Since 2010, the RAND Corporation has worked with the Kurdistan Regional Government to develop initiatives to improve the region's health care system. The third phase of the project focused on development and use of a primary care management information system; health financing reform, with a focus on policy reform options to deal with physician dual practice; and hospital patient safety training within the context of health quality improvement.

Health Sector Reform in the Kurdistan Region — Iraq

Primary Care Management Information System, Physician Dual Practice Finance Reform, and Quality of Care Training

C. Ross Anthony, Melinda Moore, Lee H. Hilborne, Anne Rooney, Scot Hickey, Youngbok Ryu, Laura Botwinick

ResearchPublished Oct 5, 2017

Since 2010, the RAND Corporation has worked with the Ministry of Health and Ministry of Planning of the Kurdistan Regional Government to develop and implement initiatives for improving the region's health care system through analysis, planning, and development of analytical tools. This third phase of the project (reflecting work completed in 2013–2015) focused on development and use of a primary care management information system; health financing reform, focusing on policy reform options to solve the problem of physician dual practice, in which physicians practice in both public and private settings; and hospital patient safety training within the context of health quality improvement.

Most main primary health care centers serve too many people, and most sub-centers serve too few people. Staffing by physicians, nurses, dentists, and pharmacists is uneven across the region. The data also identified centers where laboratory, X-ray, and/or other equipment should be repaired or replaced and where users should be trained. Though the required workweek is 35 hours, and all physicians are paid for these 35 hours, most physicians spent only three or four hours per day working in the public sector. The remainder of the time was often spent working in the private sector, where pay is much higher. The vast majority of physicians (over 80 percent) indicated that if pay were higher and public-sector resources were increased, they would prefer to work only in the public sector. To resolve the problems associated with dual practice, the authors recommend full separation between public- and private-sector practice.

Key Findings

Primary Care Management Information System

  • Most main primary health care centers serve too many people, and most sub-centers serve too few people.
  • Staffing by physicians, nurses, dentists, and pharmacists is uneven across the region. The data also identified centers where laboratory, X-ray, and/or other equipment should be repaired or replaced and where users should be trained.

Health Financing Reform: Physician Dual Practice

  • RAND conducted six focus groups with about 150 physicians during the week of December 8, 2013. The focus groups were designed to gather information about physician conduct and preferences related to working in both the public and private sectors.
  • Though the required workweek is 35 hours, and all physicians are paid for these 35 hours, most physicians spent only three or four hours per day working in the public sector. The remainder of the time was often spent working in the private sector, where pay is much higher.
  • Most physicians reported that they would prefer to work more than 35 hours per week and earn more pay through the public sector. The vast majority of physicians (over 80 percent) indicated that if pay were higher and public-sector resources were increased, they would prefer to work only in the public sector.

Creating a Sustainable Health Quality Infrastructure

  • A group of senior leaders participated in a 3.5-day education program created by RAND based on Joint Commission International quality standards.
  • Participants identified priorities for ongoing focus, including patient identification, hand hygiene, emergency cart standardization, safe surgery protocols, and completeness and standardization of medical record.

Recommendations

  • The authors recommend outsourcing the development of an online primary care management information system that can be accessed by all appropriate officials and relevant partners. The system should be user friendly and easy to access so that all appropriate users are able to enter updated data; generate tables, graphs, and maps; and use their data to inform primary care planning, resourcing, and management.
  • To resolve the problems associated with dual practice, the authors recommend full separation between the public and private sectors. In this option, physicians choose to work in only the public or private sector, with no private practice allowed in the evening for those who choose public service. Any plan should be phased in and coordinated so that the necessary inputs (facilities, medicines, and ancillary services) are available for physicians to do their work. The authors recommend full separation of public- and private-sector practice.
  • The development of a regional Quality and Patient Safety Institute based in Erbil that would use a train-the-trainer methodology would enable additional capacity-building. Hospital directors who have already demonstrated a commitment to leading quality and safety improvements should serve as co-faculty for future training, ultimately transitioning most or all training to institute staff.

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Document Details

  • Copyright: Kurdistan Regional Government
  • Publisher: RAND Corporation
  • Availability: Available
  • Year: 2017
  • Print Format: Paperback
  • Paperback Pages: 116
  • Paperback Price: $33.00
  • Paperback ISBN/EAN: 978-0-8330-9718-7
  • DOI: https://doi.org/10.7249/RR1658
  • Document Number: RR-1658-KRG

Citation

RAND Style Manual
Anthony, C. Ross, Melinda Moore, Lee H. Hilborne, Anne Rooney, Scot Hickey, Youngbok Ryu, and Laura Botwinick, Health Sector Reform in the Kurdistan Region — Iraq: Primary Care Management Information System, Physician Dual Practice Finance Reform, and Quality of Care Training, RAND Corporation, RR-1658-KRG, 2017. As of October 7, 2024: https://www.rand.org/pubs/research_reports/RR1658.html
Chicago Manual of Style
Anthony, C. Ross, Melinda Moore, Lee H. Hilborne, Anne Rooney, Scot Hickey, Youngbok Ryu, and Laura Botwinick, Health Sector Reform in the Kurdistan Region — Iraq: Primary Care Management Information System, Physician Dual Practice Finance Reform, and Quality of Care Training. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_reports/RR1658.html. Also available in print form.
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The research described in this report was sponsored by the Kurdistan Regional Government and conducted by RAND Health.

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