Post on 13-Feb-2017
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Global Network
30 years of Experience
Tailor Made Solutions
24/7 Assistance
all-in-one solution
Medical Cost Containment in Turkey
Risks and Solutions
2015
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Marmassistance Intro and Cost Containment ConceptsTurkish Healthcare System
Public Healthcare System RisksPrivate Healthcare System Risks
SolutionsBenefits of a Local Partner
Information TechnologyConclusion
Contents
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• Pioneer and leading assistance company in Turkey• Nearly 30 years of experience in medical, roadside, travel and legal
assistance services• State-of-the-art 24/7 multi-lingual Alarm Centre• In-house team of full-time doctors and specialised personnel• ISO 9001:2002 which has been renewed every two years• ISO 27001:2013 Information Security Management System• ITIC Cost Containment Company of the Year Award Finalist (2010, 2012)• ITIC Cost Containment Company of the Year Award 2013
About UsLeading Assistance Provider in Turkey and the Middle East
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• Turkey• Middle East: Iran, Iraq, Jordan, Israel, Lebanon, S.Arabia, Kuwait, Bahrain , Qatar, Oman, The UAE, Yemen.• North Africa: Egypt, Libya.• Eurasia: Azerbaijan, Georgia, Armenia, Greece, Bulgaria, Cyprus, • Asia: Turkmenistan, Kazakhstan, Tajikistan, Pakistan, Afghanistan, India, Bangladesh
Service NetworkAssisting Globally
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HospitalAgreements
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Evidence Based
Medicine
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Policy Matching
Local Legislations
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IndustryBenchmarki
ng
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Financial Review
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Cost Containment Concepts6 Step Structure
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CPost-DischargeRE-PRICING
BAdmissionEVALUATION & BILL ANALYSIS
A Pre-AdmissionLEAD PRICING
Maximal
Minimal
CCEffectivenes
s
Cost Containment ConceptsApproach
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• Centralised governance• Health Transformation Programme, in effect since 2003, has
dramatically expanded healthcare infrastructure• 2011 health financing breakdown:
72.7% public sources19.2% private out-of-pocket payments8.1% corporations other than health insurance
• Health staff have a quantitative performance-based salary component (average 52% of the salary)
Turkish Public Healthcare System
Hospital Type Foreign Patients (2012) Total Income (Euro) Average Income/PatientPublic 22,491 32% 44,982,000 2000
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• Represents 36% of hospitals and nearly 18% of all hospital beds• Hospitals receive a flat fee/patient from the Social Security Institution• Facilities are free to charge additional costs up to a maximum of 90%
more than the public hospital price• 50 JCI accredited hospitals, foreign patient influx main incentive
Turkish Private Healthcare System
Hospital Type Foreign Patients (2012) Total Income (Euro) Average Income/PatientPrivate 47,972 68% 145,172,000 3026
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• Significant increase in foreign patient prices since 2012 (2 fold to up to 10 fold for certain items)
• Being run as business models• Pushes private hospitals to inflate prices as well• Emphasis on high productivity pushes costs up, with no improvement in
quality • Cost Collection Agencies taking advantage of lower public hospital and
2nd rate private hospital prices to make inflated invoices • Chief Physicians are more actively involved in business rather than
clinical matters• Ministry of Health monitors revenues and intervenes accordingly• Increasing awareness of foreign patients’ revenue potential
Risks in Public Health Sector
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• Monopolistic mergers and acquisitions by the major hospital groups • Free market system with no price limits• Late notifications by primary insurers to local partners (post admission –
post discharge stages)• Each hospital handling foreign patients can have 3 to 7 price lists as per tourist origin:
1. Arab2. US3. European4. Turkish Citizen5. Russian6. Local Private Medical Insurance Company Insured7. SGK + Turkish Citizen
Risks in Private Health Sector
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• Clinics operating seasonally are compelled to gross a year’s income within 6 months
• Inflates prices of other hospitals
January February March April May June July August September October November December0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
Tourist vs Tourist Patients Monthly Trends
Tourists x 100 Tourist Patients
Risks in Private Health Sector
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• Fierce competition for the latest technology between hospitals leading to higher investments and price inflation
• Hospitals target IPMIS and Assistance Companies for investment returns• Non-medical background management/ownership• Pharmaceutical companies influences• Chain of Beneficiaries: Taxies - Hotels – Tour Operators – Ambulance
providers – Hospitals – Clinics
Risks in Private Health Sector
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• Discount agreements with the hospitals• Strict adherence to local pricing standards when reviewing bills• Clinically sound medical doctors cross matching medical reports with
charged services• Monitoring for unnecessary or uncovered interventions throughout the
hospitalisation• Pre-admission notification by the primary insurer facilitates patient
referral to reasonably priced high quality hospitals
Solutions
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• Detailed, updated knowledge about price rates, number of lists and policies
• Retrospective cost negotiation/reduction facility• Consistent cost containment approach towards the hospitals• Cheapest possible implementation of local pricing standards (TTB)• Auditing to identify consistently over-charging, fraudulent
hospitals for primary insurers and the MoH• Assistance partners with strong mutual support
Solutions
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• Better understanding of local market dynamics• On spot monitoring and investigations• Improved management capability of local pricing• Local cultural familiarity• Reliability of the service providers• Reputation• Period of existence• Technological edge
Benefits of a Local Partner
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In-House Technology and R&D Team24/7 Availability and SupportRemote Management and MaintenanceIP, PSTN, GSM and Satellite Communication SystemsBusiness Continuity and DR ReadinessIn-House Developed ERP SoftwareMarmNet – Realtime Collaboration ToolTransparent and Evidence Based ReportingGlobally Accepted and Certified Processes
30 years of Big Data Analysis for Best ResultTailor Made Solutions
InformationTechnologiesWhat We Provide Through Increased Productivity
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• In-house developed MarmNET -Online File Handling System- lets your operations department handle big volumes of files with total ease, control and transparency.
• MarmNET allows you to monitor all your medical files handled by us through a one-stop website.
• You will easily find any specific file you’re looking for, see at what stage that file is, view all documents associated with that file.
• What’s more, you will be able to find a general overview of your annual operations through enlightening statistics along with delicate and confidential financial reports.
RealtimeCollaboration
Online CaseTracking
ComprehensiveStatistics
TransparentReporting
MarmNetTransparent and Evidence Based Reporting
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Next generation mobile application using “Personalized Mobility and Cloud Communication” platform. Application is compatible with IOS and Android devices.
Realtime Collaboration via Video, Voice and TextCustomizable ArchitectureHardware Independent
Roadside Assistanc
e
Information
Services
24/7 Alarm Center
Emergency
Assistance
Time and Cost Saving
Mobile AppLet Us Assist You Anytime Anywhere
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• The exponential expansion of the Turkish Healthcare System over the last decade has had a direct impact on costs
• High investments in infrastructure, technology and accreditations has resulted in a high profit orientation
• An established, scientific and consistent professional approach is needed to counter the inflating prices
• Effective and timely support from the primary insurer is also vital for maximising the cost containment outcomes
Conclusion
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AddressGrup Center Is Merkezi Mustafa Akyol Sokak No:158 Yenisehir Kurtköy, Pendik 34912 Istanbul / Turkey
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+90 216 560 07 24+90 216 560 07 07marm@marm.com.tr
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