which patients are most frequently referred for, rank high in the variation of unit costs, with more than ILS 15,000 variation. The high unit cost of referrals is aggravated by the fact that most cancer referrals are sent to East Jerusalem hospitals and outside Palestine. The variation in unit cost goes at an even more granular level than condition and referral destination: even for one disease and one destination, the unit cost of referral varies by hospital. For example, cancers referred to EJHN see large variation both across hospitals and within hospitals, as seen by the large standard deviations in unit cost within each hospital. This demonstrates the importance of scaling up existing efforts to standardize prices within conditions, incorporating the specificities of case mix as well as geographic location of hospitals.
Efforts in price standardization across hospitals and price reduction have been made for specific procedures and inputs, however conducting a costing exercise would enable further price reduction and standardization. Price lists have been developed and endorsed by some private facilities for cardiovascular, chest surgery, ophthalmology, neurology, endoscopy and dermatology procedures. Recent interviews with SPU representatives have pointed to further price reductions after developing price lists related to accommodation days for different bed types, as well as the standardization of medication costs across hospital types, as well as the removal of drug administration fees that hospitals charged. However, the current pricing process does not rely on actual costing methodology and only high-level line items are used to set prices. Conducting a costing exercise based on robust evidence would enable to inform price negotiations and lead to further price reduction and standardization across hospitals.
Approach and Objectives
The firm will appoint a team led by senior advisor(s) to work closely with SPU and health economics department within MOH in Ramallah. The team will work closely with SPU leadership, management and staff, and with representatives of other MoH entities across two main areas: first, the costing activity to inform price negotiations with private and EJHN hospitals; and second, technical assistance to SPU to strengthen organizational and procedural aspects related to auditing function in particular. The firm is expected to have routine access to SPU offices in Ramallah, with regular in-person working sessions and support to ensure ongoing capacity building and co-implementation.
Scope of Work
The firm will produce the following products:
· Costing and provider payment method revision for services constituting high volumes of OMR expenditures
· Strengthening SPU procedures, organization, and capacity
· Deliverables and payment schedule
Duration of the Assignment
The duration of this consultancy is to be implemented between September 1 – June 30, 2025.
**Please refer to the Terms of Reference to find complete details on the procurement opportunity.
Category
· 90 - CONTRACT CONSULTANTS
Project Country
Not country related
Capabilities
· Health: Health
Material Group
· 90.40 - FIRMS FOR OPERATIONAL PROJECTS
This procurement is for legal services (Please upload the clearance from your Legal representative before proceeding with the engagement of Legal Services.)
Yes
No
Search Tags
· Palestinian SPU
Publication Date
07/31/2024 12:00 AM EDT
EOI Deadline
08/07/2024 11:59 PM EDT
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SELECTION OF CONSULTING FIRMS BY THE WORLD BANK GROUP
REQUEST FOR EXPRESSION OF INTEREST (EOI)
Electronic Submissions through WBGeProcure RFx Now
ASSIGNMENT OVERVIEW
Assignment Title: Strengthening the Capacity of the Service Purchasing Unit (SPU) at the Palestinian Ministry of Health
Assignment Countries:
- Not Country Related
ASSIGNMENT DESCRIPTION
Background
Due to insufficient hospital capacity, treatment for most non-communicable diseases (NCD) are referred to non-governmental hospitals, imposing an important financial burden for the Palestinian Authority (PA). NCD often require sustained treatment and continuous access to preventive, curative, and palliative care. Since 2015, almost 90,000 cases per year (23 percent from Gaza and 73 percent from the West Bank) have been referred from public health facilities to private or NGO-run hospitals in the east Jerusalem Hospital Network (EJHN) , the West Bank, Gaza, or Israel, resulting in an average annual financial expenditures of about ILS 850 million (almost US $250 million), equivalent to one-third of annual Palestinian Ministry of Health (PMOH) health expenditures or roughly 1.3 percent of GDP (2022). This is in addition to over US $345 million in cumulative arrears to hospitals for services provided, constituting one of the largest drivers of public sector arrears. Between 2020 and 2022, the top three conditions for these outside medical referrals (OMR) were cancer, cardiovascular conditions, and urological conditions, representing a combined 60 percent of all referral expenditures.
The PMOH, through its Services Purchasing Unit (SPU), oversees the medical and financial aspects of the referral process. Claims for OMR are fully managed by the SPU, with the submission of claims by the referral receiving hospitals to the SPU, which conducts a medical and financial audit prior to the reimbursement of hospitals. Despite recent improvements in the digitalization and automation of the claims management process, including the introduction of an OMR-specific information system called eReferrals which allows for electronic submission of referral requests from public hospitals to SPU, the administrative burden associated with the process remains heavy.
