Transcript HCF - Impulsis

Micro-zorg verzekeringen
Christina de Vries
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Voorgeschiedenis
Gezondheidszorg economie
Soorten micro-zorg financiering
Keuzes
Valkuilen
Stappen
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Primary Health Care 1978
Bamako initiatief (WHO en UNICEF)
onderscheidt drie acties voor PHC:
 strengthening community capacity
 the essential drug supply system
 financing of recurrent costs of PHC
Result: many revolving drug funds.
gezondheidszorg-kosten stijgen altijd door
factoren als:
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Toename bevolking in catchment area
Utilisatie van zorg neemt toe
Verwachtingen clienten
Kosten voor medicijnen en technologie
Management
Infrastructuur
Kosten gekwalificeerd personeel
Inkomsten en subsidies voor de micro-zorg
verzekering zijn niet gegarandeerd
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Financiële crisis
Opting out van clienten
Opportunity costs, competitie met ander health
beleid
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Fee for service
Drug sales
Personal prepayment
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P4P
Income generation
Community labour
Donations
Festival raffles, etc.
Subsidies
Social assistance
Recurrent currency
Recurrent currency
Annual or monthly fixed
payment, admin.
 Monthly, admin.
 Enterprise risks
 One time or recurrent
 One time
 One time
 Annual, admin., buffer
 Drawing from fund,
voluntary work
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Maintenance of buildings
Running a bakery or a shop
Milling rice and other grains
Growing a palm plantation
Farming fish, keeping chickens, rabbits or
goats
Operating a printing press
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Selling clean, used, disposable syringe barrels
as hair curlers or for artwork
Hiring out vehicles
Selling photocopies, printing services
Grazing goats on health centre land
Renting out tables and benches
Funeral services
Renting out health education equipment
1. limiting the breadth of population coverage
2. limiting the scope of publicly financed benefits to
which people are entitled
3. limiting the depth of publicly financed coverage
limiting the breadth of population coverage
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by instituting means-tested access to publicly
financed health care (excluding richer people),
by excluding other groups (for example, selfemployed people) or
by allowing people to ‘opt out’ (effectively
giving them a choice between public and private
coverage);
limiting the scope of publicly financed benefits
to which people are entitled
by rationing the quantity and/or quality of health
care (including rationing by waiting lists);
limiting the depth of publicly financed coverage
by introducing or increasing price rationing
(for example, user charges, own risk).
Insurance-related risks
Het mechanisme veroorzaakt ander productie vraag dynamiek
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Behaviour changes of
 Clients
 Service providers
 management
Threat
 Adverse selection
 Overuse
 Demand for
overprescription
 Fraud (use by nonmembers)
 Irregular payment of
contributions
Threat
 Adverse selection
 Overuse
 Demand for
overprescription
 Fraud (use by nonmembers)
 Irregular payment of
contributions
Preventive measure
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Household or group enrolment
Co-payment, referral letter
Standardised treatment
guidelines, well defined
packages
Membership card with photo;
list of members up-to-date with
payment
Annual contributions, sanctions
Threat
 Overprescription or
underprescription
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Not enthousiastic to participate
(fear for loss of income, work
overload, power of clients)
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Staff turn over
Threat
 Overprescription or
underprescription
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Not enthousiastic to participate
(fear for loss of income, work
overload, power of clients)
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Staff turn over
Preventive measure
 Adapted payment arrangements
(incentives)
 Negotiate respect of nat.
Treatment guidelines
 Defined package of services
 Use of generic drugs
 Give good information, the right
incentives, must be a win-win
situation
 Set up of a good MIS for
registration of pts and for
payment
 Continuous flow of information
Threat
 Embezzlement of
funds
 Insufficient capacity
and management skills
 Cost escalation
Threat
 Embezzlement of
funds
 Insufficient capacity
and management skills
 Cost escalation
Preventive measures
 Control by members
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Create local expertise
& support centres
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Intensive
communication
between all partners
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Bezint eer ge begint
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Alle hens aan dek
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Alles of niets