Transcript Pealkiri

Ensuring financial sustainability
of health system in Estonia
Hannes Danilov
Head of Management Board
JOINT OECD AND WHO MEETING ON FINANCIAL SUSTAINABILITY OF HEALTH SYSTEMS
TALLINN, ESTONIA 28-29, JUNE, 2012
Estonian Health Insurance Fund
(EHIF)
• Established 2001
‐ independent legal body (semi-public)
‐ acts under Health Insurance Law
‐ 4 geographically placed regional offices
Main obligations of Estonian
Health Insurance Fund
• To public:
- purchasing of high quality health care
services
- compensating temporary sick leave benefits
- compensating prescribed medications
• Sustainability:
- solvency of the Fund
- sustainability of funding
Pre crisis time 2001- 2007(8)
• Economical growth, specially after the joining
EU 2004, was from 6,7 to 10,3% per year
• Collecting reserves in EHIF:
- solvency reserve – 6% of total budget
- risk reserve – 2% of budget of health
by law
care benefits
- surplus – difference between
forecasted revenues and expenditures
EHIF
initiative
EHIF revenues, expenditures and
reserves
1000
900
800
700
600
Revnues mln. eur
500
Expend. mln.eur
400
Solvency reserves mln.eur
Surplus mln. eur
300
200
100
2016*
2015*
2014*
2013*
2012*
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
0
Decisions made coping the crisis – dental
care and nursing care
• Before 2009 all insured persons aged 19 and over
were entitled for dental care cash benefit of 19.18
eur, but from 2009 only retired persons retained this
right
• 15% co-insurance rate for nursing inpatient care,
2010
Decisions made coping the crisis –
temporary sick leave benefits
• Sharing responsibilities between patient and
employer from July 2009:
- No benefits paid for the first 3 days of sickness or
injury (previously only one day)
- Employer pays benefits from 4 to 8 days, from 9th
pays EHIF (previously employer did not participate)
- Reducing benefit rate from 80% to 70%
Decisions made coping the crisis – reducing
tariffs
• 2009
- Reducing all health services tariffs by 6%
• 2011
- Raising health services tariffs by 1%
• 2012
‐ Tariffs raised to pre-crisis level
• Key messages for EHIF
-
-
Reducing out of pocket payments
for medications
Strengthening primary health
care
Improving health technology
assessment
Monitoring outcome indicators
Stronger oversight of capital
investments in infrastructure and
technology
Paying attention to improving
„value for money“
EHIF expenditures and OOP for prescribed
medications 2007 - 2011
OOP for medications %
•
•
39
•
38
37
36
OOP for medications
%
•
•
35
•
34
33
•
32
2007
2008
2009
2010
2011
Requested ATC based prescriptions
since 2010
Implementing electronic prescription
with prescription centre 2010
Requested offering of cheapest
medication in pharmacies 2012
Promotion campaignes for public
OOP has fallen 37,8% to 34,5% within
last 3 years for medications
Ceiling of compensation 50%
compensated prescribed medications
will abolish since Oct 2012
Total OOP has decreesed from 24 per
cent 2006 to 19 per cent 2011
Stregthening primary care - better coordination
of care for chronically ill patients
‐P4P payment
‐Financial support for recruiting second family nurse
since Jan 2013
‐Request to be referred by family physician to specialist
for chronically ill patients since Oct 2012
‐E-referrals, E-health IT system
Improving Health Technology Assessment
• Using pharmacoeconomical assessment of
medications before including positive list since 2004
• Economic evaluation of health care services before
added to the benefit package since 2003
• Developing health technology assessment unit in
Tartu University within next 5 years. Supported by
the EU structural funds
Monitoring outcome indicators
Case-mix index by hospitals
Proportion of caesarian sections from all
deliveries in hospitals
European Health Consumer Index
„value for money“
Lessons learned
• Assess your risks and be ready for crisis situations
before the crisis
• Crisis time - introduce reasoned actions and try to
avoid delays
• When you need to make cuts, try to retain balance of
burden on providers and insured persons
• Retain sustainability of health system
Thank you for your attention!