ToR: Development of a Business Development Plan for a Tiered Patient Fee System

ToR: Development of a Business Development Plan for a Tiered Patient Fee System

Background

Nigeria bears a significant burden of avoidable blindness and visual impairment, particularly due to cataracts and uncorrected refractive errors. Access to quality eye care remains constrained by poverty, limited health insurance coverage, and high out-of-pocket expenditures. As a result, many patients delay or forego treatment, leading to avoidable vision loss and reduced quality of life.

St. Joseph's Eye Hospital Mgbirichi is committed to ensuring that all patients, regardless of their socioeconomic status, can access quality eye care services. Currently, the hospital's patient fee system does not sufficiently guarantee affordability for vulnerable and low-income populations while ensuring long-term financial sustainability.

To address this challenge, the hospital seeks to develop a robust, transparent, accountable, and financially sustainable tiered patient fee system based on a cross-subsidization approach. Under this model, higher-paying patient groups, insurance reimbursements, and other revenue streams will partially subsidize care for patients with limited ability to pay.

An external consultant will be engaged to work closely with the hospital management and relevant stakeholders to develop a comprehensive Business Development Plan. The external consultant will assess the existing fee structure, identify gaps and weaknesses, design a differentiated pricing framework, develop a practical means-testing mechanism, and prepare a detailed implementation and scale-up roadmap.

The external consultant’s engagement will be limited to the development of the Business Development Plan and the accompanying implementation roadmap, including recommendations, tools, and guidance to support execution. Responsibility for the actual implementation, roll-out, and management of the proposed pricing and means-testing systems will remain with the hospital and relevant stakeholders and will not form part of this consultancy assignment.

Purpose of the Assignment

The purpose of this consultancy is to develop a comprehensive Business Development Plan for a Tiered Patient Fee System that will:

• Improve equitable access to eye care services for poor and vulnerable populations.
• Enhance financial sustainability of St. Joseph's Eye Hospital Mgbirichi.
• Establish a transparent and accountable cross-subsidization mechanism.
• Strengthen revenue generation while maintaining the hospital's social mission.
• Support evidence-based decision-making and long-term growth.

Objectives

General Objective

• To design a financially sustainable, socially equitable, and operationally feasible patient fee system for St. Joseph's Eye Hospital Mgbirichi.

Specific Objectives

The external consultant shall:

• Assess the current patient fee structure and financing mechanisms.
• Develop a differentiated (tiered) pricing system based on patients' ability and willingness to pay.
• Design a transparent cross-subsidization model to support indigent patients.
• Develop a practical patient classification and means-testing system.
• Analyze service costs, revenue streams, and sustainability scenarios.
• Propose governance, operational, and accountability frameworks.
• Identify weaknesses in the existing fee system and recommend improvements.
• Develop a phased implementation and business growth strategy.
• Produce financial projections and sensitivity analyses for a period of 3-5 years.

Scope of Work

The external consultant shall undertake the following tasks:

Inception Phase

• Review relevant project documentation, hospital records, and financial reports.
• Hold inception meetings with hospital management and key stakeholders.
• Develop an inception report outlining methodology, work plan, stakeholder engagement strategy, and data collection tools.

Situational Assessment and Diagnostic Review

• Review the existing patient fee system, pricing policies, and revenue model.
• Analyze hospital service utilization trends, patient demographics, and payer mix.
• Assess current financial performance, cost recovery levels, and operational efficiency.
• Identify strengths, weaknesses, risks, and opportunities within the current system.

Market and Socioeconomic Assessment

• Conduct patient segmentation based on socioeconomic status.
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