Universal Health Insurance Contracting and Provider Payment Reforms in Amman

Programme Overview

National health systems across the Middle East and North Africa are transitioning towards mandatory universal coverage models that separate healthcare purchasing from direct service provision.⁣​‌​‌​​‌​​‌‌​‌​‌‌​‌‌​‌​​‌​‌‌​‌‌‌​​​‌​‌‌‌​​​‌‌​​​‌​‌‌‌‌​​​​‌‌​‌​​‌⁣ This four-day intensive programme in Amman equips public healthcare leaders with technical competencies required to establish strategic purchasing frameworks. Participants examine how public payer organisations deploy legal contracting, payment mechanisms, and financial forecasting to guarantee service delivery while protecting actuarial solvency and ensuring equitable access for enrolled populations across diverse socio-economic groups.

The curriculum concentrates on structural reforms governing the interface between health insurance authorities and healthcare providers. Participants explore primary care capitation design, case-based hospital payments, and diagnosis-related grouping principles. Through operational case studies and simulation exercises, delegates review how national insurance funds mandate clinical accreditation, negotiate standard service level agreements with public and private facilities, and introduce performance-linked incentives that improve healthcare quality without escalating aggregate public health expenditure.

Technical modules address administrative, financial, and digital governance necessary for robust system implementation. Delegates analyse methods for claims processing, medical audits, tariff-setting methodologies, and fraud detection within unified health management information systems. The programme provides public officials with practical techniques to design mixed provider payment systems, monitor healthcare utilisation trends, and manage operational transitions from historical line-item budgeting to performance-driven, output-based contracting in alignment with international standards.

The operational roll-out of wide-ranging national reforms, such as those within the Supporting Egypt Universal Health Insurance System project and peer regional modernisation agendas, requires a rapid transition from passive financing to active strategic purchasing.⁣​‌​‌​​‌​​‌‌​‌​‌‌​‌‌​‌​​‌​‌‌​‌‌‌​​​‌​‌‌‌​​​‌‌​​​‌​‌‌‌‌​​​​‌‌​‌​​‌⁣ Public institutions face urgent demands to negotiate balanced provider contracts, introduce modern payment mechanisms, enforce clinical quality benchmarks, and implement rigorous electronic claims adjudication systems. Developing these operational and financial capabilities ensures public payers can safeguard actuarial stability, control escalating medical inflation, and maintain uninterrupted service delivery during large-scale health system restructuring.

Delivered by Risalat Consultants International in Amman, Jordan, it combines expert-led sessions, real cases and group work, so that participants can apply what they learn in their own institution.

The Programme Strengthens Institutional Capability

• Transitioning from passive funding to active strategic purchasing under universal health coverage
• Institutional governance: separating purchasing, regulation, and service provision functions
• Structuring provider networks: public, private, and non-profit facility enrolment models
• Drafting master service agreements, quality clauses, and performance-based contract terms
• Regulatory compliance, patient rights, and legal mechanisms for contract dispute resolution
• Principles of primary healthcare financing and modern provider payment taxonomies
• Designing risk-adjusted capitation formulas based on demographic and epidemiological profiles
• Integrating performance bonuses, key performance indicators, and quality-linked top-up payments
• Service planning and management
• Quality improvement and standards
• Human resources and workforce planning
• Financing and budgeting for services

It is designed for health insurance authority directors and executive managers, health economists and health financing specialists, ministry of health planning and policy officials and others who want practical, current skills in health, education and social services.

The Growing Importance of Universal Health Insurance Contracting and Provider Payment Reforms in Amman

Health, education and social services reach people directly, and their quality depends on planning, management and the use of evidence. Governments and partners expect better results from limited budgets.

Leaders and managers in these sectors face rising demand, staff shortages and new technologies. Strong management skills help institutions plan services, use resources well and show results.

Organisations increasingly require professionals capable of:

• Plan and manage services to meet demand
• Improve quality against standards
• Manage staff and resources effectively
• Use data to guide decisions
• Work with communities and partners

Strong health, education and social services systems help organisations:

• Deliver better services to more people
• Use budgets and staff efficiently
• Meet quality standards
• Show results to government and partners

This Universal Health Insurance Contracting and Provider Payment Reforms in Amman programme brings these elements together in a practical format, so that participants understand not only what good practice looks like but also how to introduce it in their own setting, with the people and resources they have.

Who Should Attend This Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training?

