Capitation Info Strategic Plan of the Dom zdravlja Subotica presented Prof. Dr. Vesna Bjegovic-Mikanović, professor of health management at the Faculty of Medi- cine, University of Belgrade and expert on the project “Support to the Implementation of Capi- tation Payment in Primary Health Care in Ser- bia” attended the presentation of the Strategic Plan for 2010 to 2015 at the Dom zdravlja (DZ) Subotica which was held on 19th November in Subotica. Management of DZ Subotica prepared the Stra- tegic Plan which indicated that the main strategic programs will be promotion of preventive health services, promotion of healthy lifestyles, orga- nizing educational programs for employees and registration of users of health care by chosen doctors. The plan was presented by Director of DZ Dr. Ruzica Crnjakovic, Dr. Ljiljana Miljacki, Head of GP and Ivanka Beokovic, assistant di- rector for finance. Prof. Dr. Bjegovic-Mikanovic commended the Strategic Plan of DZ Subotica and held lecture on the introduction of capitation which was attended by employees of DZ Subotica. She stressed that the reform of financing of Primary Health Care lead to significant changes in the relationship between doctors and patients. “Manage- ment of your DZ prepared an excellent plan. Capitation will lead to big changes and better doctors will have in- creased salaries, but no one will lose the salary”, said Dr. Bjegovic-Mikanovic. In November Prof. Michael Jones, expert on our proj- ect visited several DZs in order to revise strategic plans (Zajecar, Cuprija, Vozdovac, Zemun, Sabac, Sremska Mitrovica, Nis, Pozarevac, Kragujevac and Pancevo). Prof. Jones together with Prof. Dr. Bjegovic-Mikanovic held seminars for strategic planning during June and July 2009. In this issue 7 Support to the Implementation of Capitation Payment in Primary Health Care in Serbia A Project funded by the European Union Republic of Serbia MINISTRY OF HEALTH Capitation Seminar about Capitation About Capitation By Vukasin Radulovic and Zoran Kaljevic Strategic Plan of DZ Subotica
Transcript
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
CapitationInfo
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
InfoStrategic Plan of the Dom zdravlja Subotica presented
Prof. Dr. Vesna Bjegovic-Mikanović, professor of health management at the Faculty of Medi-cine, University of Belgrade and expert on the project “Support to the Implementation of Capi-tation Payment in Primary Health Care in Ser-bia” attended the presentation of the Strategic Plan for 2010 to 2015 at the Dom zdravlja (DZ) Subotica which was held on 19th November in Subotica.
Management of DZ Subotica prepared the Stra-tegic Plan which indicated that the main strategic programs will be promotion of preventive health services, promotion of healthy lifestyles, orga-nizing educational programs for employees and registration of users of health care by chosen doctors. The plan was presented by Director of DZ Dr. Ruzica Crnjakovic, Dr. Ljiljana Miljacki, Head of GP and Ivanka Beokovic, assistant di-rector for fi nance.
Prof. Dr. Bjegovic-Mikanovic commended the Strategic Plan of DZ Subotica and held lecture on the introduction of capitation which was attended by employees of DZ Subotica. She stressed that the reform of fi nancing of Primary Health Care lead to signifi cant changes in the relationship between doctors and patients. “Manage-ment of your DZ prepared an excellent plan. Capitation will lead to big changes and better doctors will have in-creased salaries, but no one will lose the salary”, said Dr. Bjegovic-Mikanovic.
In November Prof. Michael Jones, expert on our proj-ect visited several DZs in order to revise strategic plans (Zajecar, Cuprija, Vozdovac, Zemun, Sabac, Sremska Mitrovica, Nis, Pozarevac, Kragujevac and Pancevo). Prof. Jones together with Prof. Dr. Bjegovic-Mikanovic held seminars for strategic planning during June and July 2009.
In this issue
7Info7Info
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union Republic of Serbia
MINISTRY OF HEALTH
Capitation
Seminar about Capitation
About Capitation
By Vukasin Radulovicand Zoran Kaljevic
Strategic Plan ofDZ Subotica
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Info7Info7InfoCapitation
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Vukasin Radulovic
Serbia: Toward performance based financing in primary health care
Vukasin Radulovic, B.Sc.E.E, Executive director of Health Insurance Fund of SerbiaandZoran Kaljevic, M.Sc.E.E.CIO of Health Insurance Fund of Serbia
Developed western countries introduced the capitation model of payment of primary healthcare services mostly to establish the mechanism for controlling costs in situations when service-based payment was running out of control. Former communist countries had completely different starting points and thus the reasons for deciding for capitation payment model, and Serbia was not the exception either.
The health insurance system in Serbia is organized on the basis of Bismarck solidarity model. There is one institution in Serbia, the Health Insurance Fund of Serbia (HIF) which is a national and non-profit organization for health insurance. The HIF is funded through health insurance contribution payment financing healthcare services for around 7 million insurees in Serbia. Unfortunately, the funds allocated for healthcare are rather modest and with 280 EUR per capita Serbia is among the countries at the bottom of the list of the European countries.
