Resource Scarcity, Efficiency and. of the Universal Access of Explicit Guarantees

Transcription

1 Parallel Session 4.2 on Resource Scarcity, Efficiency and Coverage withhealthservices Chileanexperience experience inthe last six years of the Universal Access of Explicit Guarantees in Health Services Friday 27, Bangkok, Thailand MD, MPH Manuel Inostroza Palma Academic of Andrés Bello University And former Superintendent of Health General Background of the Chilean Health Care System Indicators Population * Population over 65 years old (%) 6,1 7,2 9,0* Population under 15 years old (%) 29,9 27,8 22,3* Life expectancy at birth (years) Infant Mortality Rate per 1000 live birth 18,3 9,0 7,0 GDP (MM US$) GDP per capita (US$) Health Expenditure (% of GDP) 5,3 ** 6,6 8,2 Health Expenditure per capita (US$) 264 ** Health Expenditure of Public Sector (%) 48,2 ** 52,1 46,8 Health (% of total public budget) ,3 14,8 Affiliates of FONASA (%) 73,1 65,6 73,5 Affiliates of ISAPREs (%) 15,9 20,00 16,3 Note: The rate of natural population growth is 8.59 (per thousand) for the five years (*) Data for 2010 (**) Data from 1995

2 Health Care System Organization Treasury Contribution Wage earners Companies 7% 0,9% Financing Sources FFAA FONASA +3% ISAPRE MUTUALES Insurances Health Care Services: Networks of Publics Providers Public Sector Reform Private Clinics and Centers Private Sector Providers HEALTH PROBLEMS 2003: a) Serious inequities b) Epidemiological changes c) Need for more efficiency in use of resources d) Citizens dissatisfaction Health lthrf Reform Process and Instruments. t Health Objectives Superintendence of Health Tool AUGE System General Health Care Guarantee Scheme Requirements Health Care Model Components Ensures Guarantees Deals with Guarantee Managers: FONASA ISAPRE Health Care Authority POLICIES AND REGULATIONS SUPERVISING GUARANTEE Human Resources Current contractual Scheme Emphasis on Training Health Care Network Inter-level collaboration Autonomy Public Hospitals /Private Clinics Risk financing Financing Risk sharing and joint financing for GES or HEG Tax contributions

3 Prioritized Health Problems The most frequent The most serious The most expensive What hurts more the quality of life Health Explicit Guarantees Prioritizing System Guaranteed Interventions Effectiveness Promotion Prevention Healing Rehabilitation Phased implementation (Gradually) DS 170 DS 228 DS 44 July 2005 July 2006 July 2007 Feasibility of the Plan Country's supply capacity. Available resources DS 1 July 2010 GES or HEG GES or HEG GES or HEG GES or HEG BURDEN DISEASE OF CHILE 1993 and 2004 DALYS BY SUBGROUPS OF DISEASE, BOTH GENDER. CHILE 1993 Subgroups both gender DALYS 1 Congenital anomalies Acute respiratoty infections Ischemic Heart Disease Hypertensive disease Cerebrovascular disease Asthma Road accident Alcohol dependence Biliary disorders Depressive disorders-mad Osteoarthritis Alzheimer and alzheimer typ perinatal conditions Psychosis Liver cirrhosis DALYS BY SPECIFIC CAUSE. BOTH GENDER Both gender DALYS 1 Hypertensive heart disease Unipolar depression Biliary and Gallbladder Disorders Alcohol dependence Liver cirrhosis Road accidents Violence Peptic Ulcer Adult audition disorders Diabetes type II Cerebrovascular disease Ischemic Heart Disease Anxiety disorders Cataracts Falls DALYS and HEALTH EXPICIT GUARANTEES (56): 53% OF TOTAL DALYS is associated with conditions of HEALTH EXPLICIT GUARANTEES (CONSIDERING ALL AGES). 39% OF TOTAL DALYS is associated with the specific Benefit Packages of the HEALTH EXPLICIT GUARANTEES.

4 Health Explicit i Guarantees Health Care Model Diseases GES/AUGE The attending physician informs the patient that their diagnosis is included in the Health Plan Guarantee Beneficiary ISAPREs agreements Financial protection Opportunity Private network of Accredited providers ality: editation Qu Accre Diagnosis Treatment Follow-up FONASA Opportunity Financial protection Public Network of Accredited providers 100% 80% Distribution of the Population according to Insurance System Beneficiaries (thousands) % 20.0% 16.4% 18.8% 16.9% 17.8% 16.9% 17.0% 16.0% 16.6% 15.7% 16.3% 14.2% 16.3% 13.0% % 10.8%.5% % % 9.4% % ARMY 614 (thousands) 3,6 % Others 1 million 5,8% (thousands) 60% 40% 65.6% 64.9% 65.2% 66.1% 67.4% 68.0% 69.5% 70.4% 72.7% 73.5% % (thousands) 20% 0% Since 2004 approximately 2 millions of Chileans have been incorporated to the Health Care System: 1,82 millions in Fonasa and 0,15 millions in Isapres FONASA ISAPRES FFAA y OTROS (1) (1) Without social protection Source: Superintendence of Health

