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PUBLIC INSURANCES IN BOLIVIA BOLIVIA Ministry of Health and Sports Public Insurances Unit Dr. Margarita Flores.

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Presentation on theme: "PUBLIC INSURANCES IN BOLIVIA BOLIVIA Ministry of Health and Sports Public Insurances Unit Dr. Margarita Flores."— Presentation transcript:

1 PUBLIC INSURANCES IN BOLIVIA BOLIVIA Ministry of Health and Sports Public Insurances Unit Dr. Margarita Flores

2 Ministry of Health and Sports

3 Health protection, disaggregated by provider – 2003 (National Health Insurance Institute - INASES) Public health: 30% Short-term social security (SSCP): 25% Private health services: 12% 33% of the Bolivian population is unprotected INTRODUCTION

4 Health protection, disaggregated by provider – 2003 (INASES) 33% unprotected population 30% public health 25% SSCP 12% private 30% unprotected population 30% public sub-sector 28% SSCP sub-sector 12% private sub-sector NATIONAL CONTEXT Health protection coverage, 2004 Sources: National Health Information System - SNIS, National Institute of Statistics - INE and INASES, 2003-2004

5 National Health Spending, disaggregated by source of financing – 2002 (in thousands of current dollars) Sources Total Percentage Public Sector 113,416 20.94% SSCP Private Insurance NGO Households Percentage of GDP TOTAL 222,410 41.07% 3.83% 1.49% 541,547 32.67% 6.95% 176,908 8,086 20,727 Source: Estudio CNFGS. Cuentas Nacionales de Financiamiento y Gasto en Salud. Segunda Edición. Marina Cárdenas. Bolivia – 2004. INTRODUCTION

6 Public health: US$ 42 per capita (30%) SSCP: US$ 91.5 per capita (25%) Private: US$ 190 per capita (12%)

7 National Maternal and Child Insurance D.S. 24403 in 1996 32 Services. Basic Health Insurance D.S. 25265 in 1998 92 Services. Free Old-Age Health Insurance Law 1886 in 1998 Comprehensive Health Care. Universal Maternal and Child Insurance Law 2426 in 2002 500 Services. Expanded SUMI Law 3250 in 2005 27 Services in Sexual and Reproductive Health, Women of Reproductive Age. Health Insurance for the Older Adult (SSPAM) Law 3323 in 2006 Comprehensive Care, Payment is 100% Municipal. PUBLIC HEALTH INSURANCES

8 Current situation SUMI Ministry of Health and Sports

9 WHAT IS THE SUMI Component of of the Bolivian Poverty Reduction Strategy. It is a state policy and health strategy for reducing maternal and child morbi- mortality. It provides free services for the child under five years of age and the pregnant woman up to 6 months following delivery, in a compulsory, restrictive manner in public and social security establishments. The services are provided using the existing technology and problem-solving capacity that corresponds to the levels of care and according to established protocols.

10 It is a State Policy created by the Law of the Republic 2426 Priority within the Health Policy of the Ministry of Health and Sports Component of the Bolivian Poverty Reduction Strategy Primary instrument for meeting the Millennium Development Goals SUMI

11 SUMI Reduce maternal and child morbidity and mortality Protect the most vulnerable population groups in the country, where the highest mortality rates are concentrated

12 SUMIBENEFICIARIES Girls and boys from birth to five years of age Pregnant women, from the start of pregnancy until 6 months following the birth TARGET POPULATION: – 1,279,269 children under 5 years of age – 328,682 pregnant women

13 POPULATION PROJECTIONS SOURCE: National Institute of Statistics - INE

14 SUMI WHERE IS IT PROVIDED? Throughout the country, in 2,259 health establishments, in urban and rural areas In Public Health and Short-Term Social Security Establishments (National Health Insurance) and others that are included through agreements At all levels of care, according to problem-solving capacity and available technology

15 HOW IS IT PROVIDED? SUMI It is universal, comprehensive and free (For the user) Provided in a compulsory, restrictive manner For communities with difficult access or without health infrastructure, there are Mobile Brigades through the Extend (Extensa) Program

16 EXPANSION OF THE SUMI In December 2005, Law Number 3250 for the expansion of the SUMI was passed Services that have a close link with safe maternity: 1. Prevention of Cervical Cancer 2. Treatment of Pre-malignant Injuries 3. Voluntary Contraceptive Methods 4. Treatment of STIs

17 FINANCIAL ADMINISTRATION Ministry of Health and Sports

18 Financing of the SUMI Tributary Co-Participation 7% in 2003 8% in 2004 10% starting in 2005 Tributary Co-Participation 7% in 2003 8% in 2004 10% starting in 2005 Exceeds Investment in Health Infrastructure, Basic Sanitation and Special Health Insurance Programs Lacks National Solidarity Fund Up to 10% of the resources from the Dialogue Account 2000 Essential medicines, supplies and reagents Human Resources Public: National Treasury - TGN Social Security: Own resources Human Resources Public: National Treasury - TGN Social Security: Own resources Ministry of Health and Sports

19 ACHIEVEMENTS OF THE PUBLIC HEALTH INSURANCES Ministry of Health and Sports

20 Ministerio de Salud y Deportes One of the contributions of the Public Insurances implemented in the country is the reduction of the mortality rates. Although this represents an important process, we remain nevertheless the country with the second highest maternal mortality ratio and child and neonatal mortality rates. Contribution to reductions in the Mortality Rates

21 ENDSA: Demographic and Health Survey Source : Monitoring and Evaluation of the Poverty Reduction Strategy – PRS MORTALITY RATES IN CHILDREN < 5 YEARS OLD -47%

