Micro-zorg verzekeringen

Christina de Vries

VoorgeschiedenisGezondheidszorg economieSoorten micro-zorg financiering Keuzes Valkuilen Stappen

Primary Health Care 1978Bamako initiatief (WHO en UNICEF)

onderscheidt drie acties voor PHC: strengthening community capacity the essential drug supply system financing of recurrent costs of PHC

Result: many revolving drug funds.

1. gezondheidszorg-kosten stijgen altijd door factoren als:

• Toename bevolking in catchment area• Utilisatie van zorg neemt toe• Verwachtingen clienten • Kosten voor medicijnen en technologie • Management • Infrastructuur • Kosten gekwalificeerd personeel

2. Inkomsten en subsidies voor de micro-zorg verzekering zijn niet gegarandeerd

• Financiële crisis• Opting out van clienten• Opportunity costs, competitie met

ander health beleid

1. Fee for service2. Drug sales3. Personal prepayment

4. P4P5. Income generation6. Community labour7. Donations8. Festival raffles, etc.9. Subsidies10. Social assistance

Recurrent currency Recurrent currency Annual or monthly

fixed payment, admin.

Monthly, admin. Enterprise risks One time or recurrent One time One time Annual, admin., buffer Drawing from fund,

voluntary work

Maintenance of buildingsRunning a bakery or a shopMilling rice and other grainsGrowing a palm plantationFarming fish, keeping chickens,

rabbits or goatsOperating a printing press

Selling clean, used, disposable syringe barrels as hair curlers or for artwork

Hiring out vehiclesSelling photocopies, printing servicesGrazing goats on health centre landRenting out tables and benchesFuneral servicesRenting out health education

equipment

1. limiting the breadth of population coverage

2. limiting the scope of publicly financed benefits to which people are entitled

3. limiting the depth of publicly financed coverage

limiting the breadth of population coverage

• by instituting means-tested access to publicly financed health care (excluding richer people),

• by excluding other groups (for example, self-employed people) or

• by allowing people to ‘opt out’ (effectively giving them a choice between public and private coverage);

limiting the scope of publicly financed benefits to which people are entitled

by rationing the quantity and/or quality of health care (including rationing by waiting lists);

limiting the depth of publicly financed coverage

by introducing or increasing price rationing (for example, user charges, own risk).

Insurance-related risksHet mechanisme veroorzaakt ander

productie - vraag dynamiek

Behaviour changes of Clients Service providers management

Threat Adverse selection Overuse Demand for

overprescription Fraud (use by non-

members) Irregular payment of

contributions

Threat Adverse selection Overuse Demand for

overprescription Fraud (use by non-

members) Irregular payment of

contributions

Preventive measure Household or group

enrolment Co-payment, referral letter Standardised treatment

guidelines, well defined packages

Membership card with photo; list of members up-to-date with payment

Annual contributions, sanctions

Threat Overprescription or

underprescription

Not enthousiastic to participate (fear for loss of income, work overload, power of clients)

Staff turn over

Threat Overprescription or

underprescription

Not enthousiastic to participate (fear for loss of income, work overload, power of clients)

Staff turn over

Preventive measure Adapted payment

arrangements (incentives) Negotiate respect of nat.

Treatment guidelines Defined package of

services Use of generic drugs Give good information, the

right incentives, must be a win-win situation

Set up of a good MIS for registration of pts and for payment

Continuous flow of information

Threat Embezzlement of

funds Insufficient

capacity and management skills

Cost escalation

Threat Embezzlement of

funds Insufficient

capacity and management skills

Cost escalation

Preventive measures Control by members

Create local expertise & support centres

Intensive communication between all partners

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