15 June 2011

Transplantation in Macedonia – challenges in program financing and

budgetingMaja Parnardzieva Zmejkova, M.Sc., CEO

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Contents

Transplantation prices and contracts2

Action Plan33

Steps in Developing44

Health Insurance Fund1

Conclusion35

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Republic of Macedonia

Population: 2.06 million citizens

HIF insured population: 1.8 million citizens

Area: 25 713 km2

GDP in 2010 in 2010:: $9.1 billion USD $9.1 billion USD

Government healthcare insurance fund (4.6 of GDP)

Life expectancy at birth:– Men 73 years – Women 77 years

Mandatory health insurance system

Insurance premium stipulated by law (7.3 % from the gross salary)

Health Contribution Rate

• Rate for employed persons is 7,3% (+0,5%) from gross salary

Source: WHO

Cross country comparison % of total public health expenditures to GDP

Source: WHO (2010)

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Health System Institutions

The Ministry of Health creates the health policy at the national level and legal health framework.

Health Insurance Fund of Macedonia is an exclusive provider of the compulsory health insurance. The Fund is defined as a purchaser of health services provided by the health care network. .

The health care network consisted from public and

private health providers

Health care network

The health care network is consisted from the public and private health providers who negotiate the delivery of their health services at the primary, secondary and tertiary levels.

Primary HC - 2646, private health providers

Secondary HC – 207, private and public health providers

Tertiary HC – 33, public health providers

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Health Insurance Fund

Health Insurance Fund

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Transplantations

2 mil EUR

Transplantations

2 mil EUR

Dialysis14 mil EURDialysis

14 mil EUR

Dialysis

• 1,399 patients• 16,178 treatments

p.a.• 14 mil EUR p.a

Centers for dialysis in MacedoniaDistribution of patients in 19

dialysis centers

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DRG Prices2010 and 2011 Analysis of the transplantation surgery with the clinics and increased prices:

A01Z Transplantation of pancreas 10,380 EUR A07Z Alogenic Transplantation of Bone Marrow 12,400 EUR A08B Autologic Transplantation of Bone Marrow 8,700 EUR A09A Transplantation of kidney with pancreas 15,900 EUR A09B Transplantation of kidney w/out pancreas 11,200 EUR

Currently Prepared new DRG prices for the associated surgery:

A10Z Transplantation of cornea 1,140 EUR A11Z Donor preparation, multiorgan and tissue explantation 5,170 EUR A12Z Donor preparation and multiorgan explantation 4,900 EUR A13Z Donor preparation and organ explantation 5,035 EUR A14Z Donor preparation and cornea explantation/ eyeball one and/or both

255 EUR A42Z Serologic analysis of donor organs/tissues 205 EUR

Dialysis vs Transplantation

• Dialysis price 80 EUR

• One patient on dialysis annually

12,400 EUR

• Transplantation price

11,200 EUR

1050011000115001200012500

Annualy

Transplantation Dialysis

Transplantation and Health Insurance Fund

Current • Waiting list for Living

Donor kidney transplantation – 32 persons

• Non existing Deceased Donor transplant program

• In 2011 there were 32 transplantations in RM:

• 10 - kidney transplantation, o/w 2 children

• 1 - children liver transplantation• 22 - bone marrow transplantation

Up coming• Establishing national

program in transplantation

• National registry for donation and waiting list for kidney transplantation

• Developing Donation from Deceased Donors

• Transparent waiting list for kidney transplantation from living donor

• Program for permanent education

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Conditional Budget Financing and

Contracting 2012For surgery- RECORD 45 transplantations Clinic for Urology- min 20 kidney transplantation Clinic for Children Surgery -3 kidney and 2 liver

transplantation Clinic for Hematology-min 20 bone marrow

transplantations Additional funds for extra transplantations

For HLA analyses Institute for Transfusion – funds for new 200 donors Institute with the Medical Faculty-funds for 500 new

donors

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Action Plan 2012

Change in the Law for transplantations and

enacting 13 bylaws Appointing the national coordinator Preparation of clinical pathways Accreditation of laboratories Creation of donors registry Software for the transplantation waiting list Education National Campaign for Transplantation

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Coordination

Action planAction planAction planAction plan

Ideas and joint work

FundMinistry of

Health

Public health care

institutions and Experts

NGO, Religious

and political authoriti

es

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Expected results

• Enabled legal framework• Adequate prices• Coordinated clinics• Increased number of

transplantations• Creation of the donors registry • Joining the Eurotransplant• Cooperation with other countries

Conclusion

Acquisition from Transplantations

Quality of life - long-term survival with a high quality of life

Economic benefit - national health care budget expenditure savings.

Organ transplantation is the most cost-effective and humane treatment for end

stage renal failure. 18

Most valuable sentence

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The most valuable sentence in ``Croatian donation network``

»Sve što može poslužiti životu, grijeh je pokopati.«

„ Се што може да послужи на животот, грев е да биде закопано„

„All that can be used for a life, it is sin to be buried”

Pope Johan Paul II

• Website: www.fzo.org.mk• E-mail: majap@fzo.org.mk

THANK YOU FOR YOUR ATTENTION

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Website: www.fzo.org.mkE-mail: majap@fzo.org.mk