Transcript REFORMAT NE SISTEMIN SHENDETESOR NE REPUBLIKEN E …

New methods of financing the
health system in
Republic of Albania
Elvana HANA
General Director
Health Insurance Institute
Tirana on 09 June 2008
THE STRUCTURE OF PRESENTATION
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An overview of Health System and Health Financing
Systems
Changes at Primary Health Care financing (achievements
and problems)
Changes at hospital care financing. Study case – Durres
Hospital – as a model for further developments.
Pharmaceutical services – Totally private but it remain
too far from European standards. The Project of electronic
control of pharmacies and drugs.
Short term efforts of Health Insurance Institute to further
increasing of financing health services efficiency.
GENERAL FRAMEWORK
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Health services in Albania are provided by a mix public and
private services providers
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Hospital services are provided by MoH and other public
institutions.
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PHC is provided through a general practitioners and private
network well developed at this sector.
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Pharmacies, dentists, and other supported health services
are totally private.
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Ministry of Health remain the main actor at policy making
and the regulator of health system.
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Local Governance is another actor in allocation of public
funds for health sector at regional level.
THE SOURCES OF PUBLIC FINANCING FOR HEALTH
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State budget
 Ministry of Health
 Ministry of Defense (Military hospital)
 Ministry of Justice (Prisons)
The obligatory contribution of health insurance
 Are gathered by Tax Office – HII
Directly payments / co-payments
Other donors
Public expenditures for health share only 2.7% of GDP
Albania’s health delivery and financing structure – note
the fragmentation of the funds
Taxation Authority
MOF Budget
for Health
Insurance
Contributions
MOH
Budget
Health Insurance
Fund/ Institute
Patient Out-Of-Pocket
Payments (co-pay)
PHC Centres, GPs
Municipal Councils
Hospitals
Health funds according to services
(Total 2008 - 30 348 milion lek)
Primary Health
Care
42%
Planing,
management
administration
3%
Public Health
3%
Hospital care
52%
THE PROBLEMS AT PRIMARY HEALTH CARE
SERVICES
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Administration of PHC Health
Centers
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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
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Providing of health services and their quality
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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
REFORM AT PHC
Based on:
 Law No. 7870, dt. 13.10.1994 “For Health Insurance in Republic of
Albania” changed
 DCM. No. 857, dt. 20.12.2006 “For financing of PHC services from
obligatory scheme of Health Insurance”
After January 2007, HII / RDHI has contracted with almost 420 Health
Centers (HC) all over the country
 Any of Health Center – juridical entity with their own account
 The Director of HC – representatives of HC for health insurance
relations
 The contracts are based at the offered packages of services
 1625 General / Family Practitioners and 6636 nurses contracted to
provide general services at HC.
REFORM AT PHC
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Move to a single purchaser financing for health services.
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Autonomy on Management, organization and operation of HC
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Definition of actors role on the system.
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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.
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Increasing of payment level for services providers.
REFORM AT PHC
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Setting up the necessary framework for health services market
function.
- Opportunity to exercise their profession as individual
contractor / or private
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Installation and using an unique system of information for all HC.
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Setting up the necessary framework for HC to manage the
allocated funds.
- New opportunity for increasing and using second
incomes
HOSPITAL SERVICES
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The hospital care in Republic of Albania is public service.
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Actually there are 36 hospitals. Number of beds - 9586 beds
which means an average of 1 bed for 322 habitants or 3.1
beds for 1000 habitants. This figure its quite high
considering the actual economic situation in Albania as well
as low utilization of the bed, with an average during last
years, 50-55%.
Number of the beds has been continually decreasing due to
strengthening of the primary health care.
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HOSPITAL SERVICE
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Physical structure of the hospital is under the desired level due to
problems related with objective lack of infrastructure at the regional
level as well as periodicities of investments provided by Ministry of
Health especially for medical equipment, maintain and consume
facilities.
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Some serius problems which reflcts at the quality and effectivenes of
the hospitals are related with lack of norms of, medical and
supported staff as well as standard protocols of treatment.
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The information system for the identification and evaluation of
hospital activities its missing.
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All those factors as well as low level of financing and weak
management have their negative impact on the services ofered by
them.
DURRES HOSPITAL EXPERIENCE
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Goal:
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Preparing the organizational, administrative and financial
situation for including the hospitals at health insurance
scheme
ACHIEVEMENT OF THE PROJECT
Hospital as juridical entity:
 Administrative independence
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Management – Board
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Financial independence
 Financing from HII – own decisions for using of
secondary incomes funds.
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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
PHARMACEUTICAL SERVICES
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Open pharmaceutical services, totally privatized.
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Monitored from Ministry of Health and National Center of Drugs
Control.
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Over 80 wholesalers and 900 pharmacies and agencies.
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The Basic List of Reimbursement Drugs (374 drugs) is compiled by
“Commission of Compiling and Reviewing of Reimbursement List of
Drugs” and from “Commission of Drugs Prices” setting up with order
of Minister of Health and approved by Council of Ministers with
proposal of Minister of Health once a year.
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Policies at pharmaceutical sector: rational usage of a number of
effective drugs, safe and with high quality, as well as available and
with a reasonable price for all the population.
ACHIEVEMENTS AND PROBLEMS
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The reforms at the sector and implementation of the pharmaceutical
policies have positive results on some directions such as: furnishing
of the market with a mix kind of drugs (3500 registered drugs), reactivate of domestic production, registration of the drugs, expanding
of drugs delivery, setting up of the new information base for drugs.
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Problems:
 Lack of transparency at prices of the drugs
 Circulation of contraband drugs as well as registration of
ineffective drugs, which are appealing from patients, doctors and
pharmacists.
 Lack at the information system, which need to include all the
units such as inspection, registration, information about drugs,
etc.
PROBLEMS WITH REIMBURSEMENT LIST OF DRUGS
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The reimbursed drugs and the cost of reimbursement are not
managed by HII
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Albania pay higher price for some drugs compare with other
countries in the region such as Slovenia – some time 89% higher.
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The priority and cost-effectively are not the critters for compiling the
list of drugs
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The new entry at the list of drugs are not accompanied by financial
support for HII.
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The physicians prescriptions consist in more drugs and of drugs
with higher cost. (due to mentality and professional education)
OBJECTIVES OF HII ON THE FUTURE
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The reimbursement list of drugs consist on:
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Part I – include drugs 100% reimbursed of the drug
price
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Part II – include drugs with co-payment for the drug
price
IMPROVEMENT OF THE GOVERNANCE ON THE
HEALTH SYSTEM
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Compiling of basic legislation for health care as well as for
obligatory scheme of health insurance
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Reviewing of licenses and accreditation procedures for
public and private system
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Regulation of contractual relation for strategic purchaser.
IMPROVING THE HEALTH SYSTEM FINANCING
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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
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Expanding of partnership public-private
 Encouragement of special service
privatization at all the levels of health care
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Reposition of manager role at public health institutions
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Setting up the standards, norms and clinical protocols in
management of health services.
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Consolidation of quality approach system and security of
health system
INCREASING OF ACCESS AT EFFECTIVE HEALTH
SERVICES
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Define of basic package of health services and its
monitoring
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Re construction of health service providers network
 Restricted due to geographical, demographic
and privatization policies conditions
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Improvement of refer system
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Maintaining and developing of programs for public health