Finance and quality in health Finance and quality in health care: assessment , contracting care: assessment , contracting and accreditation in Albanian and accreditation in Albanian context context Health Policy Dialog “Challenges in Health Policy Dialog “Challenges in reforming the health financing system in reforming the health financing system in Albania“ Albania“ Durres 24 - 25 February 2006 Durres 24 - 25 February 2006 Isuf Kalo Isuf Kalo [email protected][email protected][email protected][email protected]NATIONAL CENTRE OF QUALITY, SAFETY, AND ACCREDITATION OF HEALTH INSTITUTIONS
Transcript
Finance and quality in health Finance and quality in health care: assessment , contracting care: assessment , contracting and accreditation in Albanian and accreditation in Albanian
contextcontext
Health Policy Dialog “Challenges in Health Policy Dialog “Challenges in reforming the health financing system in reforming the health financing system in
Albania“Albania“Durres 24 - 25 February 2006Durres 24 - 25 February 2006
IOM USA 2001IOM USA 2001Crossing the quality chasm: A new health system for the 21Crossing the quality chasm: A new health system for the 21stst
centurycentury
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Health system goalsHealth system goals
Health improvement
Responsiveness to people expectations
Fairness in financing
Level Distribution
Quality Equity
Efficien
cy
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Health Systems have a Health Systems have a responsibility not just to responsibility not just to
improve people’s health, but improve people’s health, but to protect them against the to protect them against the financial burden of illness financial burden of illness
and to treat them with and to treat them with dignity and appropriate dignity and appropriate
quality quality
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ResponsivenessResponsiveness
Respect for personsRespect for persons• Dignity – not humiliationDignity – not humiliation• Confidentiality for one’s health Confidentiality for one’s health
informationinformation• ChoiceChoice
Client orientationClient orientation• Prompt attentionPrompt attention• Amenities of adequate qualityAmenities of adequate quality• Access to social support networksAccess to social support networks
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Accountability in Health Accountability in Health system system
Includes:Includes:
• The quality of The quality of answerabilityanswerability(the right to receive relevant information (the right to receive relevant information and explanation for actions)and explanation for actions)
• The quality of The quality of enforceabilityenforceability(the right to impose sanctions if the (the right to impose sanctions if the information or rationale is deemed information or rationale is deemed inappropriateinappropriate
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Evolution of health Evolution of health systemssystems
Classical universalism:Classical universalism:
““All services for all”All services for all”
New universalism:New universalism:
Select : “Only effective interventions for Select : “Only effective interventions for all” all” ((less for better and more…!less for better and more…!))
WHO: World Health Report 2000WHO: World Health Report 2000
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Active PurchasingActive Purchasing
Requires active consideration Requires active consideration of costs and effects of of costs and effects of competing interventions.competing interventions.
Need for technology Need for technology assessment, broader concept.assessment, broader concept.
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“… if we do not have measures on health
outcome our reforms are doomed to fail …”
Alan Maynard
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Health Technology Health Technology AssessmentAssessment
Public & Public & community community healthhealth
• Utilization Utilization
• PromotionPromotion
• PreventionPrevention
• ProtectionProtection
Environmental Environmental healthhealth
Individual care Individual care provisionprovision
• Infrastructure and Infrastructure and equipmentequipment
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OutcomeOutcomess
CostCost
UseUse
““In God we In God we trust”trust”
Everyone else must provide Everyone else must provide evidence!evidence!
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A legitimate request from A legitimate request from the Minister of Healththe Minister of Health
•I expect from you the truth I expect from you the truth and nothing but the truth.and nothing but the truth.
•How to distinguish the truth How to distinguish the truth from advertising?from advertising?
•I expect you to produce I expect you to produce evidence for, or against, the evidence for, or against, the policy.policy.
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Is Free market in public Is Free market in public health system so free ? health system so free ?
