equitable access to care, where referral backup is essential.
Geographical monopoly limits competitive contracting, for which
issues on quality of care are addressed by hospital accreditation
and other quality incentive mechanisms. DHS as gate keeping
contributes to rational use of services and systems efficiency.
Comprehensive benefit package offered free at point of service
contributes to financial risk protection. Comprehensive package
is financially feasible as the self-cost-contained closed end
payment was applied. In contrast, CSMBS fee for service OP
services results in excessive use of health resources and cost
escalations. Potential drawbacks of closed end payment especially
under-provision and poor quality are addressed by complaint
handling via 24-h call centre, unbundling services from
capitation such as chemotherapy, radiation therapy and
antiretroviral therapy (ART), and from DRG such as cataract
and pay on an agreed few schedules. DRG creep is countered by
medical audits and NHSO reclaims of the over-disbursed
amounts, see Box 1. Global budget prevents financial impacts
from DRG creep. NHSO institutional capacities, especially
executing monopsonistic purchasing was gradually initiated,
whereas external partners contribute to HTA evidence guiding
policy decision on inclusion of new medicines and interventions
into benefit package.