Overview:

• Residents in the client’s nation now have the choice of public or private hospitals, with claims being paid by one of the more than thirty competitive health insurers.

Challenge:

The health ministry of a country that belonged to the Gulf Cooperation Council (GCC) wished to provide a comprehensive healthcare package to all of its citizens. The system in the country was ripe for reform, but there were potential conflicts of interest that had so far hindered any initiative. There were also several inefficiencies involved in placing all aspects of healthcare in the hands of the public sector.

They approached Challenge Advisory to help design a new nationwide healthcare framework, and to implement this framework across the nation.

The Revelation:

The Challenge Advisory health team began this project by establishing a solid fact base from which to build their strategy. To do this, they conducted interviews with all relevant stakeholders and key personnel. This included moderating workshops with operations and financing teams, conducting market assessments, interviewing local physicians, and convening focus groups with patients.

The team met regularly with the senior leaders of government agencies to define the smaller details of the new framework, with the express aim of understanding the needs of the patient in order to satisfy these needs to an acceptable standard.

Efficiency was a key objective for the new framework established by the Challenge Advisory health team. For example, the team recommended an outcomes-based funding model for both public and private facilities; this means that claims would be based on the outcome of healthcare, rather than the sheer volume of patients at the institution.

The framework also suggested that healthcare delivery be separated from the policy making itself, which should also result in greater healthcare efficiency. The health team then helped to identify institutional partners that were suitable for work in the client’s nation, building a foundation for public/private partnerships (PPPs) and assisting in the recruitment of the international managers who now operate many of the nation’s public hospitals.

Outcomes:

The national has revolutionised its system, and is now a viable healthcare market. No longer self-regulating, all of its citizens now have health insurance coverage through a mandated system. Residents in the client’s nation now have the choice of public or private hospitals, with claims being paid by one of the more than thirty competitive health insurers.