The current claims auditing process is inadequate as it primarily focuses on the medical referral process without effectively evaluating intervention efficacy. Auditing results are not integrated into decision-making, highlighting a need for audits that improve efficiency and effectiveness. There's a shortage of human resources for evidence-based decision-making in both the Ministry of Health (MOH) and OMR receiving hospitals. The auditing process suggests a lack of coordination, with concerns about referral standardization and transparency. There is a need for stricter auditing policies to prevent abuse, especially in financial and medical practices. Overall, there's a call for enhancing auditing practices to monitor patient care and improve service delivery.
Purchasing of services from private hospitals for OMR relies on a mix of fee-for-service and case-based payments; and there are substantial challenges with price standardization. Specialized health services from private hospitals are purchased based on memorandums of understanding (MOU) that are signed with individual referral receiving private hospitals in East Jerusalem, West Bank, and Gaza. No MOU is signed with hospitals outside of these geographies, with the prices determined unilaterally by the private hospitals in these jurisdictions. Notably, there is no price transparency for OMR to Israeli hospitals, which deducts payments automatically from the customs revenue for the Palestinian Authority. Other than the financial and medical audit system, as well as various quality considerations included in the MOU, there are no modalities to ensure the efficiency and effectiveness of services purchased through OMR arrangements. This prohibits a potential transition towards a strategic purchasing system for OMR, which would contribute to improved sustainability and quality for these services.
As a result, large variations in unit cost of OMR exist across disease categories, referral destination and referral hospitals, highlighting the high level of inefficiency in purchasing services outside MoH and the lack of predictability in OMR spending. Analysis of OMR data suggests that cardiovascular conditions and neoplasms, which patients are most frequently referred for, rank high in the variation of unit costs, with more than ILS 15,000 variation. The high unit cost of referrals is aggravated by the fact that most cancer referrals are sent to East Jerusalem hospitals and outside Palestine. The variation in unit cost goes at an even more granular level than condition and referral destination: even for one disease and one destination, the unit cost of referral varies by hospital. For example, cancers referred to EJHN see large variation both across hospitals and within hospitals, as seen by the large standard deviations in unit cost within each hospital. This demonstrates the importance of scaling up existing efforts to standardize prices within conditions, incorporating the specificities of case mix as well as geographic location of hospitals.
Efforts in price standardization across hospitals and price reduction have been made for specific procedures and inputs, however conducting a costing exercise would enable further price reduction and standardization. Price lists have been developed and endorsed by some private facilities for cardiovascular, chest surgery, ophthalmology, neurology, endoscopy and dermatology procedures. Recent interviews with SPU representatives have pointed to further price reductions after developing price lists related to accommodation days for different bed types, as well as the standardization of medication costs across hospital types, as well as the removal of drug administration fees that hospitals charged. However, the current pricing process does not rely on actual costing methodology and only high-level line items are used to set prices. Conducting a costing exercise based on robust evidence would enable to inform price negotiations and lead to further price reduction and standardization across hospitals.
Approach and Objectives
The firm will appoint a team led by senior advisor(s) to work closely with SPU and health economics department within MOH in Ramallah. The team will work closely with SPU leadership, management and staff, and with representatives of other MoH entities across two main areas: first, the costing activity to inform price negotiations with private and EJHN hospitals; and second, technical assistance to SPU to strengthen organizational and procedural aspects related to auditing function in particular. The firm is expected to have routine access to SPU offices in Ramallah, with regular in-person working sessions and support to ensure ongoing capacity building and co-implementation.
Scope of Work
The firm will work on the two areas below:
· Costing and provider payment method revision for services constituting high volumes of OMR expenditures
· Strengthening SPU procedures, organization, and capacity
Duration of the Assignment
The duration of this consultancy is to be implemented between September 1 – June 30, 2025.
**Please refer to the Terms of Reference to find complete details on the procurement opportunity.
SUBMISSION REQUIREMENTS
The World Bank Group invites eligible firms to indicate their interest in providing the services. Interested firms must provide information indicating that they are qualified to perform the services (brochures, description of similar assignments, experience in similar conditions, availability of appropriate skills among staff, etc. for firms; CV and cover letter for individuals). Please note that the total size of all attachments should be less than 5MB. Firms may associate to enhance their qualifications unless otherwise stated in the solicitation documents. Where a group of firms associate to submit an EOI, they must indicate which is the lead firm. If shortlisted, the firm identified in the EOI as the lead firm will be invited to the request for proposal (RFP) phase.
Expressions of Interest should be submitted, in English, electronically through WBGeProcure RFx Now
NOTES
Following this invitation for EOI, a shortlist of qualified firms will be formally invited to submit proposals. Shortlisting and selection will be subject to the availability of funding.
Only those firms which have been shortlisted will be invited to participate in the RFP phase. No notification or debrief will be provided to firms which have not been shortlisted.
If you encounter technical difficulties while uploading documents, please send an e-mail to the Help Desk at corporateprocurement@worldbank.org prior to the submission deadline.
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Terms of Reference |
Qualification Criteria
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Provide information showing that they are qualified in the field of the assignment. |
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Provide information on the technical and managerial capabilities of the firm. |
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Provide information on their core business and years in business. |
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Provide information on the qualifications of key staff. |
Documentation
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