1 / 42

PUBLIC INSURANCES IN BOLIVIA

PUBLIC INSURANCES IN BOLIVIA. Ministry of Health and Sports Public Insurances Unit. BOLIVIA. Dr. Margarita Flores. Ministry of Health and Sports. INTRODUCTION. Health protection, disaggregated by provider – 2003 (National Health Insurance Institute - INASES). Public health: 30%

gabe
Download Presentation

PUBLIC INSURANCES IN BOLIVIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PUBLIC INSURANCES IN BOLIVIA Ministry of Health and Sports Public Insurances Unit BOLIVIA Dr. Margarita Flores

  2. Ministry of Health and Sports

  3. INTRODUCTION Health protection, disaggregated by provider – 2003 (National Health Insurance Institute - INASES) Public health: 30% Short-term social security (SSCP): 25% Private health services: 12% “33% of the Bolivian population is unprotected”

  4. 30% unprotected population 30% public sub-sector 28% SSCP sub-sector 12% private sub-sector 12% private 33% unprotected population 25% SSCP 30% public health INTRODUCTION Health protection, disaggregated by provider – 2003 (INASES) NATIONAL CONTEXT Health protection coverage, 2004 Sources: National Health Information System - SNIS, National Institute of Statistics - INE and INASES, 2003-2004

  5. INTRODUCTION National Health Spending, disaggregated by source of financing – 2002 (in thousands of current dollars) Sources Total Percentage 20.94% Public Sector 113,416 41.07% SSCP 222,410 Private Insurance 20,727 3.83% NGO 8,086 1.49% Households 176,908 32.67% 541,547 TOTAL 6.95% Percentage of GDP Source: Estudio CNFGS. Cuentas Nacionales de Financiamiento y Gasto en Salud. Segunda Edición. Marina Cárdenas. Bolivia – 2004.

  6. INTRODUCTION Public health: US$ 42 per capita (30%) SSCP: US$ 91.5 per capita (25%) Private: US$ 190 per capita (12%)

  7. PUBLIC HEALTH INSURANCES • National Maternal and Child Insurance D.S. 24403 in 1996 32 Services. • Basic Health Insurance D.S. 25265 in 1998 92 Services. • Free Old-Age Health Insurance Law 1886 in 1998 Comprehensive Health Care. • Universal Maternal and Child Insurance Law 2426 in 2002 500 Services. • Expanded SUMI Law 3250 in 2005 27 Services in Sexual and Reproductive Health, Women of Reproductive Age. • Health Insurance for the Older Adult (SSPAM) Law 3323 in 2006 Comprehensive Care, Payment is 100% Municipal.

  8. Current situationSUMI Ministry of Health and Sports

  9. WHAT IS THE SUMI • Component of of the Bolivian Poverty Reduction Strategy. • It is a state policy and health strategy for reducing maternal and child morbi-mortality. • It provides free services for the child under five years of age and the pregnant woman up to 6 months following delivery, in a compulsory, restrictive manner in public and social security establishments. • The services are provided using the existing technology and problem-solving capacity that corresponds to the levels of care and according to established protocols.

  10. SUMI • It is a State Policy created by the Law of the Republic 2426 • Priority within the Health Policy of the Ministry of Health and Sports • Component of the Bolivian Poverty Reduction Strategy • Primary instrument for meeting the Millennium Development Goals

  11. SUMI • Reduce maternal and child morbidity and mortality • Protect the most vulnerable population groups in the country, where the highest mortality rates are concentrated

  12. SUMI BENEFICIARIES • Girls and boys from birth to five years of age • Pregnant women, from the start of pregnancy until 6 months following the birth • TARGET POPULATION: • 1,279,269 children under 5 years of age • 328,682 pregnant women

  13. POPULATION PROJECTIONS SOURCE: National Institute of Statistics - INE

  14. SUMIWHERE IS IT PROVIDED? • Throughout the country, in 2,259 health establishments, in urban and rural areas • In Public Health and Short-Term Social Security Establishments (National Health Insurance) and others that are included through agreements • At all levels of care, according to problem-solving capacity and available technology

  15. SUMI HOW IS IT PROVIDED? • It is universal, comprehensive and free (For the user) • Provided in a compulsory, restrictive manner • For communities with difficult access or without health infrastructure, there are Mobile Brigades through the Extend (Extensa) Program

  16. EXPANSION OF THE SUMI In December 2005, Law Number 3250 for the expansion of the SUMI was passed Services that have a close link with safe maternity: 1. Prevention of Cervical Cancer 2. Treatment of Pre-malignant Injuries 3. Voluntary Contraceptive Methods 4. Treatment of STIs

  17. FINANCIAL ADMINISTRATION Ministry of Health and Sports

  18. Financing of the SUMI Tributary Co-Participation 7% in 2003 8% in 2004 10% starting in 2005 Human Resources Public: National Treasury - TGN Social Security: Own resources Exceeds Lacks Investment in Health Infrastructure, Basic Sanitation and Special Health Insurance Programs Ministry of Health and Sports National Solidarity Fund SUMI Essential medicines, supplies and reagents Up to 10% of the resources from the Dialogue Account 2000

  19. ACHIEVEMENTS OF THE PUBLIC HEALTH INSURANCES Ministry of Health and Sports

  20. Ministerio de Salud y Deportes Contribution to reductions in the Mortality Rates One of the contributions of the Public Insurances implemented in the country is the reduction of the mortality rates. Although this represents an important process, we remain nevertheless the country with the second highest maternal mortality ratio and child and neonatal mortality rates.

