Design Options And Data Needs For The Ambulatory Payment Innovation In The Public Health Sector Of Peru

Design Options and Data Needs for the Ambulatory Payment Innovation in the Public Health Care Sector of Peru
February 2002 Prepared by:
Alexander Telyukov, PhD Abt Associates Inc. Miguel Garavito Consultant Abt Associates, Inc. Alfredo Sobrevilla Consultant Project 2000 Luz Loo Consultant Project 2000

Partners for Health Reformplus
Abt Associates Inc. 4800 Montgomery Lane, Suite 600Bethesda, Maryland 20814 Tel: 301/913-0500 Fax: 301/652-3916 In collaboration with: Development Associates, Inc. Emory University Rollins School of Public Health Philoxenia International Travel, Inc. Program for Appropriate Training in Health SAG Corporation Social Sectors Development Strategies, Inc. Training Resource Group Tulane University School of Public Health and Tropical Medicine UniversityResearch Co., LLC. Funded by: U.S. Agency for International Development Order No. TE003

Mission

Partners for Health Reformplus is USAID’s flagship project for health policy and health system strengthening in developing and transitional countries. The five-year project (2000-2005) builds on the predecessor Partnerships for Health Reform Project, continuing PHR’s focus on health policy,financing, and organization, with new emphasis on community participation, infectious disease surveillance, and information systems that support the management and delivery of appropriate health services. PHRplus will focus on the following results:
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Implementation of appropriate health system reform. Generation of new financing for health care, as well as more effective use of existing funds. Designand implementation of health information systems for disease surveillance. Delivery of quality services by health workers. Availability and appropriate use of health commodities.

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February 2002
Recommended Citation
Telyukov, AlexanderMiguel Garavito, Alfredo Sobrevilla, and Luz Loo. February 2002. Design Options and Data Needs for the Ambulatory Payment Innovation in thePublic Health Care Sector of Peru. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.

For additional copies of this report, contact the PHRplus Resource Center at PHR-InfoCenter@abtassoc.com or visit our website at www.phrproject.com. Contract/Project No.: Submitted to: HRN-C-00-00-00019-00 Karen Cavanaugh, CTO Policy and Sector Reform Division Office of Health andNutrition Center for Population, Health and Nutrition Bureau for Global Programs, Field Support and Research United States Agency for International Development

The opinions stated in this document are solely those of the authors and do not necessarily reflect the views of USAID.

Abstract
This report is the first technical deliverable under the Ambulatory Payment Innovation, a pilot projectthat seeks to identify and promote innovative strategies and mechanisms of ambulatory financing in the public health care sector of Peru. The report contains methodological proposals for provider financing, Health Care Network design, and information systems. The proposed methods of provider financing present an innovative combination of prospectively capitated budgets, service charges for selectprocedures, patient co-payments, and performance-based distributions according to provider-specific values of a Standards-of-Care Index. The report ponders over the definition of Health Care Networks as an organizational shell in which ambulatory financing reforms are expected to occur in Peru. The study team argues that the existing networks ought to undergo subdivision into more compact entitiesfor the contractual, managerial, and budgeting purposes. The report offers five configurations of the prospectively budgeted systems within the currently defined networks. The proposed methods of financing call for an increased use of information by regulators, purchasers and providers of care. The authors of the report envision the emergence of a health and management information system that...