5 Total accumulated cases of Health Explicit Guarantees in Fonasa and Isapres 4.1% 5.4% 4.9% 5.1% 5.2% 5.2% % 94.6% 95.1% 94.9% 94.8% 94.8% Source: Prepared by the Department of Studies and Development of the Superintendence of Health Total accumulated cases of Health Explicit Guarantees in Fonasa and Isapres to January 2011, according the level of Health Service 100% 80% % 9.5% 20.9% 11.4% 11.3% 8.7% 60% 40% 79.7% 7% 70.4% 79.3% 20% 0% Fonasa Isapre System Outpatient (PHC) Inpatient Mix Source: Prepared by the Department of Studies and Development of the Superintendence of Health

6 100% 80% Protected by Health Care System Base: Total number of persons interviewed B1. In general terms, in front of an important health problem, how protected do you feel with the current health system? 13.9% 17.8% 21.0% 19.0% 17.0% 17.0% 22.0% 60% 26.8% 30.9% 29.0% 33.0% 31.0% 23.0% 22.0% 40% 20% 59.3% 51.3% 50.0% 48.0% 52.0% 60.0% 56.0% 0% Protected/highly protected Nor protected/nor unprotected Unprotected/Highly unprotected Source: Prepared by the Department of Studies and Development of the Superintendence of Health Questions Evaluation of Health Explicit Guarantees Base: Those who have received or whose family members have received medical services provided by AUGE 100% % 12.2% 6.0% % 60% 16.0% 14.7% 19.0% 14.0% 13.0% 13.0% 15.0% % 21.0% 22.0% % % 74.9% 73.1% 75.0% 62.0% 66.0% 65.0% 56.0% % 5.2 0% Grade 6 y 7 Grade 5 grade 1 a 4 Average grade Source: Prepared by the Department of Studies and Development of the Superintendence of Health

7 General Regime on Health Explicit Guarantees in FONASA: Dissatisfaction with NO HEG National Health Survey comparison : New Challenges for our Health System Health Problem Prevalence (%) Prevalence (%) NHS 2003 NHS Tabaquism (current smoker) 42,0 40,6 Overwight 37,8 39,3 Obesity 23,2 25,1 Diabetes mellitus 6,3 9,4 Sedentary 89,4 88,6 Depressive symptoms in the last year 17,5 17,2 Source: Ministry of Health

8 Price Structure of Private Health Care Insurance Plans: Risk selection problem in ComplementaryPlan Free Choice Modality FONASA COMPLEMENTARY PLAN Minimal Coverage GES GES or HEG Price 2 Price determined by individual risk (Base price * Risk Factors) + Price 1 Unique price per Isapre Independent from Individual Risk 1.10 Evolution of risk gap between health insurances in Chile 1.05 FONASA ic risk factors Demographi Consalud ING Colmena Fusat VidaTres Ferrosalud Isapre System Banmédica MasVida Normédica Year Colmena Normédica ING VidaTres MasVida Banmédica Consalud Fusat Ferrosalud FONASA Isapre System Source: C Cid, Author s analysis in the Thesis pg 65

9 Proposal of Solidarity Fund For New Health Guaranteed Plan Central Fund Contributions according by risk Insurances Isapres Payroll tax of 7% Or equivalente subsidies Equal Comunity premiuns by Isapre Fonasa Payment Mechanisms High Incomes Citizens Low Incomes Copayment According to the income Outpatient Services Inpartient Services Public-Private Private Providers Strengthen General Regime of Guarantees with New Health Guaranteed Plan in FONASA Guarantees for the other diseases

10 New comprehensive Health Guaranteed Plan in ISAPREs Current situation New Proposal Aditional Benefits Catastrophic Coverage Complementary Plan of Health Complementary Plan Minimun Coverage MLE GES or HEG Mínimum Plan Catastrophic coverage Promotion & Preventive Health Services NO GES or NO HEG GES or HEG Health Guaranteed Plan Thank you t t l

11 Price Evolution of benefit package Surgical Treatment Hip Osteoarthritis Periodo Periodo Canasta Artrosis Cadera Lineal (Canasta Artrosis Cadera) Canasta Artrosis Cadera Lineal (Canasta Artrosis Cadera) Cirugías Frecuencia Frecuencia Frecuencia Frecuencia Frecuencia Frecuencia Frecuencia Frecuencia Frecuencia Artrosis de Cadera Source: Superintendence of Health *p<0.003 Total mortality rate and specific groups in acute myocardial infarction *p<0.01 * *p<0.003 *

12 The accomplishment of the guarantees: Supervising inform from Health lthsuperintendence, December Principal Reflexions: The paradigm of health guarantees was supported by the citizens, and despite the opposition of health workers and physicians is sustainable today. The strategy is the gradualism and focus in the implementation. Today the health reform is a permanent process and you must define the next steps, because the change are faster (more comprehensive health plan). The objectives of the Health Reform need a better implementation of other instruments as autonomy public hospitals, to improve his performance. Besides we need to improve our capacity in Health Promotion and in Preventive Health Services to address public health issues.