This programme is designed for:

• Health insurance authority directors and executive managers
• Health economists and health financing specialists
• Ministry of health planning and policy officials
• National health insurance fund contracting officers
• Public and private hospital network executives
• Primary healthcare administration directors
• Health regulatory and facility accreditation assessors
• Claims adjudication and clinical audit team leaders
• Project management unit staff on donor-financed health operations
• Service managers and administrators
• Directors and senior officials
• Planning and policy officers

The programme suits experienced professionals as well as those moving into new responsibilities. Groups that mix institutions and countries are encouraged, because participants learn a great deal from each other’s experience.

Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training Objectives

Upon successful completion of this Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training, participants will be able to:

• Design strategic purchasing models that align resource allocation with national health sector objectives
• Formulate risk-adjusted capitation payment formulas for primary healthcare delivery networks
• Structure diagnosis-related groups and case-based provider payment systems for hospital inpatient care
• Draft legally enforceable service level agreements and standard provider contracts for accredited facilities
• Establish clinical accreditation criteria and quality assurance indicators for provider network enrolment
• Execute electronic claims auditing protocols to detect billing anomalies, waste, and financial fraud
• Model actuarial projections and revenue requirements to preserve national health insurance fund solvency
• Electronic claims management pipelines: clearinghouses, standard submission formats, and verification
• Automated rules engines, utilisation reviews, and detecting fraudulent healthcare billing patterns
• Medical audit protocols for verifying clinical necessity and contractual adherence

Each objective is practised during the programme through exercises, cases or group work, so that participants leave able to do it, not only to describe it.

Programme Contents and Structure

Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training Methodology

The training employs a practitioner-led approach focused on applied public sector delivery.⁣​‌​‌​​‌​​‌‌​‌​‌‌​‌‌​‌​​‌​‌‌​‌‌‌​​​‌​‌‌‌​​​‌‌​​​‌​‌‌‌‌​​​​‌‌​‌​​‌⁣ Participants engage in interactive technical lectures, comparative analysis of international purchasing models, and hands-on simulation clinics. Delegates work through practical exercises using financial spreadsheets to model capitation adjustments, draft core contractual clauses for provider agreements, and review mock electronic claims dossiers to detect improper billing practices. Peer review sessions enable officials to contextualise technical concepts against the administrative and legislative realities of ongoing health sector transitions.

The programme combines:

• Expert-led sessions on current practice
• Regional and international case studies
• Group work and practical exercises
• Simulations and role plays where relevant
• Discussion of participants' own challenges
• Peer learning across institutions and countries
• Practical tools and templates to take back to work
• Daily reflection and action planning

Before the programme, a short pre-assessment helps the facilitators understand each participant’s role and priorities, so that examples and exercises can be adjusted to the group. Each day ends with a short reflection in which participants note what they will apply at work.

Expected Outcomes

Upon completion of this Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training, participants will be able to:

• Capability to establish and manage strategic purchasing directorates within public health payers
• Proficiency in calculating risk-adjusted capitation rates for primary care networks
• Skill in drafting legally sound healthcare provider contracts and service level agreements
• Practical ability to implement diagnosis-related case-based payment systems for hospitals
• Competence in deploying electronic claims audit matrices to minimise leakage and billing errors
• Capacity to evaluate insurance scheme financial balances and adjust purchasing policies accordingly
• Plan services to meet demand
• Improve quality against standards

Participants leave with a personal action plan and practical tools they can use in their institution from the first week back. Institutions that send several participants can use the programme to agree shared methods and templates across teams, which makes improvements easier to sustain.

Institutional Application of Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training

This programme supports organisations in strengthening:

• Service planning
• Quality management
• Workforce management
• Data use
• Partnerships

Participants return with practical tools to improve:

• Service plans
• Quality reviews
• Workforce plans
• Performance reports
• Supply planning

The programme is built so that learning moves from the classroom into the institution. Participants work on their own processes and documents where possible, and leave with an action plan that their managers can review and support.

Regional Relevance & Application

Europe

European institutions apply health, education and social services within detailed regulatory frameworks and reform agendas. Participants from Europe can compare their practice with colleagues from other regions and test how established methods work under different conditions.

Africa

Across Africa, ministries, agencies and project teams working in health, education and social services increasingly operate alongside donor-financed programmes that expect clear systems and evidence. The programme helps participants adapt good practice to the institutions and resources they work with.

Middle East

In the Middle East, national development strategies and diversification plans place growing demands on health, education and social services. Participants explore how to build the capability these plans need inside public bodies and companies.

