II-3 Cuison Health Eco

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HEALTH RESOURCES

FEATURE FRANCE MYANMAR

BUDGET,MANPOWER,FACILITIES

BUDGET Currently the total health

care expenditure is at 9.4%GDP, among the highestin Europe.

Frances budget allocation forhealth care is about 9.8% of the

GNP.

The PHI covers roughly

75% of all healthexpenditures, withservices ranging fromhospital care, outpatientservices, prescription drugs,dental, vision, nursing homecare.

Remaining expenditures areshared through out-of-pocket expenses and

private supplementaryinsurance.

An income ceiling gives low-income workers freesupplemental insurance.

All residents areautomatically enrolled with

BUDGET Total government health

expenditure increased fromkyats 464.1million in 1988-89 to kyats 48017.3 millionin 2006-2007.

HEALTH FACILITIES ( 2007-2008 )

-TOTAL NUMBER OFGOVERNMENT HOSPITALS=839

-Total hospital beds = 36121.

-No. of Primary and Secondary-Health Centers = 86

-No. of Maternal and Child-Health Centers = 348

-No. of Rural Health Centers =1473

-No. of School Health Teams =80


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an insurance fund based ontheir occupational status.

proprietary hospital sector-

accessible to all insuredpatients the coexistence ofpublic and proprietaryhospitals,

half of French NHIexpenditures were financedby employer payroll taxes(51.1%) and a generalsocial contribution (34.6%)levied by the French

treasury on all earnings,including investmentincome

Remaining sources offinancing-included payrolltaxes on employees [3.4%],special taxes onautomobiles, tobacco andalcohol [3.3%], a specifictax on the pharmaceuticalindustry [0.8%], andsubsidies from the state[4.9%].)

HEALTH FACILITIES The private hospital sector

in France (both nonprofitand proprietary hospitals)

-No. of Traditional Medicine-Hospitals = 14

-No. of Traditional MedicineClinics = 237

HEALTH MANPOWER( 2007-2008)

Total No. of Doctors=21725

-Public =8033

- Co-operative & Private =13692

Dental Surgeon =

1867

- Public =793

- Co-operative & Private =1074


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has 36% of acute beds,including 64% of all surgicalbeds, 32% of psychiatric

beds, and only 21% ofmedical beds.

Hospitals in France areeither public (65% of allinpatient beds), private not-for-profit (15% of inpatientbeds) or private for-profit(20% of inpatient beds).Private for-profit hospitalsmainly deal with minor

surgical procedures,whereas public and privatenot-for-profit hospitals focusmore on emergencyadmission, rehabilitation,long-term care andpsychiatric treatment.France has an average of8.4 hospital beds per 1000inhabitants, half of which

are acute beds,

HEALTH MANPOWER France has about 1.6

million health careprofessionals,accounting for 6.2% of

-NURSES= 22027

-Dental Nurses= 175

-Health Assistants = 1788

-Lady Health Visitors= 3259

-Midwives= 18098

-Health Supervisor (1)= 529

-Health Supervisor (2) =1444

-Traditional MedicinePractitioners = 889


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the working population.In 2002, France had 3.3physicians and 6.9 nurses

per 1000 population, bothbelow the Eur-Aaverages(Annex. Selected healthcare resources). There aregeographical disparities inthe distribution ofphysicians favouring Parisand southern France andurban relative to ruralareas.

characterized by largenumbers of administrativeand clerical personnel.

HEALTH SERVICES


COMPREHENSIVENESS, FREQUENCY,AVAILABILITY

-Health insurance iscompulsory; no one may opt out.Health insurance funds are notpermitted to compete by loweringhealth insurance premiums orattempting to micromanagehealth care

- Ministry of Health is providingcomprehensive health servicescovering promotive, preventive,curative and rehabilitative aspectsto raise the health status andprolong the lives of the citizens.