22 INFANT MORTALITY RATES < 1 YEAR OLD -44%

23 INFANT MORTALITY RATES < 1 YEAR OLD Per 1,000 live births Infant MR Urban Rural Years

24 MATERNAL MORTALITY RATE Per 100,000 live births Years MDGs PRS Project

25 PERCENTAGE OF TRIBUTARY CO-PARTICIPATION BY DEPARTMENT, SUMI 2004

26 MUNICIPAL TRIBUTARY CO-PARTICIPATION SUMI 2004 Expressed in Bs. and %

27 Percentage of Municipalities that accessed the National Solidarity Fund (FSN), by Department 2004

28 28,172,160100.00% Amount Allocated 17,313,27561.46% Amount Utilized 10,858,88538.54% Balance Not Utilized NATIONAL SOLIDARITY FUND SUMI - 2004 - Expressed in Bs. Percentage used Percentage unused

29 ANALYSIS OF THE S.U.M.I. Expansion of Coverage and Services, Extension of Health to impoverished sectors, Participation in Service Networks, Standardization of care through Protocols, Overall reduction of Maternal and Child Mortality, Insufficient Information in the National SUMI Management Unit, Lack of Technical Provisions in the Presentation and Application of the SUMI Expansion Law, Mechanisms for controlling deficient Affiliation, Unreal reference costs for services, Care for the SUMI target population, with preference for the third level of care, Irrationality in the selection of services and packages by level, Complexity in administrative processes,

30 Bureaucracy and deficient management at the municipal level, which impedes timely payment to health establishments for services provided under the SUMI Population that is highly concentrated in urban areas (64%), principally in the capital cities of La Paz (Including El Alto), Cochabamba and Santa Cruz Work-related instability and high rotation of personnel, without information about the procedures, knowledge and norms for new human resources in the management sphere Problems identified

31 Challenge UNIVERSAL HEALTH INSURANCE (SUS ) Ministry of Health and Sports

32 Gathering the experiences with public insurances, as a gradual building process, in order to achieve UNIVERSAL HEALTH INSURANCE - SUS FROM THE CURRENT GOVERNMENT AND THE MINISTRY OF HEALTH AND SPORTS

33 UNIVERSAL HEALTH INSURANCE OBJECTIVE ACHIEVE ACCESS TO HEALTH SERVICES FOR THE ENTIRE BOLIVIAN POPULATION, THROUGHOUT THE WHOLE NATIONAL TERRITORY AND IN A COMPREHENSIVE MANNER

34 Participation of the entire National Health System, Improve the quality of medical care, Implement the Model of Family, Community and Intercultural Health as an operational arm of the Insurance, Ensure that Health Promotion and Prevention are pillars of the Health System, Establish instruments to provide quality and efficiency in the provision of Health Services. UNIVERSAL HEALTH INSURANCE SPECIFIC OBJECTIVES

35 Source of FinancingPercentageUS$ / Annual Municipal Tributary Co-participation 10% 30,500,000 HIPC-II * Resources National Solidarity Fund 10%2,900,000 HDI (Human Development Index) by Prefecture 14%32,400,000 T O T A L 65,800,000 First Phase Years 0-21 Implementation January2007 * HIPC: Heavily Indebted Poor Countries Source: Ministry of Housing SOURCE OF FINANCING

36 TARGET POPULATION From 0 to 59 Years of Age

37 Legal Study Socio- Economic Study Study of the Epidemiological Profile Actuarial Mathematic Study Sustainability Study Medical Technical Study Multi-disciplinary Technical Team Coverage Premium SUS Target Population UNIVERSAL HEALTH INSURANCE ANALYSIS FOR ITS IMPLEMENTATION ANALYSIS FOR ITS IMPLEMENTATION

38 FIRST PHASE 2006 ADMINISTRATION D.S. 28748 – Financing of the harmonization of Health insurance measures- from years 5 to 21- Development of the draft project for the SUS Law REQUIRED STUDIES Study of Population Projections, Actuarial Study disaggregated by levels of care, Analysis and Evaluation of the Cost-Effectiveness of Public Insurances, Study of the structure of costs based on Public Insurances, UNIVERSAL HEALTH INSURANCE

39 FIRST PHASE 2006 ADMINISTRATION REQUIRED STUDIES Study of general costing of SUS services, Study of the Sustainability and Economic-Financial Viability of the SUS, Analysis of information on prevalent pathologies using statistics from the National Health Information System - SNIS, the National Health Insurance Institute - INASES, the National Health Insurance - Cajas de Salud, and others, Analysis of information on Incidence, Prevalence and Frequency Technical-medical-financial proposal for the Universal Health Insurance Analysis of indicators. UNIVERSAL HEALTH INSURANCE

40 FIRST ACHIEVEMENT D.S. 28748 – Financing of the harmonization of public health insurance measures SECOND ACHIEVEMENT Draft project of the SUS Law THIRD ACHIEVEMENT Health Care Model: Family, intercultural and community Quality management UNIVERSAL HEALTH INSURANCE (SUS) 2006 Administration

41 THOSE THAT ATTEMPT REFORM WILL HAVE AS ENEMIES EVERYONE THAT TAKES ADVANTAGE OF THE OLD SYSTEM, AND AS WARM ADMIRERS ONLY THOSE THAT HOPE TO OBTAIN SOME TYPE OF BENEFIT FROM THE NEW ORDER Anonymous

42 Ministry of Health and Sports


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