Asia

Institutions across Asia combine rapid growth with ambitious modernisation programmes. Participants from Asia can share their experience of scaling systems quickly and learn from approaches used elsewhere.

Pacific

Small island and Pacific states face particular constraints of size, distance and capacity. The programme highlights practical, proportionate approaches to health, education and social services that suit smaller institutions.

Holding the programme in Amman, Jordan brings participants together away from their daily pressures, so they can compare how health, education and social services is handled in different settings. The same programme can also be delivered in-house for one institution, in its own country or online, with cases taken from its current work.

Host Country Profile – Jordan

Programmes, Workshops, Exposures, Training Courses in Amman, Jordan by Risalat Consultants International

Studying away from their own country gives participants time to focus, a fresh view of their own institution and the chance to build a network with colleagues from other countries.

Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training Deliverables

Participants receive support before, during and after the programme, so that preparation, learning and follow-up form one continuous experience.

Before the Programme

• Participant Pre-Assessment
• Universal Health Insurance Contracting and Provider Payment Reforms in Amman Readiness Assessment
• Universal Health Insurance Contracting and Provider Payment Reforms in Amman Resource Pack
• Preparatory Reading Materials
• Complimentary Visa Support & Advisory

During the Programme

• Airport Pickup & Welcome Assistance
• Accommodation with Breakfast
• Welcome Networking Dinner
• Risalat Training Kit (Bag, Bottle, Mug, T-Shirt, Cap, Passport Cover, Pens, Notebook, Magnet & Keychain)
• Comprehensive Universal Health Insurance Contracting and Provider Payment Reforms in Amman Training Manual
• Service Planning Template
• Quality Improvement Plan Template
• Workforce Planning Template
• Performance Dashboard Template
• Practical Workshops & Simulations
• Group Discussions & Peer Learning
• Daily Lunch and Refreshments
• Full Access to Training Venue Facilities
• Mini Pad / Tablet with Digital Learning Materials
• Field Visit (where applicable)
• Entertaining City Tour

After the Programme

• Certificate of Completion
• Risalat Programme Participation Recognition Award
• Post-Training Reference Materials
• Service Review Checklist
• Improvement Tracking Sheet
• Post-Training Support & Follow-Up Guidance
• Programme Report

Institutions can also request a tailored in-house version of this programme, delivered at their premises or online. Request a proposal.

Common Challenges in Universal Health Insurance Contracting and Provider Payment Reforms in Amman, And How This Training Helps

How can institutions plan and manage services to meet demand?

The programme addresses this directly on the first day (Day 1: Strategic Purchasing Foundations and Provider Contracting Architecture), where participants practise the methods involved and adapt them to their own institution, then build it into their action plan.

How can institutions improve quality against standards?

The programme addresses this directly on the second day (Day 2: Provider Payment Systems: Capitation and Primary Healthcare Contracting), where participants practise the methods involved and adapt them to their own institution, then build it into their action plan.

How can institutions manage staff and resources effectively?

The programme addresses this directly on the third day (Day 3: Hospital Reimbursement Models and Diagnosis-Related Grouping), where participants practise the methods involved and adapt them to their own institution, then build it into their action plan.

How can institutions use data to guide decisions?

The programme addresses this directly on the fourth day (Day 4: Digital Claims Adjudication, Medical Audit, and Actuarial Balance), where participants practise the methods involved and adapt them to their own institution, then build it into their action plan.

How can institutions work with communities and partners?

The programme addresses this directly on the first day (Day 1: Strategic Purchasing Foundations and Provider Contracting Architecture), where participants practise the methods involved and adapt them to their own institution, then build it into their action plan.

Frequently Asked Questions

When and where does the Universal Health Insurance Contracting and Provider Payment Reforms in Amman programme take place?

It runs from 4 Jan 2027 to 7 Jan 2027, in Amman, Jordan. The registration deadline is shown at the top of this page.

Who should attend?

The programme is designed for health insurance authority directors and executive managers, health economists and health financing specialists, ministry of health planning and policy officials, national health insurance fund contracting officers, and others who want practical skills in health, education and social services.

Will I receive a certificate?

Yes. Participants who complete the programme receive a Certificate of Completion from Risalat Consultants International.

Can this programme be delivered for our institution only?

Yes. We can deliver a tailored in-house version at your premises, in another city or online, built around your own cases. Use the proposal request on this page.

Do I need prior experience in health, education and social services?

No specialist background is required beyond experience in a related role. A short pre-assessment helps the facilitators adapt the sessions to the group.

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