1. Advisor to the Minister of Health
Health reform strategy Debt reduction strategy World Bank workshop Warsaw, 19/05/03
Rudolf Zajac
Minister of Health
Peter Pažitný
Advisor to the Minister of Health

2. Content Fiscal position of Health sector
Where is the beginning of the circle?
Stabilisation measures
System measures
Network measures
Debt reduction strategy

3. I. Fiscal position of Health Sector

4. Gap is widening (Cumulative real growth of GDP, 1990=100)
USA
EU 15 SR

5. Deficit of Public Finances (% of GDP)

6. Fiscal position of Health sector (% of GDP)
Expenditures
Resources
Deficit

7. Coverage of the Deficit (% from GDP)

8. … growing debts (in bln. Sk)
Annual change 2002 … 2003
VAT and deregulation … 1,0
Providers: 16,2 … 22,0
Health insurance funds: 13,2 … 15,4

9. Where is the Beginning of the Circle?

10. Challenges and Reactions of the Reform
Growing expectations of the citizens
Increasing Costs
Limited ability to pay
Decreasing of expectations of the citizens
Increasing of efficiency
Mobilisation of Resources

11. Position of Political Decisions
How much Resources ?
Decreasing of high expectations of the citizens
Efficiency
How wide Treatment Act?

12. Where is the Beginning of the Circle?
Health Care Act
Treatment Act
New Insurance Act
CONSTITUTION
Health Insurance Act
New Treatment Act
Health Care Surveillance Authority Act
Chambers Act
Health Care Occupations Act
Health Care Providers Act

13. Schedule of reform steps
Network
measures
New
system
System
measures
Stabilisation
measures
2002
2003
2004

14. III. Stabilisation measures

15. Goals
STOP
Stopping of debt growth
Financial stabilisation of system

16. Stabilisaton measures
Modern definition of the Health Care
Introduction of marginal co-payments for Providers
New initiatives in Drug Policy

17. … stabilisation of debts (in bln. Sk)
Annual change 2002 … 2003
VAT and deregulation … 1,0
Total savings 2,5 - 3,8 bln. Sk
Providers: 16,2 … 19,6
Health insurance funds : 13,2 … 14,2

18. IV. System measures

19. Goals Decreasing of expectations of citizens
Raising the efficiency of the system
Mobilisation of Resources (particularly private)

20. System measures NEW Treatment Act NEW Insurance Act
NEW Health Care Surveillance Authority Act

21. 1. New Treatment Act A Fully reimbursed B Partially reimbursed C
Not reimbursed
Performance
Drugs
Tools and material

22. Beyond scope of Treatment Act
2. New Insurance Act
Voluntary insurance
Beyond scope of Treatment Act
Compulsory
insurance
Covering BBP in
Treatment Act

23. 3. Health Care Surveillance Authority
Strong regulatory body, which monitors:
Licences
Register of assured
Index of risk
Solvency of Health Insurance Funds
Quality of Health Care
Lege artis

24. Goal: Active role purchaser
Purchasing of goods
Drug policy
Influencing the price
Purchasing of services
Provider

25. V. Network measures

26. Current conditions – there is no feedback in the system
Hospitals and LZZ
SKK
Health Insurance Fund
Patient
Primary care
Secondary care
SKK

27. Goals Increasing allocative and technical efficiency
Increasing Quality
Enhancement of effective access
Reinforcement of competition
Equality of chances

28. Network measures NEW Chambers Act
NEW Health Care Providers and Institutions Act
NEW Health Care Occupations Act

29. Goal: Management of the patient in the future - interaction
Hospitals and LZZ
Patient
Purchaser
Primary and secondary care

30. VI. Debt reduction strategy

31. Structure of the external debt (SKK billion)
Pharmacies (7,0)
HIF
Without Perspektiva
(2,2)
Without Redistrib. Fund (3,8)
Contributors
Unpaid insurance (11,0)
Fines, Penalties (8,5)
Public finances (2,2)
Primary and secondary care (1,3)
Drugs (4,5)
Inpatient facilities
Public finances (4,1)
Energy (2,9)
Others (4,6)

32. Receivables after maturity
Maturity dates
Annual expenditures
SKK billion
Receivables after maturity
Maturity dates
in days
Public pharmacies
20,2
7,0
Hospital pharmacies
5,1
4,5
Energy suppliers
1,3
2,9

33. Bailing out the system Subject of bailing out:
Pharmacies (7,0)
Subject of bailing out:
Stock of external debt to
Public finances (2,2)
Primary and secondary care (1,3)
Drugs (4,5)
Public finances (4,1)
Energy (2,9)
Others (4,6)

34. How much is that? (SKK billion)
Annual health budget in 2002:
SKK 68 billion
GDP in 2002:
SKK 1062 billion
Pharmacies (7,0)
Public finances (2,2)
Primary and secondary care (1,3)
26,6
Drugs (4,5)
Public finances (4,1)
40,0%
2,5%
Energy (2,9)
Others (4,6)

35. Special agency MOF, MOH, NPF
receivables
HIF
Pharmacies (7,0)
Special agency “Creditor”
Purchase of receivables from creditors
Public finances (2,2)
Primary and secondary care (1,3)
receivables
Inpatient facilities
Drugs (4,5)
Public finances (4,1)
Energy (2,9)
Others (4,6)
cash

36. Resources receivables cash Pharmacies (7,0) Special agency “Creditor”
Purchase of payables from creditors
National Property Fund
Public finances (2,2)
Primary and secondary care (1,3)
Drugs (4,5)
Ministry of finance
Issue of bonds
Public finances (4,1)
Energy (2,9)
Others (4,6)
cash

37. Schedule of debt reduction 1. Phase
Pharmacies (7,0)
HIF
Without Perspektiva
(2,2)
Without Redistrib. Fund (3,8)
Contributors
Unpaid insurance (11,0)
Fines, Penalties (8,5)
Public finances (2,2)
Primary and secondary care (1,3)
Drugs
Inpatient facilities (decentralized)
(6)
Public finances
Energy
Others

38. Schedule of debt reduction 2. Phase
Pharmacies (7,0)
HIF
Without Perspektiva
(2,2)
Without Redistrib. Fund (3,8)
Contributors
Unpaid insurance (11,0)
Fines, Penalties (8,5)
Public finances (2,2)
Primary and secondary care (1,3)
Drugs (4,5)
Inpatient facilities (decentralized)
Public finances (4,1)
Energy (2,9)
Others (4,6)

39. Schedule of debt reduction 3. Phase
Pharmacies (7,0)
HIF
Without Perspektiva
(2,2)
Without Redistrib. Fund (3,8)
Contributors
Unpaid insurance (11,0)
Fines, Penalties (8,5)
Public finances (2,2)
Primary and secondary care (1,3)
Drugs
Inpatient facilities (state owned)
(10)
Public finances
Energy
Others

40. ... ??? ...
We are lucky, the hole is not on our side

41. Thank You for Your Attention
We are looking forward to Your comments and for further information attend