NON-ADMITTED PATIENTS-


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ADMITTED PATIENTS- There are budgetary

allocations as well as per diem

reimbursements. The Frenchindemnity model allows fordirect payment by patients tophysicians, coinsurance, andbalance billing by roughly onethird of physicians.

ambulatory care is dominatedby office-based solo practice,

French NHI provides a greatdegree of patient choice

French NHI coverageincreases as individual costsrise, there are no deductibles,and pharmaceutical benefitsare extensive.

NON-ADMITTED PATIENTS- For ambulatory care, all health

insurance plans operate on the

traditional indemnity modelreimbursement for servicesrendered.

NHI was extended to allindustrial and commercialworkers and their families,irrespective of wage levels.

French NHI covers services

The private, for profit, sector ismainly providing ambulatorycare existence of traditional

medicine along with allopathicmedicine.

Basic health service is one ofthe essential components ofrural health developmentscheme.

Access to health care for 70%of country population residingin rural areas has beenimproved through theexpansion of health manpowerin terms of basic health staffsand voluntary health workers,i.e. community health workersand auxiliary midwives.

The outreach services includecataract surgery,reconstructive surgery andgeneral medical and surgicalservices provided by teams ofphysicians and surgeons fromcentral, state and divisionalhospitals and Eye and ENThospitals.


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ranging from hospital care,outpatient services,prescription drugs (including

homeopathic products),thermal cures in spas, nursinghome care, cash benefits, andto a lesser extent, dental andvision care.

The health system is noted forits high level of freedom forphysicians and choice forpatients, pluralism in theprovision of health services,

easy access to health care formost people and, except forsome specialties in certainparts of the country, theabsence of waiting lists fortreatment.

HEALTH POLICIES AND PROGRAMS



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PROGRAMS ORLAWS RELATED TOHEALTH CARE

Public health policy andpractice in France involvesmany actors and sources of

funding, which leads to lack ofcohesion among the actors anddiluted responsibilities. InMarch 2003, a new bill wasproposed setting out acomprehensive legislativeframework for public healthpolicy that developed strategicplans in designated priorityareas and established a

framework of objectives andtargets.

the 1999 Universal HealthCoverage Act (CMU) hasbeen a major reform.-

this reform explicitly aims toincrease access and,consequently, health careexpenditure, for people on lowincomes.

Decentralization at the regionallevel has also raised the issueof regional inequalities andsome steps have been taken toreduce them, particularly in thehospital sector.

managed by the NationalHealth Committee

The National Health Policy

was developed with theinitiation and guidance of theNational Health Committee in1993. The National HealthPolicy has placed the HealthFor All goal as a primeobjective using Primary HealthCare approach.

The National Health Policy is

described here under:1. To raise the level of health

of the nation and promote thephysical and mental well-beingof the people with theobjective of achieving HFA goalusing the primary health careapproach.

2. To follow the guidelines ofthe population policy

formulated in the country.3. To produce sufficient as

well as efficient humanresources for health locally inthe context of the broadframework of a long-termhealth development plan.


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cost containment policiesaddressed both the demandside (often

by raising co-payments) and thesupply side (hospital planning,limitation of the number ofmedical students, pricecontrol).

The 1999 CMU Act waspassed in spite of thelikelihood that it would

increase demand for health care,illustrating that the objective of

equity hastaken precedence over costcontainment. CMU shouldstimulate demand forhealth care because it lowersfinancial barriers to access, notonly by extendingbasic coverage to all Frenchresidents, but also by exemptingthose with the

least resources from directpayment of costs and giving themfree access tocomplementary VHI ( VoluntaryHealth Insurance )

MAJOR HEALTH POLICY

4. To strictly abide by therules and regulationsmentioned in the drug laws

and byelaws which arepromulgated.

5. To augment the role of co-operative, joint ventures,private sector and non-governmental organisations indelivering health care in viewof the changing economicsystem.

6. To explore and develop an

alternative health carefinancing system.

7. To implement healthactivities in close collaborationand also in an integratedmanner with related ministries.

8. To promulgate new rulesand regulations in accordancewith the prevailing health andhealth related conditions as

and when necessary.9. To intensify and expand

environmental health activitiesincluding prevention andcontrol of air and waterpollution.