Healthcare funding is linear and on the basis of the determined budget in accordance with items determined in advance such as salaries, medicines, sanitation material, energents and the similar. Physicians’ salaries and the salaries of healthcare professionals in general are defined according to salary classes determined by professional qualifications, and smaller adjustments are possible only on the basis of years of service, managerial bonus and clinical title. The advantage of this funding
method is reflected in the impossibility to exceed the budgeted funds. The weakness of this funding method is in not distinguishing between those who work better, more and with more quality. To put it more simply, if a physician examines 10 and the other one 70 patients in average on a daily basis, there is no mechanism for rewarding the one who works better than the other one since they will be paid the same and guaranteed salary. It is simply destimulating.
While the western countries used the capitation for switching from one to another output-based payment system, the idea of introducing the capitation in Serbia
is the idea to switch from the input-based to some sort of performance-based payment system. It is the payment system in which the ones whose performance exceeds the average should be recognized and rewarded.
The HIF developed a powerful information system as a preparation for capitation and agreed on the electronic format of an invoice for rendered services with all healthcare services providers. As of 1st January 2009, the HIF collects the information with respect to each healthcare service (over 10 million a month) including a physician that rendered it,
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Info7Info7InfoCapitation
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Zoran Kaljevic
time and place, a recipient and type of services. In addition, five years ago, a similar system was developed, which pharmacies now use to invoice medicines dispensed on the basis of around 5,5 million prescriptions a month for the medicines prescribed by primary healthcare physicians. These data represent the basis for measuring and comparing the performance of physicians in Serbia.
As of 1st January 2010, a health professional salary will consist of two parts: a fixed and variable part in the proportion of 70:30 %. The fixed part will include all that the classification on the basis of salary classes used to include to-date, while a variable part will depend on the performance.
The performance will be assessed in 4 categories: registration, rationality, efficiency and quality. One key indicator is chosen for each of the categories that will be monitored so that the
performance appraisal would be easier to conduct. The category of registration means the number of patients that have chosen a particular physician, while the category of rationality means the average value of prescribed prescription drugs per insuree. The category of efficiency includes the number of services rendered, while the category of quality includes the number of preventive versus the total number of examinations. It is clear that each category could include more indicators on the basis of which the performance appraisal could be made, but we must start from the most important ones. Each category was previously adjusted against corrective factors such as for example, years, and certain limitations were introduced as well.
The key issue is that the HIF did not want to set any limits and standards during the assessment and it simply let the physicians impose them on their own. The performance appraisal of physicians against the categories is actually comparing the physicians with each other. Thus the physicians in each category get a higher performance appraisal because their performance exceeds the average performance compared to all the physicians in that category. The sum of grades per categories is the basis for the calculation of a variable part of the salary.
This is just the first step and we are looking forward to changes after decades of waiting for changes in this field.
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Info7Info7InfoCapitation
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union Republic of Serbia
MINISTRY OF HEALTH
Seminars on capitation
Within the project activities, the last in a series of seminars dedicated to introduction of health care fi nancing and payment to health care providers to management teams for Primary Health Care (PHC) was held in Belgrade on November, 6th 2009.
Management teams from DZ Vozdovac, Valjevo, Zemun, Kikinda, Pozarevac, Pancevo, Sabac i Cuprija participated in the training.
Lecturers and instructors in these training sessions were Prof. Dr. Vesna Bjegovic-Mikanovic, professor of health management at the Faculty of Medicine, University of Belgrade and project expert, Mr. George Boulton, a Project Expert and Mr. Vukasin
Radulovic, Executive Director of the Health Insurance Fund.
In addition to the general fi nancing system, the training focused on the fi nancing of PHC and the methodology of Capitation payment as well as practice and performance of doctors in PHC and some comparison of different countries.
Participants are enabled to recognize the (potential and actual) effects of payment systems and fi nancial incentives for physicians for implementation of capitation. They were provided the opportunity for further analysis of specifi c case studies related to the upcoming changes in their institutions.
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Data fi gures on the registered insureesOctober 2009. Source: Health Insurance Fund
stat
isti
csInfo7Info7InfoCapitation
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Total in Pilot DZs 3.805.724 711.242 18,69% 3.479.477 2.111.041 60,67%
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Republic of SerbiaMINISTRY OF HEALTH
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Република СрбијаМИНИСТАРСТВО ЗДРАВЉА
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u SrbijiProjekat fi nansira Evropska unija
The contents of this publication are the sole responsibility of ‘‘Support to the Implementation of Capitation Payment in Primary Health Care in Serbia’’ and can in no way be taken to refl ect the views of the European Union.
Subotica Kikinda
Srem. Mitrovica Šabac
Smederevo Užice
Kraljevo Kruševac
Zaječar Pirot
Vranje Zemun
Voždovac Savski Venac
Sombor Novi Sad Pančevo Valjevo Požarevac Čačak Kragujevac Ćuprija Niš Leskovac Vračar Zvezdara Pali lula Novi Beograd
Info7Info7InfoCapitation
Support to the Implementation of Capitation Payment in Primary Health Care in SerbiaA Project funded by the European Union
Srem. Mitrovica
KOSOVO IMETOHIJA
CONTACT
Support to the Implementation of Capitationin Primary Health Care in Serbia
Pasterova 2, 11129 Belgrade, Serbia P. O. Box 55, Post Offi ce 102 Tel +381 11 2687 470Fax +381 11 206 2068
