moldova experience in reduction of health inequity
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Moldova Experience in reduction of Health Inequity. Larisa CATRINICI Minister of Health SEECP Health Ministerial Meeting Chişinău, 7 November 2008. Health i n equities a promotional point for the system reform. 1. Low access to the medical services - PowerPoint PPT PresentationTRANSCRIPT
Moldova Experience in Moldova Experience in reduction of Health Inequityreduction of Health Inequity
Larisa CATRINICIMinister of Health SEECP Health Ministerial MeetingChişinău, 7 November 2008
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Health inequities a promotional point for the
system reform 1. Low access to the medical services
2. Disadvantaged situation of the patients with social-economical related diseases
3. Non corresponding between expectations, needs, supply and amount of medical services
4. Inequity in providing of the medical services in rural arias
5. Patients unsatisfaction regarding medical services quality
6. Respecting of the patient rights in health services decisions-making process
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1. Inequity:Low access to the medical services
Solutions :• Implementation of the Mandatory Health Insurance (2004)• Establishment of the National Health Insurance Company • Elaboration and adopting of the legislation regarding
funding and health services providers contracting within MHI framework
• Autonomy of public medical services providers contracted on the per capita (PHC) and fee for services basis
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67,63
68,5
67
67,2
67,4
67,6
67,8
68
68,2
68,4
68,6
Speranta de viata lanastere
1998
2006
2006 – 1368.87
1998 – 1427.19
Standardized Mortality per 100 000 inhabitants
Life expectation at birth
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21,2
18,3
11,2
0
5
10
15
20
25
Mortalitatea infantilă
199520002007
Infant mortality per 1 000 alive born
27,3
23,2
14,2
0
5
10
15
20
25
30
Mortalitatea infantilă
199520002007
Child mortality under 5 years old per 1 000 alive
born
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Maternal mortality per 100 000 alive borne
40,8
27,1
15,6
0
5
10
15
20
25
30
35
40
45
Mortalitatea maternă
199520002007
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2. Inequity:
• Disadvantaged situation of the patients with social-economical related diseases
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Solution:
For non-communicable disease control• Healthy life style promotion
• MoldDiab
•Iodine deficiency diseases
• Mental Health
• Oncology
• Narcology and drug addiction
•Transplant
For communicable disease control
• Tuberculosis
• HIV/AIDS and sexual transmitted infections
• The Viral Hepatites (B and C)
• Cholera and another acute diarrhea diseases
•Immunization
• Blood Transfusion Safety and blood products assurance
I. State budget coverage of the uninsured patients suffering of social related diseases
II. State financed National Programs:
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National Programs State financing
13641,2 16070,3
42636,756872,4
63235,1
115056,5
158265,5
232457,2
0
50000
100000
150000
200000
250000
2000 2001 2002 2003 2004 2005 2006 2007
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237,7
105,4
132
53,9
79,5
99,1
0
50
100
150
200
250
Incidenta Prevalenta
200020032007
TB Morbidity per 100 000 inhabitants
4,1
4,8
11,7
0
2
4
6
8
10
12
14
Inciden'a
200020032007
HIV/AIDS Incidence per 100 000 inhabitants
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3. Inequity:Non corresponding between expectations, needs,
supply and amount of medical services
• Establishing a centralized fund, designed for a sustainable and needs adjusted health system
• Approving a basic package of health services (Unique Programm)
• Renovating and improving the technical and material capacities of health services public providers
Solution:
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Pooling of all financial recourses for the health
system
National level Hospitals
Municipal and Raional Hospitals
Primary Health Care
Alocations from the state budget
Payroll Insurance contribution
(3%+3%)
National Health Insurance Company
Flat rate insurance contributions for
self-employed
Insured population
66.7% 1.7%31.6%
Ministry of Health
National Programs
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MHI fund increasing trend including the financial
transfers from the state budget
605 651
976,9
1281,7
1559,1
2036,4
2646,2
839,5
1001,5
1195
1477,2
0
500
1000
1500
2000
2500
3000
2001 2004 2005 2006 2007 2008
State BudgetTotal
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4. Inequity:The low amount of the medical services delivered in rural area
Solution:• Strengthening the PHC, particularly in rural area• Financial autonomy of the PHC providers• Socio-economic support for the specialists
employed in rural area
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5. Inequity: Low quality of the medical services
Solution:•Standards and clinical protocols elaboration • Health services providers accreditation•Internal Audit implementation •Systemic approach of the health issues:
–National Health Policy– Health system development Strategy (2008-2017)–Republic of Moldova - European Union Action Plan –National Development Strategy (2008-2011)
•Information Technologies Implementation •Re-orientation to disease prevention• Healthy life stile promotion
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6. Inequity: Non respecting of the patient rights in health
services decisions-making process Solution:
• Adopting the Law on Patients Rights and Responsibilities
• Adopting the Law on Medical Professional Obligations• Adopting the Deontological Codex• Assurance of the medical services providing
transparency• Improving the communication on health related issues
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Inequity
Solution