Common marketCommon market
• Freedom to Freedom to Offer Offer
• Freedom in Freedom in Demands Demands
• Disregards to Disregards to the real needsthe real needs
Health care marketHealth care market • OffersOffers --Freedom in Private sector Freedom in Private sector --Planed offerPlaned offer in Public sector in Public sector
• DemandsDemands - - In private sector: Freedom In private sector: Freedom
--In public sectorIn public sector:: most cost effective most cost effective interventionsinterventions ( according ( according to the agreed package)to the agreed package)
• Based on Real NeedsBased on Real Needs HTA , EBM, Clinical HTA , EBM, Clinical
guidelinesguidelines
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Health technology regulationHealth technology regulation
Develop, implement and enforce regulation and Develop, implement and enforce regulation and standards to ensure the safety, effectiveness and standards to ensure the safety, effectiveness and
quality of health services and medical devicesquality of health services and medical devices
• Market country notification, registrationMarket country notification, registration
• Post-market vigilance, adverse events and Post-market vigilance, adverse events and problem reportingproblem reporting
• Dissatisfaction/importer control & Dissatisfaction/importer control & inspectioninspection
• Safety and efficiency performance Safety and efficiency performance assessmentassessment
• Harmonization of regulatory proceduresHarmonization of regulatory procedures
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Health Technology ManagementHealth Technology Management
Provide the appropriate physical and technological Provide the appropriate physical and technological infrastructure in accordance with the level of attention infrastructure in accordance with the level of attention
of the health facility and resource availabilityof the health facility and resource availability
• PlanningPlanning
• ProcurementProcurement
• UseUse
• MaintenanceMaintenance
• EvaluationEvaluation
• DischargeDischarge
• ReplacementReplacement
• Introduction of Introduction of new technew tech
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The Albanian health systemThe Albanian health systemUnder pressure to change:Under pressure to change:
• From the inside - new socio-economic situation - democratization (people’s civil and political rights) - free initiative/market, privatization, competition
• From the outside - regional and European integration - international commitments and standards - globalization (“death of borders” )
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“Children of bondage, have weak wings in the freedom…”
E. Jevtushenko
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Are Albanian patients real Are Albanian patients real ”consumers“ in the free health ”consumers“ in the free health
care market?care market?
• Not aware about their Not aware about their real health care needs real health care needs
• Not informed on the Not informed on the quality and the quality and the appropriateness of appropriateness of the heath care the heath care services they are services they are paying for paying for
• Not able to make Not able to make informed choices due informed choices due to the lack of the to the lack of the awareness about the awareness about the alternatives and costsalternatives and costs
• Not information about Not information about the real risk or the the real risk or the potential medical error potential medical error
• Non compensated for Non compensated for the damage or bad the damage or bad quality of care quality of care
• Not protected from Not protected from the charlatans or the charlatans or corruptive health corruptive health services approaches services approaches
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Quality of care and financing in Quality of care and financing in ALBALB
DonationsDonations • 1999-2003:143 Million € 1999-2003:143 Million €
Drugs expenditures / year Drugs expenditures / year
• 47 % of Total HB47 % of Total HB• 51% of HII budgets 51% of HII budgets
• What Impact ? What Impact ?
• Any data on health gain?Any data on health gain?
• Is health care Is health care performance or quality of performance or quality of carecare improvedimproved ? ?
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Major directions for improvement Major directions for improvement of the quality in health care in of the quality in health care in
AlbaniaAlbania • Professional: the way care is deliveredProfessional: the way care is delivered
- - HTA HTA to reduce waistto reduce waist: : overuse, under use, misuseoveruse, under use, misuse - EBM: clinical guidelines to promote the best practise - EBM: clinical guidelines to promote the best practise Mandatory Licensing and Re-licensing for Mandatory Licensing and Re-licensing for
systematic assessment of the health professionals competences systematic assessment of the health professionals competences
• Organization: the way care is organizedOrganization: the way care is organized
- - StandardsStandards: in access, safety mechanisms, waiting time, : in access, safety mechanisms, waiting time, coordination, staff communication gaps. coordination, staff communication gaps. Internal and External quality assessment schemes in heath Internal and External quality assessment schemes in heath organizationsorganizations
• Relationship: the way care is providedRelationship: the way care is provided
- - co-decision-making, empathy, patient rights, informationco-decision-making, empathy, patient rights, information and empowerment and empowerment
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Examples of the Overuse in Examples of the Overuse in Albanian health care Albanian health care
systemsystem
• Drug therapy ( Antibiotics…)Drug therapy ( Antibiotics…)
• Cost -effectives High Tech Cost -effectives High Tech
• Promotion of the Physical Promotion of the Physical activity activity
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Ethical quality principles of Health Care in free Ethical quality principles of Health Care in free market market . “Money for quality, or quality for money“ ? . “Money for quality, or quality for money“ ?
