Transcript Universal Health Coverage (UHC) and the Role of Private

Universal Health
Coverage (UHC) and the
Role of Private Hospitals
Presented by: Mr. Stephen Baker
Director: Halcom Management Services Ltd
25th September 2013
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UHC – Definition
• “a health care system which provides
health care and financial protection to
all its citizens”
• "developing health financing systems so
that all people have access to services
and do not suffer financial hardships
paying for them” World Health
Organisation 2010
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Universal Health Insurance or
Universal Coverage?
Universal Health Insurance or Universal Coverage?
• Much of the debate about NHI to date has focused on the
breadth or population dimension. While popular perception
is sometimes that those without medical schemes “have no
cover”, this is not the case.
• It seems though that there is confusion between universal
coverage for healthcare and universal coverage for health
insurance.
• It was estimated that only some 18.6% of Namibians had
health insurance cover in 2012. However everyone in the
country has access to healthcare, either in the public
sector or through medical schemes, or other employerbased arrangements.
• Dissatisfaction with the current national health system is
dissatisfaction with the quality of the care in the public
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To Achieve UHC
• A strong, efficient, well-run health system focused on
primary, preventative, curative & Rehabilitation
• Affordability – a system for financing health services
so people do not suffer financial hardship when using
them.
• Access to essential medicines and technologies to
diagnose and treat medical problems.
• A sufficient capacity of well-trained, motivated
health workers to provide the services to meet
patients’ needs based on the best available evidence.
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UHC Private
Stakeholders
• Revenue Collection
• Individuals
• Employers
• All taxpayers
• Brokers
• Pooling
• Medical Schemes
• Medical Scheme Members
• Purchasing
• Medical Schemes
• Medical Scheme Administrators
• Delivery
• Private Hospitals
• Pharmaceutical Industry
• Medical Practitioners
• Nurses
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Current Private Hospital
sector
• Total Private beds 578 (very little change over
prior years)
• 9 medical schemes cover ±182 000 lives = 546
beds
• Private sector running at capacity
• Beds per 1000 =3,1
• 1 GRN medical scheme covers ± 221000 lives
(Psemas) = 663 beds
• Total lives covered 18,6% of total population
• Private Sector characterized by:
• Quality service
• Quality Facility & Equipment
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Good clinical outcomes
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Current Government
Hospital sector
• Total Government beds = 5092
• Approx. 1,7 million lives not insured = 5100
beds
• Beds per 1000 population = 3
• Government has enough beds
• May not all be functional
• Old facilities
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• May not be in the right areas or where the
need is
Findings of the “report of the Presidential
Commission of enquiry into MOHSS Jan 2013”
• Shortage of health professionals
• Quality of patient care sub optimal
• Quality of training of doctors and nurses needs
improvement
• Quality of facilities – “dilapidation and decay”
• Poor status of medical equipment
• Poor transport systems for referred patients
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Annexure 1 - Figure 3:
Dilapidated Onandjokwe hospital TB ward
Annexure 1 - Figure 4: (a) Broken toilet in Nurses home, Outapi Hospital
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Private Hospitals
Perspective of UHC
• Committed to the goals of achieving Universal
access to quality healthcare in Namibia
• Willing to engage Government to develop solutions
and be part of the decision making process
• Able to share data, expertise and in-depth
understanding of the private sector in discussions of
national health system reform
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What can the Private
Hospital Sector offer
• Skills Development and Transfer
• Gap Hospitals
• Hospital management Services
• PPP’s
• Managed Care
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Skills Development and
Transfer
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Financial Management & Cost accounting expertise
Benchmarking techniques
Risk Management
Clinical Standards
Critical Pathways
Information Technology
Productivity
Training
Internships
Financial Management
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 Zero Based Budgeting
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Never assume that any cost is forever!
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Review every structure and process to determine what
might have changed and how it has affected cost
profile
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Review patient profile and also detremine what
changes might have taken place and how it might affect
service delivery and linked resources e.g. staffing,
equipment and services
Activity based costings
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“costing methodology that identifies activities in a hospital
and assigns the cost of each activity with resources to all
products and services according to the actual utilisation”.
