Transcript VAZHDIMI I REFORMAVE NE FINANCIMIN E KUJDESIT …

REPUBLIC OF ALBANIA
INSTITUTE OF HEALTH INSURANCE
REFORMS IN THE HEALTH CARE
FINANCING
The development OF health insurance
system in albania
ELVANA HANA
GENERAL DIRECTOR
III Balkanic Forum, Montenegro – September 2009
Financing fields:
 Primary Health Care:
414 General and Specialized
HC.
 Hospital Health Care:
4 University Hospitals
12 Regional Hospitals
23 Municipal Hospitals
 11 Unique tertiary
examinations.
 Drugs reimbursement from the
Reimbursement List.
377 drugs or 944 trading
alternatives.
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Main Issues
I.
Deepening in the Financial Reform of the Primary Health Care.
Achievements and challenges.
II.
The extension of the financing scheme in the hospital health care.
III. Strengthen of HII role as a main purchaser of the health services.
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BENEFITS FROM THE REFORM ON PHC
Service Providers
Insured persons
 Financial
 A better access to obtain health
services;
 Experience
– Financial management
– Management of H. Resources
– Organization
 Medications/medical stuff
 Increase of service quality
 Conditions for following C.M.E
 Improvement of conditions to
obtain better quality from the
services.
 Standardized services (Package
of services)
 Better monitoring regarding the
 Strengthen of HC role as gatekeeper.
chronic diseases.
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Reforms achievements in PHC
 More founds were allocated to the HC as a consequence of the improvement of
their performance and quality indicators.
 The HC have a better conceptions regarding the management of the allocated
founds.
 The level of autonomy of the HC has increased. The contracts with HC have
improved and the Boards function.
 There have been improvement in the collection of the secondary incomes and
better possibilities to manage them by the HC.
 Improvement of the information technology
 It is in process of implementation, supportive supervision, as a new
methodology applied to help in solving the HC problems and improve their
performance
 HII has provided adequate support in the implementation of professional training
programs for the service providers.
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PHC FINANCING COMPARISON
(January - August 2007-2008-2009)
2007
2008
2009
1,000,000
800,000
600,000
400,000
200,000
Vl
or
Sa e
ra
nd
e
Fi
er
jir
ok
as
te
r
Ko
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e
Ku
ke
s
Tr
op
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e
Le
zh
Sh e
ko
de
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Ti
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G
Be
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ur
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El
ba
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The budget allocated to the HC in 2009 was 13% larger than in 2008
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Performance indicator
(no of vizits / day)
2006 - 2009
Performance indicator
10
9
8
7
6
5
4
3
2
1
0
8.7
7.9
5.9
no visits/day
2006
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8.8
2007
2008
2009
The Health Centers that have benefited over 80% of the financing for the
realized performance indicator:
In 2007 — 24 HC; in 2008 — 170 HC and on the first 6 m 2009 — 217 HC
PERFORMANCE FINANCING COMPARISON
(January - August 2007 2008 2009)
2007
2008
2009
80,000
60,000
40,000
20,000
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Sa
ra
nd
e
Vl
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Ku
ke
s
Tr
op
oj
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Le
zh
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Sh
ko
de
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Ti
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Ko
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ok
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Quality indicators - Bonus 5%
Quality indicators (2008-2009)
Standard - 100 points
80
70
60
50
40
68.1
59.7
65.2
65.5
III-2008
IV-2008
54
30
20
10
0
I-2008
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II-2008
6M-2009
Health Centers that have benefited over 70% of the financing for the
realized quality indicators:
In 2008 — no HC and in the first 6 m of 2009 — 64 HC
BONUS FINANCING COMPARISON
(January - August 2007 2008 2009)
40,000
2007
2008
2009
30,000
20,000
10,000
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Sa
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Vl
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The Information Technology achieved:
The application of the standard form for the visits and medical procedures
by the medical staff of the HC, which helps in:
- reporting, monitoring and financing the Performance and Services
quality
- decision-making to increase the service quality
The electronic registration of the population and the application of the
effective payments per capita (still in process)
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The extension of the financing reform in the
hospital service
What do we aim by the reforms in the hospital health care :
 Change the method of financing. HII as an active purchaser
 Autonomy of Hospitals, which consist of:
– financial: existence of a separate budget, the right to propose it and to
manage it financially.
– organizational : relative independence to be self-organized
– normative: the power to issue self-regulatory norms.
– contractual freedom : the possibility to enter in relations freely with the
others.
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Hospital legal status
 The hospital is a legal person,
 public,
 un-budgetary,
 non-profitable,
 with a separate bank account,
 provides medical services approved by the Ministry of Health.
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Funding of Hospitals by the Health Insurance
Ministry of Health
Transfers from
the State Budget
(non-Active )
Contributions of the
active
population
ISS – GDT
HII
Investments
(General Directory
of Taxation)
RDHCI
(Branches of HII)
Contracts
Regional hospital
Contracts
Board
District hospital
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District hospital
The start of the reform in Hospital care in the
January 2009 enabled:

Singing of the bilateral contracts with 39 hospitals :
- 4 University hospitals
- 12 Regional hospitals
- 23 Municipal hospitals

Signing of individual contracts between director – staff (in process)

Financing by budgeting according to a Services List

Application of a new method of reporting for the hospital
performance:
- Clinical
- Economic and financial
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(continuation)
 Working for the calculation of the actual cost for each hospital according
to the clinical services
 Defining the cost structure according to the elements of expenditure
 Working for the issuance of the actual cost per day/stay for each hospital
 Defining of some elements for measuring the hospitals performance like
bed utilization etc.
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Increase of HII role as an active purchaser requires:
I. In the Primary Healthcare
Improvement of the level of autonomy of the HC. Deepening in the
process of decentralization.
Efficiency on the information system utilization (the informatization of the
HC across the country which is still in process of conclusion
 pplication of a system with differential reward for differential work within
the HC, depending on the individual fulfillment of the quantitative and
qualitative indicators of the job.
Improvement of the method of HC financing to increase the level of their
utilization and quality service. (Revision on the actual form of payment
85/ 10 / 5 of the HC’s budget)
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(continuation)
The cost calculation of the primary service.
Support in the process of drafting guidelines for clinical practice regarding
the family doctors.
Implementation of incentive financial policies regarding the health
coverage of the vulnerable categories of the population.
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II. In the hospital healthcare:
Improving the legal framework.
Improving the level of autonomy in the hospitals
Setting the standards for the costs calculation:
- per service,
- per diagnose case and diagnose group (DRG).
Approving standards for quality and performance indicators
Implementing a unique informative system
Approving of hospital treatment protocols.
Improving and implementing rigorously a referral system in all the
health services levels.
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( continuation )
Implementing a flexible payment system based on the performance of
each provider.
Trainings of the hospital managers and hospital staff regarding the
organizational, financial and technical issues.
Increase of access by the population to benefit services.
Reducing the level of informality in the services.
Promote privatization of specific services at all levels of health care.
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THANK YOU
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