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Monitoring Quality and Performance: Contracting of Private Health Care Services in Nicaragua

Contracting with the private sector to deliver health services can often pose issues for ensuring the quality of services being provided and increasing their utilization. This is particularly true for expanding the use of reproductive health care, such as family planning, which is covered, but at times not actively promoted by providers. In Nicaragua, the Social Security Institute (INSS) implemented a health care financing and delivery model to provide health services to social security beneficiaries, which include most formal sector workers and government employees. The INSS contracts with private and public health care providers, known as Empresas Medicas Previsionales (EMPs), using a capitated payment system to deliver a defined package of health care benefits to thirteen percent of the population. Prompted by the innovative features of the INSS model, CMS partnered with the INSS and two of the largest private EMPs to increase the utilization and quality of covered family planning benefits. The intervention utilized specific benchmarks for measuring improvements in the quality and utilization of family planning services being provided by contracted providers.