Jordan Health Profile 2012

Jordan’s health system is a complex amalgam of three major sectors: Public, private, and donors. The public sector consists of two major public programs that finance as well as deliver care: the Ministry of Health (MOH) and Royal Medical Services (RMS). Other smaller public programs include several university-based programs, such as Jordan University Hospital (JUH) in Amman and King Abdullah Hospital (KAH) in Irbid. The total expenditure on health services in 2003 accounted for about JD 727 million, 10.4 percent of the GDP. Health expenditure per capita was JD 133.35 Each of the health care subsectors has its own financing and delivery system.

The MOH is the major single institution financer and provider of health care services in Jordan. It is the largest in term of the size of its operation and utilization as compared to RMS, JUH, KAH, or other private sectors. According to the new Public Health Law No.54, issued by a Royal decree in 2002, the Ministry of Health is responsible for all health matters in the Kingdom, and in particular:

• Protecting health through providing preventive and curative services as well as monitoring responsibilities
• Organizing and supervising health services provided by the public and private sectors
• Providing health insurance for citizens within available resources
• Establishing educational and training health institutions managed by the MOH

Article 4 of the Law defines areas of work for the Ministry including health promotion and healthy lifestyles, disease control, prevention of nutritional deficiencies, maternal and child health, school health, health of the elderly and prevention and control of no communicable diseases. The Law contains provisions on the practice of medical and health professions, private heath care institutions, mental health and drug addiction, communicable diseases, immunization, pharmaceuticals, water and sanitation. The organizational structure of the MOH. It does not reflect the latest changes that involve the establishment of the Directorate of Health Economics, the Directorate of Health Insurance and assigning several assistants for the General Secretary . The Ministry of Health (MOH) provides primary, secondary and tertiary health care services. Primary Health Care services are mainly delivered through an extensive primary health care network, consisting of 52 comprehensive health centers, 340
primary health care centers, 260 Village Clinics and 353 MCH Centers. The MOH owns and operates 29 hospitals in 11 governorates, with 3456 hospital beds accounting for 37 percent of total hospital beds in Jordan. In terms of utilization, 43 percent of inpatients care and 45 percent of outpatients care occur within its hospitals. The bed occupancy rate in MOH hospitals was 69.8 percent for the year 2004.36 The MOH employs 25 percent of all practicing physicians in Jordan. In 2002 and 2003 the MOH budget accounted for 5.7 and 5.9 percent of the general budget respectively.3 The MOH is the largest in terms of expenditures, which accounted for 25 percent of total health expenditures in 2003. Over 76 percent of MOH expenditures are financed through the government budget, some 11 percent from insurance premiums from Civil Health Insurance enrollees, and the reminder from user charges and donors. In the year 2003, the MOH allocated 83 percent of its fund (JD 185 millions) to facilities it owns and operates, and the remaining amount (JD 31.5 millions) was spent on reimbursing private and other public providers for their services. In addition to its general public health functions, the MOH has a dual financing function. First, it is responsible for administering the Civil Health Insurance Plan (CHIP) which covers civil servants and their dependents.
Individual certified as poor, the disabled, children below the age of six years, and blood donors are also formally covered under the CHIP, which covers about 20 percent of population. Second, the MOH is in effect the insurer of last resort for the entire population, since any individual can come to MOH facilities and pay highly subsidized charges (15 to 20 percent of the costs) for the entire range of MOH services.

Royal Medical Services:
The Royal Medical Services (RMS) mainly provides secondary and tertiary care services. It has 10 hospitals (7 general and 3 specialist), 1801 beds representing 19% of hospital beds in Jordan with occupancy rate of 79 percent. It employs 8 percent of all practicing physicians .RMS is responsible for providing health services and a comprehensive medical insurance to military and security personnel. Beneficiaries include active and retired staff and their dependents, staff of the Royal Court, Royal Jordanian Airlines, Aviation Academy, Mu’ta and Al Al-Bait Universities and others. RMS also provides care to uninsured patients referred from MoH and the private sector. The Military Health Insurance system currently covers 1,500,000 people of whom less than 10% are active military and police personnel. RMS acts also as a referral center through providing high quality care, including some complex procedures and specialty treatment to Jordanians (including MOH beneficiaries) and Arab patients. It plays a major role politically through contributing in activating the role of Jordan in the region and world by sending medical teams and field hospitals to disaster and conflict area such as (Iraq, West Bank, Ariteria, Afghanistan, Croatia and Seralion). The RMS, like all other public providers, receives most of its annual budget (JD 96 million in 2003) from the Ministry of Finance (MOF), almost 61 percent. The remaining source of funds comes from other government entities including the MOH, households and private firms.

Jordan University Hospital:
Jordan University Hospital (JUH) was established in 1971 under the name of Amman Grand Hospital, and was named JUH in 1975 after it was affiliated with Jordan University  and its medical school. With over 531 beds, its one of the most specialized and high-tech medical centers in the public sector, along with King Hussein Medical Center and King  Abdullah Hospital. JUH patients are referral from the MOH, employees of Jordan University and their dependents, employees of private firms with whom JUH has contractual agreements, as well as some independent private patients. It has 5.8 % of the total number of hospital beds in Jordan and accounts for 4.2 percent of the admissions for the year 2004.36 JUH has an occupancy rate of 72.2 % and employs 2 percent of physicians. 49 percent of the JUH revenue for the year 2001 was from MOH resources.

King Abdullah Hospital:
King Abdullah Hospital (KAH) was established in 2002 by Jordan University of Science and Technology (JUST). The total bed capacity of the hospital is 650 beds and the operating (opened beds) are 200 beds.40 The hospital serves as a teaching hospital to the Faculty of Medicine at JUST and as a referral hospital for all public sectors in the Northern Region. More than 85 percent of the hospital admissions are for patients referred by the MOH and the RMS. Thus, the two agencies are the main source of fund for KAH.

The private sector plays an important role in terms of both the financing and delivery of services. Many private firms provide health care coverage for their employees either through self-insuring or the purchase of private health insurance. According to the Jordan’s National Health Accounts (JNHA), 49 percent of the health expenditure goes to private sector physicians and hospitals in 2001. Many individuals including those with public coverage, purchase services privately through direct out-of-pocket payment. The NHA reported that the total out-of pocket expenditures from households amounted to  JD 274 million in 2001. The private sector received 81 percent of this amount, while the public sector received only 19 percent. In terms of service delivery system, the private sector accounts for 36 percent of hospital beds and 56 percent of hospitals in Jordan with occupancy rate of 46.2 percent. In addition, the private sector employs 61.8 percent of all physicians, 93 percent of all pharmacists, 71 percent of all dentists, and 52 percent of all nurses. The private sector contains much of the country’s high tech diagnostic capacity. This sector continues to attract significant numbers of foreign patients from nearby Arab nations. The JNHA reported that the private sector received about $600 million in revenue from foreign patients in 2001. This sector under the absence of strict regulatory environment is flourishing and growing steadily

Public/private interactions (Institutional):
The private sector is represented in all public independent health organizations as the Jordan Medical Council, the High Health Council, the High Nursing Council, the Jordan Food and Drug Administration (JFDA) and Councils of Health Professions Faculties, etc. The private health sector also participates in the development of national health polices and strategic plans. The Present Minister of Health, Dr. Saeid Darwazah, came from the private pharmaceutical industry. Jordan governments have adopted more liberal policy toward public-private partnership. The MOH has adopted plans to attract private physicians and other health professions to work at the new MOH Prince Hamzeh hospital, which will be opened soon.