  21. MORTALITY RATES IN CHILDREN < 5 YEARS OLD -47% ENDSA: Demographic and Health Survey Source : Monitoring and Evaluation of the Poverty Reduction Strategy – PRS

  22. INFANT MORTALITY RATES < 1 YEAR OLD -44%

  23. INFANT MORTALITY RATES < 1 YEAR OLD Infant MR Per 1,000 live births Urban Rural Years

  24. MATERNAL MORTALITY RATE Per 100,000 live births PRS Project MDGs Years

  25. PERCENTAGE OF TRIBUTARY CO-PARTICIPATION BY DEPARTMENT, SUMI 2004

  26. MUNICIPAL TRIBUTARY CO-PARTICIPATION SUMI 2004 Expressed in Bs. and %

  27. Percentage of Municipalities that accessed the National Solidarity Fund (FSN), by Department 2004

  28. NATIONAL SOLIDARITY FUND SUMI - 2004 - Expressed in Bs. Percentage used Percentage unused

  29. ANALYSIS OF THE S.U.M.I.

  30. Problems identified • Bureaucracy and deficient management at the municipal level, which impedes timely payment to health establishments for services provided under the SUMI • Population that is highly concentrated in urban areas (64%), principally in the capital cities of La Paz (Including El Alto), Cochabamba and Santa Cruz • Work-related instability and high rotation of personnel, without information about the procedures, knowledge and norms for new human resources in the management sphere

  31. ChallengeUNIVERSAL HEALTH INSURANCE (SUS) Ministry of Health and Sports

  32. FROM THE CURRENT GOVERNMENT AND THE MINISTRY OF HEALTH AND SPORTS • Gathering the experiences with public insurances, as a gradual building process, in order to achieve UNIVERSAL HEALTH INSURANCE - SUS

  33. UNIVERSAL HEALTH INSURANCE OBJECTIVE ACHIEVE ACCESS TO HEALTH SERVICES FOR THE ENTIRE BOLIVIAN POPULATION, THROUGHOUT THE WHOLE NATIONAL TERRITORY AND IN A COMPREHENSIVE MANNER

  34. UNIVERSAL HEALTH INSURANCE SPECIFIC OBJECTIVES • Participation of the entire National Health System, • Improve the quality of medical care, • Implement the Model of Family, Community and Intercultural Health as an operational arm of the Insurance, • Ensure that Health Promotion and Prevention are pillars of the Health System, • Establish instruments to provide quality and efficiency in the provision of Health Services.

  35. SOURCE OF FINANCING First Phase Years 0-21 Implementation January2007 * HIPC: Heavily Indebted Poor Countries Source: Ministry of Housing

  36. TARGET POPULATION From 0 to 59 Years of Age

  37. UNIVERSAL HEALTH INSURANCE ANALYSIS FOR ITS IMPLEMENTATION Sustainability Study Medical Technical Study Coverage Premium Multi-disciplinary Technical Team Actuarial Mathematic Study Legal Study SUS Target Population Socio- Economic Study Study of the Epidemiological Profile

  38. UNIVERSAL HEALTH INSURANCE • FIRST PHASE 2006 ADMINISTRATION D.S. 28748 – Financing of the harmonization of Health insurance measures- from years 5 to 21- Development of the draft project for the SUS Law REQUIRED STUDIES • Study of Population Projections, • Actuarial Study disaggregated by levels of care, • Analysis and Evaluation of the Cost-Effectiveness of Public Insurances, • Study of the structure of costs based on Public Insurances,

  39. UNIVERSAL HEALTH INSURANCE • FIRST PHASE 2006 ADMINISTRATION REQUIRED STUDIES • Study of general costing of SUS services, • Study of the Sustainability and Economic-Financial Viability of the SUS, • Analysis of information on prevalent pathologies using statistics from the National Health Information System - SNIS, the National Health Insurance Institute - INASES, the National Health Insurance - Cajas de Salud, and others, • Analysis of information on Incidence, Prevalence and Frequency • Technical-medical-financial proposal for the Universal Health Insurance • Analysis of indicators.

  40. UNIVERSAL HEALTH INSURANCE (SUS) 2006 Administration FIRST ACHIEVEMENT • D.S. 28748 – Financing of the harmonization of public health insurance measures SECOND ACHIEVEMENT • Draft project of the SUS Law THIRD ACHIEVEMENT • Health Care Model: Family, intercultural and community • Quality management

  41. “THOSE THAT ATTEMPT REFORM WILL HAVE AS ENEMIES EVERYONE THAT TAKES ADVANTAGE OF THE OLD SYSTEM, AND AS WARM ADMIRERS ONLY THOSE THAT HOPE TO OBTAIN SOME TYPE OF BENEFIT FROM THE NEW ORDER” Anonymous

  42. Ministry of Health and Sports THANK YOU

More Related