Dr. Bahaa Eldin Fateha, CEO, NHRA*
*National Health Regulatory Authority
Kingdom of Bahrain
National Health Regulatory Authority, NHRA
 Established by law in 2009.
 Became fully operational in September 2011.
 Responsible for regulation of healthcare services,
public and private: Facilities and professionals.
 Registration, licensing and pricing of pharmaceuticals
and health-related supplements.
 Investigating medical errors and handling patient
complaints.
 Authorizing experimental medical research.
Bahrain experience, so far
 The task is huge, and therefore there must be a
strategy to assure unified process of monitoring.
 The main objective of NHRA is to improve the health
system.
 Therefore, we should have a common understanding
of what we need to improve.
 We will also illustrate the dilemma facing National
Health Insurance and NHRA proposed solution.
Components of The Dynamic Health Systems
Resources
Facility;
Manpower
Financial
We put a lot of resources into
the health systems: Buildings,
equipment, all categories of
manpower: Physicians,
nurses, technicians, admin. In
addition, financial resources
to assure sustainability.
Is this sufficient to have a
functioning Health System?
The Dynamic Health Systems’ Model
Resources
Facility;
Manpower
Financial
+
Processes
Direction
Strategy & Planning
Management
Monitoring &
Evaluation
How to use the
resources: Strategy,
plans and programs,
management inclusive
of monitoring and
evaluation.
Is this sufficient?
Probably – but
something is missing!!
The Dynamic Health Systems’ Model
The third component is the
outcome of the system.
It needs something extra to
call it DYNAMIC
Resources
Facility;
Manpower
Financial
Outcome
+
Processes
Direction
Strategy & Planning
Management
Monitoring &
Evaluation
=
Quality,
Efficiency
Safety
The Dynamic Health Systems’ Model
Resources
Facility;
Manpower
Financial
Analysis
Outcome
+
Quality,
Efficiency
Safety
=
Processes
Direction
Strategy & Planning
Management
Monitoring &
Evaluation
Analysis
Continuous Analysis to
Improve the outcome through modifying
Resources or the Process.
NHRA “wider” view of the Health Systems
Management
Oversight
Dept.
Dept.
Dept.
Unit
Directorate
Dept.
Section
Department
Performance Appraisal of healthcare organizations*
Leading system
Others compare with
it
Outstanding
Achievement
Excellent System
Compare with others
Extensive
Achievement
Good System
Decisions supported
by evidence
Weak System
Operating but
No evaluation!
Unknown Status
Facility, Staffing, PPG
Moderate
Achievement
Some
achievement
Low
achievement
*Modified from ACHS
The Failing Health Systems’ – Phase I
Input
Resources :
Facility;
Manpower
Financial
Analysis
Outcome
+
Poor Quality,
Wastage
Higher Risk
=
Failing Process
1, Poor monitoring
2, Loss of control
3, Loss of direction
4, Crisis Management
5, Dissociated System
Analysis
Applies to individual department or
to the hospital as a whole.
The Failed System – Phase II
Input
Resources :
Facility;
Manpower
Financial
Outcome
?
?
Process
Individual-based
practices
No evaluation
No direction
No integration
Wastage
Ill-health
Unsafe Practice
Dissociated from
the community
“This is what we hope to have”
Secondary
Care
Community
Primary
Care
System
Tertiary
Care
This is what we must avoid:
“Dysfunctional” Health Systems
Secondary
Care
Community
Primary
Care
System
Tertiary
Care
Repairing a failed system
 Once a system becomes dysfunctional, it is extremely
difficult and too costly to repair it. Patients’ and
community confidence in the system may be damaged.
 The best solution is prevention of failure.
Health Insurance Reimbursement Dilemma
 Reimbursement is based on DRG- or DRG-Derived
system.
 The problem?
 If reimbursement is based on equal payment to all
facilities: It will kill future quality improvement, as
high-expense facilities will cease investing in
development.
 If based on variable payment based on actual costing
studies of each facility: Health insurance companies
will channel patients to low-cost facilities, thus again
killing future quality improvement.
NHRA Contribution to the Insurance Dilemma
 Ranking of healthcare facilities based on a unified
system of appraisal.
 Reimbursement is based on DRG, but with an
approved scale based on the ranking.
 The system is binding, and enforced by a strong
governance.
 Insurance companies may use the system as an add-on
privileges to their subscribers.
NHRA interpretation of an Appraisal System
(based on ACHS/ACHSI)
Leading system
Others compare with
it
Outstanding
Achievement
Excellent System
Compare with others
Extensive
Achievement
Good System
Decisions supported
by evidence
Weak System
Operating but
No evaluation!
Unknown Status
Facility, Staffing, PPG
Moderate
Achievement
Some
achievement
Low
achievement
NHRA Categorization of healthcare organizations
Leading System
Others compare with
it
Outstanding
Facility
Excellent System
Compare with others
Excellent
Facility
Good System
Decisions supported
by evidence
Weak System:
Operating but
No evaluation!
Passes Minimum
Requirements
Good Facility
Mediocre
Licensed passable