10. To promote national


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DEVELOPMENTS

19901991

EVIN Act (Act 91-32 of 10January 1991) regulating directand indirectadvertising of alcohol andtobacco, prohibiting smoking inpublic placesand excluding the price of tobaccofrom the general price index toallow itto increase more freely;

restriction of doctors access toSector 2; introduction of a General SocialContribution (CSG) to strengthensocialsecurity financing; Hospital Act setting upregional strategic health plans(SROS) as a tool for

planning hospital equipmentcapacity at the regional level.

1993 Loi Teulade (Act 93-8)concerning relations betweenhealth care professions

physical fitness throughexpansion of sports andphysical education activities by

encouraging communityparticipation, supportingoutstanding athletes andreviving traditional sports.

11. To encourage medicalresearch activities not only onprevailing health problems butalso giving due attention tocarry out heath systemresearch.

12. To expand health serviceactivities not only to ruralareas but also to borderregions so as to meet theoverall health needs of thecountry.

13. To foresee any emerginghealth problems that wouldpose a threat to the health andwell-being of the people so

that preventive and curativemeasures can be initiated.

14. To reinforce the serviceand research activities ofindigenous medicines tointernational levels and toinvolve in community health


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and health insurance fundsincluding, in particular, the settingof ceilings for

growth in health careexpenditure, the introduction ofpractice guidelines(RMOs), the establishment of abasis for the coding of proceduresanddiagnoses and the creation ofregional unions of self-employeddoctors(URML), with the intention that

they should participate inanalysing thehealth care system and itscomponents, monitor the qualityof treatment andparticipate in public health action; Agreement of 21 October1993 bringing the Loi Teuladeinto force: ceilingsfor expenditure growth, setting

out RMOs and implementation oftheirnegative phrasing; Act on the Medical Safety ofBlood Transfusions andMedicines (Act 93-5of 4 January 1993) creating the

care activities.15. To strengthen collaboration

with other countries for

national health development.

The Ministry of Health issystematically developingHealth Plans, aiming towardsHealth for All Goal.

Myanmar Health Vision2030-a long-term (30 years)health development plan tomeet any future health

challenges

Health Legislation

Legal provision for the interestof health of the people isaccomplished throughenacting the following healthrelated laws:

Public Health Law (1972)- Itis concerned with protection ofpeoples health by controllingthe quality and cleanliness offood, drugs, environmentalsanitation, epidemic diseasesand regulation of privateclinics.


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Blood Agency and the MedicinesAgency; last increase, to date, in

patients contributions to thecosts of health care.

1994 creation of the FrenchInstitute for Transplants (Act94-43 of 18 January1994); Framework Agreement of 24January between the government

and thepharmaceutical industry,envisaging a revision of prices ifconsumptionvolume exceeds a fixed level.

1996 Constitutional Act (96-138 of22 February 1996) introducingannual

legislation on social securityfunding, estimating the receipts ofsocialsecurity bodies for the year tocome and setting a growth target(ceiling)for total health care expenditure

Dental and Oral MedicineCouncil Law (1989) -Providesbasis for licensing and

regulation in relation topractices of dental and oralmedicine. Describes structure,duties and powers of oralmedical council in dealing withregulatory measures.

Law relating to the Nurseand Midwife (1990)-Provides basis for registration,licensing and regulation of

nursing and midwiferypractices and describesorganization, duties andpowers of the nurse andmidwife council.

Myanmar Maternal andChild Welfare AssociationLaw (1990) Describesstructure, objectives,membership andformation,duties and powers ofCentral Council and itsExecutive Committee.

National Drug Law (1992) -Enacted to ensure access bythe people safe and efficacious


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by the health insurance funds; theAct alsoapproved the governments policy

directions in health and socialsecurity.

1997 1998 Social Security FundingAct: replacement of almost allearnings-relatedhealth insurance contributionswith the CSG at the rate of 5.1%of earned

income; the government divides up thetotal financial budget for hospitalsbetweenthe regions with the aim ofreducing regional inequalities; signing for the first time of anagreement on targets andmanagement betweenthe government and the health

insurance funds, covering threeyears; scheme for early retirement ofself-employed doctors.

