Transcript Slide 1
Challenges on financing the health care from
obligatory health insurance scheme
Albania: Health System under reforms
ELVANA HANA
General Director
Health Insurance Institute
IInd Balkan Forum, Ljubljana – November 2008
Area 28,748 km2
Population 3,622,720
Nr. of Prefectures 12
65 Municipalities, 311
Communes
Religion:
(Mostly; Muslims,
Orthodoxies, Catholics)
Life expectancy at birth 73,8
years
Crude birth rate (‰):13.8
Crude death rate (‰): 5.7
Infant (♀+♂) mortality rate
(‰): 14.9
GDP per Capita 5.6% (2.7%
from public funds)
OVERVIEW - ALBANIAN HEALTH INSURANCE
SYSTEM
HII presents the national health insurance model and its managed
from the Board (or Administrative Council)
Restricted autonomy and report to Ministry of Health and Parliament
At administrative structure there are: Main office consist on 9
departments, 12 regional directories and … agencies …………..
FINANCING SOURCES AND THE
ADMINISTRATION OF CONTRIBUTIONS
FROM HII
1. The contributions of health
insurance are obligatory
State determine the contribution
rate based on individual incomes
paid directly at tax office or social
insurance office.
2. Direct transfers from state
budget
State is responsible to cover the
inactive population (such as
pensioner, veterans, invalids,
students, etc)
The structure of incomes (Fact)
State Contrib.
55%
Other incomes
1%
Health
insurance
contrib.
44%
THE STRUCTURE OF HEALTH SERVICES
FINANCED FROM HII
Primary health care
Contracts with Public Health Center for services package
Drugs reimbursement
Contracts with open network pharmacy (totally privatizes system)
Tertiary unikal examinations
(11 expensive examinations done at university clinics)
Durres Regional Hospital
FINANCING OF HEALTH INSURANCE
Active population
contribution
State Budget Transfer
MoH
HII
HC of
primary care
Administrative
expenditures
and Investments
SII - TO
Co-payment
Durres hospital
Drug reimbursement
(pharmacy with contract)
Tertiary
examinations
THE EXPENDITURES STRUCTURE
YEAR 2008
Investments
Examinations
0%
1%
Administrative
5%
PHC
50%
Durres
Hospital
5%
Reimbursment
39%
THE PROBLEMS AT PRIMARY HEALTH CARE
SERVICES
short history
…..
Administration of PHC Health Centers
Dual independence, institutional and financial (HII - MoH)
Fragmented financing of primary health care
Payments from HII, only for Family doctors – discouraged
for team work – indifferent to the quality
Lack of Autonomy for HC
Low deposits of secondary incomes – main reason of
informal payments
THE PROBLEMS AT PRIMARY HEALTH CARE
SERVICES :
Providing of health services and their quality
Lack of standard packages of health services for providers of
services
Partly standard for health services level and norms of coverage the
population within ambulatory care (the rapport (doctors/nurses
and norms of coverage for nurses staff)
Lack of measures and evaluations indicators for quality of health
services
Standards not completed for protocols of ambulatory treats from
GFP
Lack of basic equipments for services
4
SCHEME OF REFORMED PHC FINANCING
M. of Finance
Contributions
Contrib. Of inactive population and transfer for PHC
Tax Authority
HII
RDHI
RDHI
active
SII
Farmers
Tarifa per te
pasiguruarit dhe
bashkepagesa
Population
HC1
HC….
HC1
RDHI
HC…
HC1
HC….
Salary
Salary
Salary
Health and social
insurance
Health and social
insurance
Health and social
insurance
Goods and
services
Goods and
services
Goods and
services
REFORM AT PHC
Move to a single purchaser financing for health services.
Autonomy on Management, organization and operation of HC
Definition of actors role on the system.
Development of new method of payment for HC.
-
Application of a mix payment formula:
- 85% fix budget,
- 10% monthly added payment based on the activities
of the HC
- 5% bonus payment 3 month based for HC which
fulfils the quality indicators.
Increasing of payment level for services providers.
REFORM AT PHC
Setting up the necessary framework for health services market function.
- Opportunity to exercise their profession as individual
contractor / or private
Installation and using an unique system of information for all HC.
Setting up the necessary framework for HC to manage the allocated funds.
- New opportunity for increasing and using second
income
LIST OF INDICATORS FOR EVALUATION OF
HC ACTIVITY
The performance:
- number of visits for the insured persons
(daily average of visits per doctor within HC)
The quality
- First contacts with the patient within the year
- Respecting the average/prescription cost for specified diagnoses
- Monthly attendance of chronic patients (% of chronics every month)
- Attendance of pregnant women (% of pregnant women for their first visit of
first trimester of pregnancy)
- Vaccination in the ages 0-14 years old
- Participating in the Continuous Medical Education
SOME POSITIVE INDICATORS
HC Productivity
Invreasing of daily average of doctor’s
visits at national level
In urban areas:
- 7.9 vis/day year 2006
- 10 vis/day year 2007
- 11.1 vis/day first 6 months of
2008 ;
In rural areas:
- 3.9 vis/day year 2006
- 6 vis/day year 2007
- 6.9 vis/day first 6 months of 2008
Performance of no of visits/day per
doctors during years
12
10
8
urbane
6
rurale
4
2
0
2006
2007
2008
FINANCING OF PERFORMANCE AND
QUALITY INDICATORS
Performance:
year 2007 49.8 %
year 2008 72.5 %
80
70
Quality:
year 2007 –
year 2008 – 35.5 %
60
50
performance
40
quality
30
20
10
0
2007
2008
HOSPITAL SERVICES
Durres Hospital Experience, Priorities, problems and challenges.
Hospital as juridical entity:
Administrative independence
Management – Board
Financial independence
Financing from HII – own decisions for using of secondary incomes
funds.
More efficiency in using the health insurance funds through:
Setting up an coherent information system
Processing of payment method for DRG
Compiling of hospital treatment protocols
Financing of Durres Hospital during years
700
600
500
400
Buxheti
300
200
100
0
2002
2003
2004
2005
2006
2007
2008
THE CHALLENGES IN THE CURRENT
FINANCING OF HOSPITAL SERVICE
Implementing a contemporary computer network for all the
hospital activity and economic/technical one, up to services
Improving the financing method (from budgetary – to cost per
case – DRG)
Financing the new services
Improving the quality of health services:
- the permanent supply in medicaments and medical goods, referring
cost/efficiency
- privatization of supporting services
(The experience in financing this regional hospital will serve to extend the scheme in all
the hospital service)
IMPROVING THE HEALTH SYSTEM
FINANCING
Reinforcement of HII role as strategic purchaser of health services in public
and private system
Improvement of collecting contribution system
Efficiency at collecting contribution from salaries
Consolidation of contributions from obligatory insurance for
inactive population, from state budget
Reconsideration of the contribution rate
Decreasing of informality
Presentation of co-payment
Identifying the insured population through health card
Utilization of secondary incomes
ENCREASING OF MANAGERIAL CAPACITIES
AT HEALTH SERVICES
Expanding of partnership public-private
Encouragement of special service privatization at
all the levels of health care
Reposition of manager role at public health institutions
Setting up the standards, norms and clinical protocols in management
of health services.
Consolidation of quality approach system and security of health system
INCREASING OF ACCESS AT EFFECTIVE
HEALTH SERVICES
Define of basic package of health services and its monitoring
Re construction of health service providers network
Restricted due to geographical, demographic
and privatization policies conditions
Improvement of refer system
Maintaining and developing of programs for public health