Orthopaedic devices & Fair Cost recovery system Experience of the Hô ChiMinh-City Hospital for Care & Rehabilitation of Professional Diseases Patrick Le Folcalvez Séminaire Handicap International Tananarive, Madagascar Octobre 2015

Background Decreasing of Viêtnam Government subsidies for Public Health Services Wide range of devices needed by wide range of disabilities Economical improvements induce a demand for high-tech or comfort devices PWDs have to participate more and more in the costs for rehabilitation

$$ ? Challenges Combine financial sustainability and fair access Meet the needs of the PWDs Rehabilitation

HCM-City Orthopaedic department No financial subsidies form Government 2 technicians Employs : 1 bench worker 1 administrator 1 part-time doctor 1 part-time physiotherapist Administrated by the HCM-City Health Services …BUT

HCM-City Orthopaedic department Delivers : Basic orthopaedic devices (polypropylene technology) Orthopaedic devices with options Assistive devices made at the workshop Commercial devices from local suppliers Imported devices High tech orthopaedic devices USER-CLIENT has the choice

Price policy Calculation using ISPO method + 7,5 % for “Reserve fund” + 7,5 % for SOCIAL FUND

Price policy Consequence : Prices 20% - 30 % higher than in the other centers… BUT Multidisciplinary service One-year guarantee on products => “QUALITY APPROACH” Recall system for follow-up Written report to prescription doctors

Social Fund… how it works Clients who want options or high tech products are charged full price Clients who request the basic are assessed through a “Social questionnaire” According to their social category, they get a discount of The discount is covered by the SOCIAL FUND The SOCIAL FUND is supplied with the 7,5 % of the products prices 50 % (poor) 70 % (very poor)

Results Large range of products available : Orthopedic devices Assistive devices Commercial products

Results Large production enables to reach financial sustainability … and to maintain the SOCIAL FUND USD

Results In one year, the department serves an average of 230 persons with Disabilities of various origins …coming mainly from the metropolis …referred by : 23 % children

Results Notable positive social impact on 56 % of the beneficiaries of the poor categories (assessed after 1 year) The Social Fund supports 25 % of the beneficiaries 11 % of the beneficiaries are supported by charity organization, employer, insurance or responsible of accident

Difficulties & challenges The department is financially sustainable and accessible for the poorest PWDs…. BUT … with a limit of 36 % of its users Additional sources for the Social Fund (estimation US$ 3,000 /year) are still necessary to completely break discrimination

Difficulties & challenges Internal management of the Social Fund, meaning : Dependent Social Fund Risk of prioritizing financial income and neglect accessibility Social assessment made by a non-professional Difficulty to approach private sponsors to complete the Fund

Difficulties & challenges Implement “Private-type management” in a Government structure, meaning : Department closed on weekends, public holiday, and after 16:00 every day Heavy administrative procedure Prices higher than in public workshops No incentive for the persons who refer clients Necessary “Marketing”

THANKS for your attention ! THANKS for your attention !