1998 Act reinforcing medical

drugs. Describes requirementfor licensing in relation tomanufacturing, storage,

distribution and sale of drugs.It also includes provisions onformation and authorization ofMyanmar Food and Drug Boardof Authority.

Narcotic Drugs andPsychotropic SubstancesLaw (1993) - Related tocontrol of drug abuse anddescribes measures to be

taken against those breakingthe law. Enacted to preventdanger of narcotic andpsychotropic substances andto implement the provisions ofUnited Nations ConventionAgainst Illicit Traffic in NarcoticDrugs and PsychotropicSubstances.

Prevention and Control of

Communicable DiseasesLaw (1995) - Describesfunctions and responsibilitiesof health personnel andcitizens in relation toprevention and control ofcommunicable diseases. It also


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safety, with the creation of theInstitute forMonitoring Public Health, the

French Agency for the MedicalSafety ofFood Products, and the FrenchAgency for the Medical Safety ofHealthProducts; 1999 Social Security FundingAct introduces payment of apenaltycontribution by pharmaceutical

companies, based on theirturnover, in theevent of pharmaceuticalexpenditure in excess of ceilingsset.

1999 introduction of pharmacistsrights to substitute generic forbrand drugs;

introduction of a reference tohealth care networks in theSocial SecurityCode; clauses in the GeneralPractitioners Agreement from1998 concerning

describes measures to betaken in relation toenvironmental sanitation,

reporting and control ofoutbreaks of epidemics andpenalties for those failing tocomply. The law alsoauthorizes the Ministry ofHealth to issue rules andprocedures when necessarywith approval of thegovernment.

Eye Donation Law (1996)

Enacted to give extensivetreatment to persons sufferingfrom eye diseases who mayregain sight by cornealtransplantation. Describesestablishment of National EyeBank Committee and itsfunctions and duties, andmeasures to be taken in theprocess of donation and

transplantation. Traditional Drug Law

(1996)- Concerned withlabeling, licensing andadvertisement of traditionaldrugs to promote traditionalmedicine and drugs. It also


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penalties in cases of failure totake account of RMOs aredeclared illegal

(Decree of the Council of Stateof 10 November); announcement by CNAMTS of apolicy plan for quality health carefor allaimed at a substantial reductionof statutory health insurancecosts: definitionof a basket of care andadjustment of reimbursement

rates in light of medicaleffectiveness; the governmentrejects these provisions, whichwere muchdisputed, but debate continues onthe plans provisions and, inparticular,on the basket of care; 2000 Social Security FundingAct: restriction of the areas of

expendituremanaged by CNAMTS, defining aallocated expenditure targetcoveringtreatment in private practice,excluding pharmaceutical costs;ONDAM

aims to enable public toconsume genuine quality, safeand efficacious drugs. The law

also deals with registration andcontrol of traditional drugs andformation of Board of Authorityand its functions.

National Food Law (1997)Enacted to enable public toconsume food of genuinequality, free from danger, toprevent public from consuming

food that may cause danger orare injurious to health, tosupervise production ofcontrolled food systematicallyand to control and regulate theproduction, import, export,storage, distribution and saleof food systematically. The lawalso describes formation ofBoard of Authority and its

functions and duties. Myanmar Medical Council

Law (2000)Enacted to enable public to

enjoy qualified and effectivehealth care assistance, tomaintain and upgrade the


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growth rate set at 2.4 %.

2002

Act on Patients Rights andQuality of Care (4 March2002): enhancementof the collective and individualrights of patients (includingimproved accessto medical records), developmentof continuing education for healthcareprofessionals and evaluation of

professional practices,compensation ofpatients for accidents occurringwithout any fault on the part ofthe healthcare professionals involved;

2003 the Ordinance for thesimplification of hospital and

other medical facilitiesplanning merges in a single tool(the regional strategic plan) thestrategicplanning of hospital facilities andactivities; previously, this wasmanaged

qualification and standard ofthe health care assistance ofmedical practitioner, to enable

studying and learning of themedical science of a highstandard abreast of the times,toenable a continuous studyof the development of themedicalpractitioners, tomaintain and promote thedignity of thepractitioners, tosupervise the abiding andobserving inconformity with

the moral conduct and ethicsof the medicalpractitioners.