Benchmarking
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“The comparison of one’s own hospital to other similar
systems (not every hospital is the same and the objective
is not meet what others are achieving but to stimulate the
thinking as to find better ways of delivering the same, if
not improved, services and at more cost effective levels)”
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“If you can’t measure it, you can’t improve it”
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Statistics based on Unit Values
 Nursing Staff cost per patient
 Average Length of Stay
 Medicine costs per patient day (PPD)
 Catering costs PPD
 Laundry costs PPD
 Fixed overheads per bed
 Maintenance costs per bed
 Admin cost per bed
Clinical Standards
Standards
 Determine the “best practice” way of doing things,
documenting then measuring compliance
 Identify what needs to be done to achieve optimum quality
of service and clinical outcomes
 Develop, implement, monitor and continuous improvement
of SOP’s
 Hospital accreditation
Information Technology
Use of Technology
 Professional resources are in seriously short supply
therefore, it is compelling that management finds
ways to complement available resources,
particularly Nursing staff
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The “digital” or “paper-less” hospital which
implements IT solutions to develop an
electronic patinet record (EPR/EMR)
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Less forms and less people intervention thereby
reducing propensity for errors
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GAP Hospitals
“ Gap Hospitals are typically private hospitals designed, built
and operated to cater for lower revenue models than existing
medical insurance pays: i.e. for NHI, UHC, Psemas etc.”
• Typical state of the art hospital costs N$ 2.5 – N$ 2.7 million
per bed i.e.: N$ 250 –N$ 270 million for a 100 bed hospital
• GAP hospital costs > N$ 1.7 million per bed
• More compact, optimally designed: 60 sq. per bed
compared to 90-100
• Single story (lifts cost 1 million each)
• Conservative finishes
• Rationalise on the latest medical equipment
• Short point to point distances, optimising efficiency
• Financial focus is on balancing project capex with
revenue streams and opex from proposed case mix
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• Result:
• GAP hospitals are cheaper to operate and staff
• Can produce the same IRR on 26% less fees, can
also allow risk sharing models i.e.: Per Diems,
Capitation etc.
• Produce the same quality of patient care
• Can be scaled according to demand (30-40 bed
hospitals are viable)
• Due to flexibility can be located in lower
population areas, increasing access to care.
• GAP hospitals are viable in an NHI setting
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Hospital Management
Services
• Provide management services to existing hospitals
• Develop centers of excellence i.e.: (Psychiatric, Level
1 Trauma, Radiation Oncology, Cardiology units)
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PPP’s
• To develop UHC private sector is able and willing to
engage in PPP’s
• Proposals were made for the Level 1 Trauma Hospital
in 2012, inclusive of N$ 200 million in funding in
response to MVA requests. MVA are now going to issue
another expression of interest.
• The bulk of forecasted expenditure on PPP’s from the
private sector would be hospital
construction/renovation
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Hospital Management
0.60%
Medical equipment services
0.70%
Ancillary medical and accomodation services
Clinical services
6.70%
8.70%
14.10%
Clinic construction or expansion
69.10%
Hospital construction or expansion
0.00%
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10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Why PPP’s in Healthcare
• Improving cost efficiency
• Improving quality of services
• Modernizing facilities, equipment & services
• Increasing access to underserved areas &
populations
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What is a PPP in
healthcare
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Government pays Private Operator service
payments but only once facility is
operational
Government defines service and output
requirements. Inputs, design, etc. to
bidders
Buying services, not equipment &
facilities.
Private party is typically responsible for all
or part of the capital financing
Payment is tied to performance not
inputs/milestones
Managed Care
“The management of an episode of care from preadmission to discharge”
Objectives:
• Reduce cost of each episode of care
• Reduce length of stay
• Improve patient outcomes
• Ensure appropriateness of treatment
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Summary
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Thank You