Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Implementing health sector reforms and addressing public financing constraints: can they go hand in hand? Irina Smirnov, Economist, The World Bank Constitutional provisions in Health Insurance and Care system State BiH Republika Srpska Canton A Federation BiH Canton B Brčko District Canton C Republika Srpska Health System Central Government Ministry of Health Public Health Insurance Fund Institute for Public Health Primary health care assigned to the local government level Resource base: contributions, other payments by contributors and other sources Federation Health System Federation BiH Canton A Municipality B1 Canton B Municipality B2 Canton C Municipality B3 Canton A Min. of Health PHF HIF Wide variations accross cantons in access to health services Health Spending in BiH Health care financing and delivery systems are fragile and not sustainable Ongoing reforms are both broader and in a more advanced state than in other social sectors, yet need to be deepened to ensure sustainability and improve the efficiency, equity and quality Per capita expenditures in Health Sector (in KM), 1999 Revenues and expenditures of BiH Health Sector, 1999 8,5 9,0 8,0 8,0 7,7 8,0 6,8 7,0 250,0 6,7 6,0 200,0 5,0 226,0 175,0 150,0 KM 4,0 3,0 98,0 100,0 2,0 1,0 50,0 0,0 BiH FBiH RS 0,0 Revenues as % of GDP Expenditures as % of GDP BiH Besides that , 4.7 % GDP in private payments Per capita expenditures (in KM) FBiH RS Health Spending in BiH (2) Financing of health care scores poorly on equity and efficiency, despite the good intentions of the system’s designers Fragmentation of the system – no economies of scale and no risk-sharing Information systems are under-developed and there is no information exchange Barriers hinder access to health care underfunding results in rationing arrears in insurance contribution payments makes access uncertain Cross-border care (Entities, cantons) coordination, portability of insurance Health Spending in BiH (3) Most available health indicators in BiH are acceptable for low-income countries; but, BiH’s health sector, like others in Eastern Europe, under-emphasizes health promotion and disease prevention Fragmentation and weak management of the system – lack of coordination and inefficient use of specialized skills Limited resources and role of PHIs in FBiH in planning, analysis and informed decision-making Health Spending in BiH (4) Public dissatisfaction with health care in BiH Wrong mix of primary, secondary, and tertiary levels of care and facilities Shortages of materials and equipment and uneven knowledge of medical protocols A physician-dominated health care system that does not utilize the potential for nurses and other health professionals Health Reforms are needed... The challenge: reintegrating the system to better exploit economies of scale in the delivery, financing, and administration of health care Improve financial sustainability/discipline, flexibility and equity enforcing revenue collection and broader coverage assigning function with positive externalities to the FBiH government (primary health care) implementing hard budget constraints establishing global budgets for health care facilities higher level of co-payments, with exemptions for the needy Pursuing better coordination through the State government Health Reforms are needed... The challenge also includes... Introducing clear rules for the administration of private payments: prohibiting receipt of private payments by publicly employed doctors for services provided as part of their normal duties, allowing private payments to non-publiclyemployed doctors if they are transparent and do not conflict with related public policies, levying charges set at cost-recovery levels for the use of publicly owned facilities by doctors who are practicing privately Health Reforms are needed... And last but not the least... Strengthening Effectiveness of Delivery Systems Rationalizing the network of health facilities Coordinating health care and rationalizing facility capabilities across Entity borders, and, in the Federation, across cantonal borders to avoid duplication of services Assessing the overall effectiveness and efficiency with which pharmaceuticals are procured and used in BiH Strengthen procurement processes for equipment and materials And the main question is still unanswered... Public spending on health in BiH will NOT grow over medium term However, reforms must continue, efficiency, equity and quality need to improve