The law describes theformation, duties andpowersof the Myanmar MedicalCouncil and the rights of themembers and that of executivecommittee, registrationcertificate of medicalpractitioners, medical

practitionerlicense, duties andrights of registered medicalpractitionersand the medicalpractitioner license holders.

Traditional MedicineCouncil aw (2000) Enactedto protect public health by


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using several tools; the Ordinancealso decentralizes almost all typesof

authorization for hospitalactivities, facilities and othermedical equipmentto the regional hospital agency; presentation of the PublicHealth Bill to parliament (tobe passed in2004); creation of the High Councilfor the future of health

insurance to proposesolutions for the modernization ofhealth insurance; 2004 Social Security Funding Actdetails the implementation ofpayment per case for hospitals.Act of 9 August 2004 on the public healthpolicy, which introduces five major five-

year programmes and regional public

health policy management. The five

programmes for 2004-2008 are:The cancer plan,The plan to combat violence, abuse, risk

behaviour and addictive behaviour,

The plan to curb the impact ofenvironmental factors on health,

The plan to improve the quality of life of

applying any type of traditionalmedicine by the traditionalmedical practitioners.

Blood and Blood ProductsLaw (2003) - Enacted toensure availability of safeblood and bloodproducts bythe public.

Body Organ Donation Law(2004) -Enacted to enablesaving the life of the personwho is requiredto undergobody organ transplant by

application of bodyorgantransplant extensively,

The Control of Smoking andConsumption of TobaccoProduct Law (2006) -Enacted to convince the publicthat smoking andconsumptionof tobacco product canadversely affect health,tomake them refrain from theuse, to protect the public bycreating tobacco smoke freeenvironment.


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patients with chronic illnesses,

The plan to improve treatment and carefor patients with rare diseases.

The 2012 Hospital Planendowed with 10 billion euros isto enable the launching of newinvestments with three priorities:the strengthening ofcomplementarity betweenhospitals located in one territory,the upgrading of security

standards, and thecomputerization of the hospitalsystem.

COMPARISON OF HEALTH CARE SYSTEM


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FEATURE FRANCE( PHI )

MYANMAR

HEALTH INSURANCECOVERAGE

UNIVERSAL-the core of the system is PHI( public health insurance)- originally based on occupationalstatus, the program evolved toinclude every French citizen.-universal health insurancecoverage was established on thebasis of residence in France(99.9% coverage).

-Mandated public plans, privatesupplementary plans (87% of pop.purchases)-Public and private providers,govt reimbursement, public plans-statutory health insurancesystem has three main schemes.

The general scheme coversabout 84% of the population(employees in commerce and

industry and their families). Theagricultural schemecovers farmers and their families(7.2% of the population). Thescheme for self-employedpeople covers 5% of thepopulation.

70 PERCENT-


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FINANCING TAXES Portion of salariesproportional to income Low income population receivehealth care funded by thegovernment-Payroll tax (13% of income fromemployer, 0.75% employee),incometaxation (5.5%)

-The PHI is financed by acombination of employer andemployee contributions.-Employers pay equivalent of13.1% of employee's salary to thenational health insuranceprogram. Employees pay 0.75% ofsalary. Income taxes also helpsprovide universal coverage forretirees, unemployed, disabled

and the poor. Most people (87%)also have supplemental insurancefrom private for-profit insurers,which they purchase or is oftenpaid for by an employer.

MIX OF PUBLIC AND PRIVATESYSTEM- financed by government andprivate households-hospital trust funds-community cost-sharing system-social support is provided bymedical social workers- financial support is providedby NGOs and other individual

donors.

