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Micro-zorg verzekeringen Christina de Vries. Zekere gezondheidszorg met verzekering ?. Deze presentatie. Voorgeschiedenis Gezondheidszorg economie Soorten micro-zorg financiering Keuzes Valkuilen Stappen. Bamako initiatief 1987. Primary Health Care 1978 - PowerPoint PPT Presentation
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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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