Model of interaction between medical organizations based on the principles of Fund management – a way to improve the efficiency of primary health care

2020 ◽  
pp. 3-11
Author(s):  
R. A. Halfin ◽  
◽  
M. V. Avksentieva ◽  
D. N. Muravyov ◽  
S. A. Orlov ◽  
...  

The article analyzes the experience of per capita financing of primary health care based on the principles of stock provision in the system of compulsory health insurance (MHI). The article shows the features of practical implementation of Fund-forming models of per capita financing, their impact on the final results of the activities of medical organizations of Fund-holders. A unified scheme of interaction between the MHI participants (medical organizations, insurance medical organizations, territorial MHI Fund) (medical and economic model of business processes) is proposed for the implementation per capita financing of primary health care, with provision of decoding with partial filling of the Fund for the implementation of a patient-oriented model of medical care.

Author(s):  
Satibi Satibi ◽  
Dewa Ayu Putu Satrya Dewi ◽  
Atika Dalili Akhmad ◽  
Novita Kaswindiarti ◽  
Dyah Ayu Puspandari

Objective: In national health insurance (JKN) era, pharmacy can play roles in the form of behind refer pharmacies, or networking pharmacy and clinic pharmacy pratama. Behind refer pharmacies drug cost can be claimed directly to BPJS, meanwhile for the other type of pharmacy have to negotiation first with the primary health care. Drug cost variations in the JKN era affect the profitability of the business pharmacies. This research aims to the drug percentage charges against capitation and variety of drug costs.Methods: This research is analytic observational cross-sectional. This research uses secondary data from a JKN prescription patient. This research was conducted on 6 affiliated pharmacies, 6 networking pharmacies, and 7 clinical pharmacy pratama in DIY. The sampling in this research is by purposive with 8.430 prescriptions. Data drug costs JKN era was analyzed by descriptive statistics and comparative test (Kruskal Wallis test).Results: The result showed that average percentage of drug costs for capitation fee in the networking pharmacy is 13.58% and primary health care is 15.91%. Pharmacy in JKN era has drug cost variations (p=0.000). Drug cost in JKN era depends on the pattern of play roles with the health facilities and BPJS. The average percentage of drug costs against capitation health facilities in networking pharmacy is lower than clinical pharmacy pratama.Conclusions: Drug costs in an era of JKN depending on the pattern of cooperation with health facilities pharmacies and BPJS. The average percentage of the cost of drugs to the pharmacy capitation health facilities in networking lower than clinic pharmacy pratama. Differences in drug costs JKN era influenced by the long days of drug administration, the number of prescription sheets, margin.Keywords: Drug cost analysis, National health insurance (JKN), Pharmacy, Primary health care, Capitation.


2019 ◽  
pp. 9-52
Author(s):  
Krystyna WojtczaK

In 2019, twenty-five years have passed since the implementation of the first legisla-tive act introducing for the first time family doctors (primary health care physicians) into the Polish model of basic health care. The beginning of changes in this area, falling in the nineties of the last century, was not easy and has not yet been complete but will continue until the end of 2024. Over the years, not only the conditions for the education and professional development of primary health care physicians, in-cluding family doctors, have undergone changes. Also the organisational and legal forms of providing basic health services by this group of doctors were changing, as well as the conditions allowing patients, the recipients of medical services, to choose their doctor from among those with whom health insurance institutions (health insurance funds, or the National Health Fund) concluded agreements on the provision of basic health care services, or those employed by a medical entity with whom the National Health Fund signed relevant agreements.The scope of changes introduced at that time was wide, and when it started at the beginning of the 1990s it was almost impossible to achieve the goals without the support of the World Bank and the PHARE programme, alongside the efforts of the Ministry of Health and Social Welfare and three regional health care consortia (unions). Their work and contribution of each of them and their activities were sig-nificant and together constituted a solid basis for further work on the improvement of the model of a universal primary health care after 1998.The Act on primary health care of 2017 has completed the process of changes in this respect. For the first time, the objectives of the basic, or primary health care have been clearly defined. Although the implementation of each of these objectives is to serve the patient who is the recipient of the services, the value of the services pro-vided by primary care physicians varies. Family doctors (general practitioners) are to provide the patient and the patient’s family with health care services, coordinating at the same time all the stages of the process of their provision. However, the social mission of their profession is to ensure the implementation of broader tasks, such as health promotion adapted to the needs of various groups of society, education of the medical services recipients in the field of responsibility for their own health, as well as shaping pro-health awareness, setting health priorities of the population covered by care and implementation of preventive actions.


Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1718
Author(s):  
Euphemia Mbali Mhlongo ◽  
Elizabeth Lutge

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.


Author(s):  
Taisiya Ivanovna Krishtaleva ◽  
Irina Dmitrievna Demina

The article examines the historical aspect of the effectiveness of the compulsory health insurance system in Russia, the search for rational methods of paying for medical care both in outpatient and inpatient settings, the reform of Russian health care based on the insurance model and the introduction of per capita payment methods. In order to substantiate the per capita payment for PHC with elements of fund holding and the consolidation of social equality in the provision of medical services, the article analyzes the types of payment for medical services from fees (for the volume of services provided — visits, beddays, etc.) to per capita (for the number of attached to a medical organization of the insured, taking into account the results of activities, in conditions of partial or full fund holding). A deep analysis of the opinions of scientists and experts on the issue under consideration is given. The article was prepared based on the results of research carried out at the expense of budgetary funds on the state order of the Financial University in 2020.


Author(s):  
Elena Nikolaevna Dombrovskaya

The article is devoted to the features of the organization and accounting of payment for medical care provided by medical institutions. The article highlights the trends in reforming the system of payment for medical care, which include the use of per capita payment based on the principles of Fund maintenance. The review of the current regulatory framework in the field of financial support of medical care was conducted. Based on the analysis of models of per capita financing of primary health care in the subjects of the Russian Federation, their insufficient focus on achieving final results is noted. The article deals with the organizational mechanism and accounting mechanism of payment for medical care in health care institutions.


2020 ◽  
Vol 19 (3) ◽  
pp. 433-443
Author(s):  
Md Mizanur Rahman ◽  
Sharmin Mizan ◽  
Razitasham binti Safii ◽  
Sk Akhtar Ahmad

Background and Objective: With the growing concern over treatment cost in health care and the desire to improve the effectiveness and equality of healthcare financing and the quality of the care, policy-makers have turned their attention to health insurance, especially, for the poor. This study attempted to determine the willingness to pay for health insurance among the mothers who utilized the urban primary health care clinic (UPHCC) for maternal and child health. Methods: This cross-sectional study was carried out in the working areas of UPHC Project in Bangladesh following two-stage cluster sampling technique to select the participants. Data were collected from 3949 women aged 15-49 years having at least one child aged two years or less. The data on willingness to pay for health insurance was collected using the contingent valuation method with bidding style. Data analysis was done by SPSS 22.0 version. Two generalized linear models with binary logit link function and normal identity link function were developed to identify the potential predictors for willingness to pay for monthly health insurance. Results: Three-fifths (67.5%) of the respondents agreed to pay for monthly health insurance. The median monthly premium for health insurance was BDT 15.5. Multivariate analysis revealed that utilization of UPHC clinic, quality of life, family size, age, wealth index, level of education, husband and respondent’s occupation, ownership status of the house, religion and family income appeared to be potential predictors for health insurance (p<0.05). However, utilization of UPHC clinic and quality of life appeared to be important predictors across all the models. Conclusion: A large proportion of the community agreed to pay premium for health insurance. Based on the finding of the current study the policy makers might consider introducing a scheme for health insurance especially among the urban poor. Bangladesh Journal of Medical Science Vol.19(3) 2020 p.433-443


2021 ◽  
pp. 251-257
Author(s):  
Raharni ◽  
Rini Sasanti ◽  
Yuyun Yuniar

Objective: This study aimed to identify medicine management in district health offices and primary health care centres (PHCs) after the national health insurance (JKN) programme implementation. Methods: A cross-sectional study was carried out by collecting documents related to medication management and in-depth interviews with the head of the PHC officials and JKN medicine management officers at the PHC in four provinces of Indonesia. Results: The results showed no regional policies related to medicine management; all policies were based on central policies. Medicine management in districts follows the procurement planning suggested by PHCs, which relies on disease patterns. Medicine procurement at PHCs is done by e-purchasing using an e-catalog. Medicines above IDR 200 million are purchased through catalogs provided by the procurement service unit (ULP), and those under IDR 200 million are obtained through a direct appointment. Conclusion: The storage of medicine requires more space and air humidity controlling. The reporting and monitoring of medications e-logistic system are based on 20 indicators and have not been carried out regularly. It is necessary to improve reporting and monitoring systems.


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