REIMBURSEMENT -PHYSICIAN FINANCING GLOBAL BUDGET TO


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-Mainly private fee for service,salaried in public hospitals-HOSPITAL FINANCING

-Rates set by government-fee-for-service private practicefor ambulatory care and publichospitals for acute institutionalcare, among which patients arefree to navigate and bereimbursed under NHI.-Physicians in private practice(and in proprietary hospitals) arepaid directly by patients on the

basis of a national fee schedule.-Patients are then reimbursed bytheir local health insurance funds-Proprietary hospitals arereimbursed on a negotiated perdiem basis (with supplementaryfees for specific services)public hospitals (including privatenonprofit hospitals working inpartnership with them) are paid

on the basis of annual globalbudgets negotiated every yearbetween hospitals, regionalagencies, and the Ministry ofHealth.

HOSPITALS; SALARIES ANDCAPITATION PAYMENTS TOPHYSICIANS

CONSUMER OUT-OF-POCKET PRICE

POSITIVE-the co-payments for many

POSITIVE BUT GENERALLYSMALL


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servicesare relatively high.-About 87% of the population opts

to pay for supplemental insurancepremiums, which range fromnational to occupation-basedplans.-patients are exempted from bothwhen (1) expenditures exceedapproximately $100, (2) hospitalstays exceed 30 days, (3) patientssuffer from serious, debilitating,or chronic illness, or (4) patient

income is below a minimumceiling, thereby qualifying themfor free supplementary coverage.

PRODUCTION PRIVATE-France demonstrates that it ispossible to achieve universalcoverage withouta single-payer system or theexclusion of private insurance.-

PUBLIC

PHYSICIAN CHOICE UNLIMITED-patients have free choice ofphysician.-patients have an extraordinarydegree of choice amongproviders.

RELATIVELY LIMITED


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REFERENCES:

http://www.itup.org/Reports/Fresh%20Thinking/France.pdfhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447687http://itup.org/Reports/Fresh%20Thinking/International%20Table.pdfhttp://www.npr.org/news/specials/healthcare/healthcare_profiles.htmlhttp://www.who.int/bulletin/archives/78(6)770.pdfhttp://www.euro.who.int/document/e83126.pdfhttp://www.codebluenow.org/vital-signs/Health%20System%20Comparison%20Charts%205.30.2008.pdfhttp://www.moh.gov.mm/file/Myanmar%20Health%20Care%20System.pdfhttp://www.whomyanmar.org/LinkFiles/Health_in_Myanmar_2008_04_policyplan.pdfhttp://www.whomyanmar.org/EN/Section6_146.htmhttp://www.searo.who.int/EN/Section313/Section1522_10908.htmhttp://www.euro.who.int/document/e83126.pdf

RESEARCH PROJECT

(Comparative Analysis of Health Resources, Services and

Policies of Two Countries)

Submitted to: Dr. CuisonSubmitted by:
http://www.euro.who.int/document/e83126.pdfhttp://www.codebluenow.org/vital-signs/Health%20System%20Comparison%20Charts%205.30.2008.pdfhttp://www.whomyanmar.org/LinkFiles/Health_in_Myanmar_2008_04_policyplan.pdfhttp://www.whomyanmar.org/EN/Section6_146.htmhttp://www.searo.who.int/EN/Section313/Section1522_10908.htmhttp://www.euro.who.int/document/e83126.pdfhttp://www.euro.who.int/document/e83126.pdfhttp://www.codebluenow.org/vital-signs/Health%20System%20Comparison%20Charts%205.30.2008.pdfhttp://www.whomyanmar.org/LinkFiles/Health_in_Myanmar_2008_04_policyplan.pdfhttp://www.whomyanmar.org/EN/Section6_146.htmhttp://www.searo.who.int/EN/Section313/Section1522_10908.htmhttp://www.euro.who.int/document/e83126.pdf


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LUMBRES, JOHN PAUL B.

MARTINEZ, TON EDRIC

LO, RICHMOND ELEAZARFELIX, JUSTIN ALEXIS

NERI, MARTIN JAREN

MERCADER, JUAN MIGUEL

BSN II-3

MAY 11,2009

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