In Zhytomyr region model of health insurance questions and answers
the Vice-Minister of health of Ukraine Pavlo Kovtonyuk provides answers to topical questions on implementation of insurance medicine. What model of health insurance chose Ukraine, how it differs from others? Each country has its own insurance model of financing health care. In all of these models have three components: * prepaid insurance premium of the citizen: * accumulation of funds collected in the insurance pool; * payment to the medical institution for an insured event for a particular patient. Each country chooses its own way to collect insurance premiums, their accumulation and the implementation of insurance payments to medical institutions. Now the MINISTRY of health of Ukraine there are two practical assignments — to develop a real deployment of the insurance model of healthcare funding in 2017 and to provide 100% coverage of citizens with medical care. So I selected a model that requires minimal changes in legislation and recommended by the Who and international partners. 1. Prepaid insurance premium citizen The collection of insurance premiums in Ukraine is already there: it is a common system of taxation. In Ukraine a very large proportion of the black labor market. But even if a citizen receives a salary in an envelope or goes to work abroad, he pays indirect taxes (VAT, excise duties), making any purchase in the store. The introduction of additional special levy on wages or payroll will lead to further shadowing of the labor market in conditions of economic crisis. Restricting access to medical care for citizens who are not officially employed, cannot be discussed — access to medicine cannot be repressive by the method of regulation of the labour market. Therefore was the chosen method of collection of insurance contributions through General taxation — it is already there and working. 2. The accumulation of collected funds in the insurance pool The Fund is also already active: paid by the citizens taxes are accumulated in the national budget. In some countries, a special private or state Fund, where accumulated assets. In practice, such funds are never sufficient and dofantasy from the budget. Also, the establishment of such a Fund in the Ukrainian reality carries serious risks of corruption and is guaranteed to lead to long-term political bargaining. There is another model where funds accumulate private insurance companies. In practice, private insurance companies benefit from working with healthy patients and profitable to work with patients — and countries that have implemented such a model has faced challenges in access to care of citizens who most need it. In addition, such a scheme from 20% of the health budget goes to the profit of private companies that Ukraine can not afford financially. So I chose a scheme with the accumulation of funds in the budget — it already exists and works. 3. Payment for an insured event for a particular patient This element does not exist in Ukraine and we create it. Its implementation creates a technical Agency, “national Health service” (in the status of Central body of Executive power). The collected funds remain in the budget, the Agency does not own them, but only manages. The Agency has three key functions: * to conclude contracts with medical institutions and private practices, * monitor the quality of services, * collect and analyze data. The role of the Agency is to pay particular doctors and medical institutions for providing services to specific patients. That Agency maintains the principle “money follow the patient". A similar model (taxes-the budget-the Agency) operates in the UK, Scandinavia, Italy, Spain, Canada, and has shown its high efficiency. Also this model is recommended by who for implementation in countries that are developing. Primary level How to work insurance model at the primary level? Each patient chooses a family doctor (GP, pediatrician), and concludes with him an agreement that clearly defines the amount of guaranteed medical services. Income family physician will directly depend on the number of transactions with patients. The Agency on the basis of these data provides payment to the doctor for each patient. How much the Agency will pay for one citizen? The Tariff for each patient takes into account the risk ratios for sex and age (infants, children, women of reproductive age, seniors). Because the management of these patients more, and the rate for them is significantly higher. For example, the coefficient on children under one year will be at least twice the ratio of the control group males 18-39 years. The average family doctor will receive from the Agency 210 UAH per one patient. Why the model is called insurance, if the Agency at the primary level does not pay for specific cases, and pays the annual fee for the support of the patient? International experience shows that the expansion of primary care into separate services and control over it leads to the fact that the cost of the administrative work of the family doctor is higher than the effect. We introduce a model that has proved its effectiveness in the world — the doctor receives a rate for the support of the patient and is responsible for the quality of work and the Agency together with the citizen controls the outcome. The rate for patients is formed so to cover all the average situation that a family doctor treats patients. Our goal is to create a new repressive system of reporting instead of the old. Our task is to build financial incentives, which the family doctor will be interested to support the healthy citizen, and the citizen will be able to change the doctor if he did not like the quality of the services. The control of work of family doctors? The doctor monitors the Agency and the citizen. Main control — from the citizens themselves. If they don't like the quality of the doctor, they change it. The Agency will initiate contract termination for non-compliance of medical treatment protocols. Also we are now looking for an opportunity to create a hotline for patients, where they can consult specialists of the Agency with the request to check the quality of work of family doctor. Will the family doctor to issue a sick leave? Will it be the forms of strict accountability and who will control the family doctor in this matter? Thus, primary care physicians will be given a hospital. Together with the Ministry of social policy of Ukraine we are working to develop e-sick list and we hope that it will be introduced in 2017. Why the emphasis is on a family doctor, internist, pediatrician? The family doctor knows everything about your patients and about how the medical system. Its main task — not to allow the patient to get sick. But if this happens, the family doctor becomes his chief assistant. If the family doctor can cure the citizen himself, he does it — and international experience shows that this is the most effectively. Primary care of efficiently working systems in the world covers up to 82% of all medical cases. In Ukraine, to family physicians, pediatricians, internists treat only 20% of cases. If the family doctor cannot cure a man himself, he directs it in the system of health care, coordinates treatment, he knows where it is I can do. What exactly does a primary care physician, and for which he pays the Agency? The family doctor is the person to whom you can turn with all questions related to health, an agent of the citizen in the medical world. A family doctor has several key objectives: * early identification of risks to human health, * treatment of all, what can a doctor without specialized equipment, * coordination of treatment of the citizen in more complex cases. The list of duties of family doctors, internists, pediatricians will be spelled out in standard first aid and added to their agreements with national. There are many complaints that family doctors are not professionally trained and will not be able to heal people? The Ukrainian experience shows that by creating the right financial incentives and training of doctors in modern European techniques, it is possible to achieve a significant improvement in quality of care. And our goal is to give doctors access to these tools. We are not trying to deceive anyone - Ukrainian doctors know what they can do. Our task is to create conditions under which every Ukrainian until 2019, the year will be able to find a doctor who knows how to operate in accordance with modern standards. We are convinced that Ukrainian doctors are no less capable than the Croatian, Macedonian, Polish. And the introduction of decent wages and competition for patient will do the rest. Why a primary is being reformed, not improving something that works now? Primary care is the Foundation of any health system that works effectively. If the primary is down, the system falls apart, as happened in Ukraine. A primary care system capable 20-30% of the budget of medicine to solve 80% problems of the citizens. This means that we can free resources to treat people with more complicated diseases. You will not end money for a primary in the middle of the year? Since we calculated the means per citizen, is also scheduled for the entire next year. In some regions the reform will work faster? Conditions to run the system we create at the same time across the country. Any preferences or “pilot regions” will not. And success in a specific region will depend on the efforts of the local authorities. The MINISTRY of health is developing a road map and a clear list of requirements that you must comply with the local authorities to ensure that the Agency has begun contracts with practitioners in primary care medicine. In those regions that meet these conditions first, people will feel the difference faster than others. How to choose your family doctor? This was reported in the Zhytomyr regional state administration.Ïåðåâåäåíî ñåðâèñîì "ßíäåêñ.Ïåðåâîä÷èê": translate.yandex.ru.
Source: http://uzinform.com.ua/
