Resource Type: Tool
Authors: Thomas Schwark, Nadwa Rafeh, and Mahmoud Farag
The Ministry of Health (MOH) in Egypt has initiated major reforms to improve health outcomes and the financial sustainability of Egypt’s health care system. A key component of the reforms is the separation of financing from the provision of care at the Health Insurance Organization (HIO). The mission of the HIO is to become an effective health care services enterprise able to design, price, negotiate, contract, and pay for services covered under the social health insurance scheme and to ensure high-quality health care services for all Egyptians.
This guide is divided into two parts: (1) guidelines for auditing PHCs and (2) guidelines for auditing hospitals. For each part, the guidelines are provided in two main sections:
The first section is a guide for auditing compliance with HIO contracts. This section provides guidelines on how to audit and score each of the articles in the contract.
The second section is a guide for auditing compliance with selected MOH accreditation standards that are relevant to HIO.