Zekere gezondheidszorg met verzekering ?

1. Micro-zorg verzekeringen Christina de Vries Zekere gezondheidszorg met verzekering ?

2. Deze presentatie • Voorgeschiedenis • Gezondheidszorg economie • Soorten micro-zorg financiering • Keuzes • Valkuilen • Stappen

3. Bamako initiatief 1987 • 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.

4. Delivery of health care - economics • gezondheidszorg-kosten stijgen altijd door factoren als: • Toename bevolking in catchment area • Utilisatie van zorg neemt toe • Verwachtingen clienten • Kosten voor medicijnen en technologie • Management • Infrastructuur • Kosten gekwalificeerd personeel

5. Delivery of health care -economics • Inkomsten en subsidies voor de micro-zorg verzekering zijn niet gegarandeerd • Financiële crisis • Opting out van clienten • Opportunity costs, competitie met ander health beleid

6. Community-based health financing • Fee for service • Drug sales • Personal prepayment • 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

7. Examples of IGA for HCF (1) • 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

8. Examples of IGA for HCF at smaller scale • 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

9. What level of health care should we provide ?Three dimensions of health care coverage: 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

10. Health care coverage - 1 limiting the breadthof population coverage • by instituting means-tested access to publicly financed health care (excluding richer people), • by excluding other groups (for example, self-employed people) or • by allowing people to ‘opt out’ (effectively giving them a choice between public and private coverage);

11. Health care coverage -2 limiting the scopeof publicly financed benefits to which people are entitled by rationing the quantity and/or quality of health care (including rationing by waiting lists);

12. Health care coverage limiting the depthof publicly financed coverage by introducing or increasing price rationing (for example, user charges, own risk).

13. Sustainability trade-offs

14. Valkuilen • Insurance-related risks Het mechanisme veroorzaakt ander productie - vraag dynamiek • Behaviour changes of • Clients • Service providers • management

15. Threats related to clients Threat • Adverse selection • Overuse • Demand for overprescription • Fraud (use by non-members) • Irregular payment of contributions

16. Threats related to clients Threat • Adverse selection • Overuse • Demand for overprescription • Fraud (use by non-members) • Irregular payment of contributions Preventive measure • 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

17. Threats related to health care providers Threat • Overprescription or underprescription • Not enthousiastic to participate (fear for loss of income, work overload, power of clients) • Staff turn over

18. Threats related to health care providers Threat • Overprescription or underprescription • Not enthousiastic to participate (fear for loss of income, work overload, power of clients) • 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

19. Threats related to the managers Threat • Embezzlement of funds • Insufficient capacity and management skills • Cost escalation

20. Threats related to the managers Threat • Embezzlement of funds • Insufficient capacity and management skills • Cost escalation Preventive measures • Control by members • Create local expertise & support centres • Intensive communication between all partners

21. Conclusie • Bezint eer ge begint • Alle hens aan dek • Alles of niets