Health care centersHealth care centers
• Money is a tool not the goal Money is a tool not the goal
• The new research findings The new research findings are shared openly as are shared openly as public propriety public propriety
• Rivalries among Rivalries among institution or colleagues institution or colleagues are unethicalare unethical
• Money, Competition are Money, Competition are needed to insure the best needed to insure the best quality and most cost quality and most cost effective care for patients effective care for patients
• Emergency care for life Emergency care for life saving is, always free of saving is, always free of charche for allcharche for all
Usual business enterprisesUsual business enterprises
• Money ( financial profit ) is Money ( financial profit ) is the main goal the main goal
• The new research novelties The new research novelties are private propriety and are private propriety and protected by copy rights protected by copy rights
• Rivalry is a rule Rivalry is a rule
• Selling and earning is the Selling and earning is the main aim , despite the quality main aim , despite the quality or prices or prices
• No any services is free for No any services is free for any body any body
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What financing needs for quality of What financing needs for quality of care improvement in Albaniacare improvement in Albania
Improve Providers competenceImprove Providers competence A continuous education system, A continuous education system, evidence-based, to be establishedevidence-based, to be established
Provider motivation: Provider motivation: promoting the promoting the best quality practise in terms of best quality practise in terms of the outcomes , patient the outcomes , patient satisfaction and cost satisfaction and cost effectiveness effectiveness
contracting based on performance contracting based on performance and quality indicators providing and quality indicators providing rewarding Incentives to teams and rewarding Incentives to teams and centres rather than individualscentres rather than individuals
Sufficient resources for providers and Sufficient resources for providers and patientspatients
Essential drugs, tools, devices, staff, Essential drugs, tools, devices, staff, time, informationtime, information
Promote patients’ safety , patient Promote patients’ safety , patient centeredness : rights and roles centeredness : rights and roles
Patients Bill of Rights; structures for Patients Bill of Rights; structures for complaints, therapeutic education, complaints, therapeutic education, empowermentempowerment
EBM for quality improvement: policy EBM for quality improvement: policy making and clinical use making and clinical use
A national centre for EBM to be A national centre for EBM to be establishedestablished
Monitoring and evaluation for quality Monitoring and evaluation for quality improvementimprovement
Suggested priorities for ALB Suggested priorities for ALB health financing reform related health financing reform related
to qualityto quality
• Reduction of the wasteReduction of the waste (Money liking due to the overuse (Money liking due to the overuse
and misuse) by promoting HTA and misuse) by promoting HTA and EBMand EBM
• Establish safety Establish safety mechanismsmechanisms to reduce risks , to reduce risks , errors in order to minimize the errors in order to minimize the litigations and patients damage litigations and patients damage compensations compensations
• Reallocation of existing Reallocation of existing resources ( HII as single resources ( HII as single purchaser covering whole purchaser covering whole health care system )health care system )
• Institutionalization of the Institutionalization of the cooperation between the HII cooperation between the HII and NCQSA-HI in and NCQSA-HI in standardization and in standardization and in identification of the most cost identification of the most cost effective care practices effective care practices
• Active purchasing by Active purchasing by selecting and selecting and contracting based on contracting based on Licensing , Rilicensing , Licensing , Rilicensing , Accreditation and in the Accreditation and in the HTA -EBM findings (less HTA -EBM findings (less for more )in public and for more )in public and private PHC and private PHC and HospitalsHospitals
• Developing motivating Developing motivating incentives by Rewarding incentives by Rewarding the best quality practicethe best quality practice
• Promoting partnership for Promoting partnership for multiplicity of resources multiplicity of resources founding founding
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We all must think to find We all must think to find new ways to correct new ways to correct
problems, that we have problems, that we have created with our created with our previous ways of previous ways of
