Transcript Slide 1

Moldova Experience in
reduction of Health Inequity
Larisa CATRINICI
Minister of Health
SEECP Health Ministerial Meeting
Chişinău, 7 November 2008
Health inequities a promotional point
for the system reform
1. Low access to the medical services
2. Disadvantaged situation of the patients with
social-economical related diseases
3. Non corresponding between expectations,
needs, supply and amount of medical services
4. Inequity in providing of the medical services in
rural arias
5. Patients unsatisfaction regarding medical
services quality
6. Respecting of the patient rights in health
services decisions-making process
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1. Inequity:
Low access to the medical services
Solutions :
• Implementation of the Mandatory Health Insurance (2004)
• Establishment of the National Health Insurance Company
• Elaboration and adopting of the legislation regarding
funding and health services providers contracting within
MHI framework
• Autonomy of public medical services providers
contracted on the per capita (PHC) and fee for services
basis
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Life expectation at birth
68,6
Standardized Mortality
per 100 000 inhabitants
68,5
68,4
68,2
68
67,8
1998
67,63
67,6
67,4
67,2
67
Speranta de viata la
nastere
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2006
1998 –
1427.19
Child mortality under 5
years old per 1 000 alive
born
Infant mortality per 1 000
alive born
25
21,2
20
30
18,3
25
15
11,2
10
1995
2000
2007
27,3
23,2
20
15
14,2
10
5
5
0
Mortalitatea infantilă
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0
Mortalitatea infantilă
1995
2000
2007
Maternal mortality per 100 000 alive borne
45
40,8
40
35
30
27,1
25
20
15
15,6
10
5
0
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Mortalitatea maternă
1995
2000
2007
2. Inequity:
• Disadvantaged situation of the patients
with social-economical related
diseases
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Solution:
I.
State budget coverage of the uninsured patients suffering of
social related diseases
II. State financed National Programs:
For communicable disease control
• Tuberculosis
• HIV/AIDS and sexual transmitted infections
• The Viral Hepatites (B and C)
• Cholera and another acute diarrhea diseases
•Immunization
• Blood Transfusion Safety and blood products
assurance
For non-communicable disease
control
• Healthy life style promotion
• MoldDiab
•Iodine deficiency diseases
• Mental Health
• Oncology
• Narcology and drug addiction
•Transplant
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National Programs State financing
250000
232457,2
200000
158265,5
150000
115056,5
100000
56872,4
63235,1
42636,7
50000
13641,2
16070,3
2000
2001
0
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2002
2003
2004
2005
2006
2007
HIV/AIDS Incidence per
100 000 inhabitants
TB Morbidity per 100 000
inhabitants
250
14
237,7
11,7
12
200
10
150
100
8
132
99,1
105,4
79,5
2000
2003
2007
6
4
53,9
4,8
4,1
50
2
0
0
Incidenta
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Prevalenta
Inciden'a
2000
2003
2007
3. Inequity:
Non corresponding between expectations, needs,
supply and amount of medical services
Solution:
• Establishing a centralized fund, designed for a
sustainable and needs adjusted health system
• Approving a basic package of health services
(Unique Programm)
• Renovating and improving the technical and
material capacities of health services public
providers
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Pooling of all financial recourses for
the health system
Alocations from
the state budget
66.7%
Payroll Insurance
contribution
(3%+3%)
31.6%
National Health
Insurance Company
Ministry of
Health
National
Programs
National level
Hospitals
Municipal and Raional
Hospitals
Primary Health Care
Insured population
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Flat rate insurance
contributions for
self-employed
1.7%
MHI fund increasing trend including the financial
transfers from the state budget
3000
2646,2
2500
2036,4
2000
1559,1
1477,2
1500
1281,7
1001,5
976,9
1000
1195
839,5
605
651
500
0
2001
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2004
2005
2006
2007
2008
State Budget
Total
4. Inequity:
The low amount of the medical services delivered
in rural area
Solution:
• Strengthening the PHC, particularly in rural area
• Financial autonomy of the PHC providers
• Socio-economic support for the specialists
employed in rural area
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5. Inequity:
Low quality of the medical services
Solution:
•Standards and clinical protocols elaboration
• Health services providers accreditation
•Internal Audit implementation
•Systemic approach of the health issues:
–National Health Policy
– Health system development Strategy (2008-2017)
–Republic of Moldova - European Union Action Plan
–National Development Strategy (2008-2011)
•Information Technologies Implementation
•Re-orientation to disease prevention
• Healthy life stile promotion
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6. Inequity:
Non respecting of the patient rights in health
services decisions-making process
Solution:
• Adopting the Law on Patients Rights and
Responsibilities
• Adopting the Law on Medical Professional Obligations
• Adopting the Deontological Codex
• Assurance of the medical services providing
transparency
• Improving the communication on health related issues
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Inequity
Solution
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