Primary Health Care 1978 Bamako 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 service 2. Drug sales 3. Personal prepayment 4. P4P 5. Income generation 6. Community labour 7. Donations 8. Festival raffles, etc. 9. Subsidies 10. Social assistance Recurrent currency Annual or monthly fixed payment, admin. Monthly, admin. Enterprise risks One time or recurrent One time Annual, admin., buffer Drawing from fund, voluntary work
Maintenance of buildings Running a bakery or a shop Milling rice and other grains Growing a palm plantation Farming fish, keeping chickens, rabbits or goats Operating a printing press
Selling clean, used, disposable syringe barrels as hair curlers or for artwork Hiring out vehicles Selling photocopies, printing services Grazing goats on health centre land Renting out tables and benches Funeral services Renting 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 risks Het 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
Bezint eer ge begint Alle hens aan dek Alles of niets
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