The Slovak  W ay on how to  I mprove the  H ealthcare  S ystem  E fficiency  Adriana Liptakova, MD, PhD Ministry of Health...
 
Country facts <ul><li>Capital Bratislava </li></ul><ul><li>Total Area 49,035 km2 </li></ul><ul><li>Population 5,429,763 (2...
Government Type Multiparty democracy <ul><li>President President Ivan Gašparovič </li></ul><ul><li>Economy </li></ul><ul><...
The Slovak health system  is a system in progress   <ul><li>Major health reform in the period 2002-2006 introduced a new a...
www.hpi.sk Healthcare Surveillance Authority Healthcare Insurance company Healthcare providers Ministry of Health Municipa...
1 HIC 2 HIC www.hpi.sk 67% 33% Healthcare insurance companies Healthcare providers Ministry of Health Gov. Municipalities ...
The  Ministry of Health <ul><li>The Public Health Authority </li></ul><ul><li>The National Institute for Drug Control </li...
Health Indicators in Slovakia <ul><li>Average life expectancy grows  (2001-2010 1,35year )   </li></ul><ul><li>Still high ...
Self-Governing Regions <ul><li>Issue permits for healthcare facilities </li></ul><ul><li>Managment of local network </li><...
NCHI, 2010 23 Košice 25 Prešov 25 Banská Bystrica 13 Žilina 16 Nitra 12 Trenčín 9 Trnava 24 Bratislava 147 Slovakia In-pat...
Physicians and nurses  World Health Statistics WHO,2010) 67245 (158) 13141 (31) Ireland 35757 (66) 16868 (31) Slovakia Nur...
Health Economics
Health expenditure as a share (%) of GDP in the WHO European Region, 2008, WHO estimates Slovakia 7,8% Ireland  8,7%
Health expenditure in US$PPP per capita in the WHO European Region, 2008, WHO estimates   Source: WHO, Health for All Data...
Total Expenditure on Health (% of GDP) in 2007(2009) <ul><li>Public sources  4,9%(5,8%) </li></ul><ul><li>Public health in...
Healthcare expenditure (2009) <ul><li>Drugs and medical aids 32% </li></ul><ul><li>Drugs 29% </li></ul><ul><li>Ambulatory ...
How to be more effective?
Elections in June 2010 <ul><li>Change from left of centre parties government to right of centre parties government (SDKÚ, ...
Main challenges <ul><li>E-health </li></ul><ul><li>Expert forum „Health 2020“ </li></ul><ul><li>Standardisation of therape...
Main challenges for providers <ul><li>Transformation of contributory hospitals to joint-stock companies </li></ul><ul><li>...
Main challenges for HIC <ul><li>Reduction of broad basic benefit package </li></ul><ul><li>E-health </li></ul><ul><li>Ethi...
What we have done? <ul><li>First hospitals were selected for transformation </li></ul><ul><li>Conceptual framework for urg...
Next steps for further improvements Report on Current Healthcare in Slovakia, in process GP - Payments per capita Outpatie...
  Our strategy is well known  but...  <ul><li>Healthy population </li></ul><ul><li>=  </li></ul><ul><li>Good economics  </...
<ul><li>Thank you for your attention! </li></ul><ul><li>[email_address] </li></ul><ul><li>www.health.gov.sk </li></ul>
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Dr Adriana liptokova The Slovak way on how to improve the Healthcare system efficiency

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Dr. Adriana Liptakova, Department of Health Slovakia.
Presentation at 2011 National Healthcare Conference in Dublin

Published in: Health & Medicine, Business
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Dr Adriana liptokova The Slovak way on how to improve the Healthcare system efficiency

  1. 1. The Slovak W ay on how to I mprove the H ealthcare S ystem E fficiency Adriana Liptakova, MD, PhD Ministry of Health Slovakia
  2. 3. Country facts <ul><li>Capital Bratislava </li></ul><ul><li>Total Area 49,035 km2 </li></ul><ul><li>Population 5,429,763 (2010 est.) </li></ul><ul><li>Official Language Slovak </li></ul><ul><li>Life Expectancy 70,85 (male) 78,73 (female) (2008) </li></ul><ul><li>National Day 1 September Day of the Constitution of the Slovak Republic </li></ul><ul><li>Ethnic Group Slovak, Hungarian, Roma, Czech </li></ul><ul><li>Religion Roman Catholics, Protestants, Eastern Orthodox   </li></ul>
  3. 4. Government Type Multiparty democracy <ul><li>President President Ivan Gašparovič </li></ul><ul><li>Economy </li></ul><ul><li>GDP $88.208 billion (2009 est) GDP-per capita $16,281(2009 est) </li></ul><ul><li>Unemployment rate 12,1% (2010) </li></ul><ul><li>Imports 3 851,1 mil. € (July 2010) Principally fom Russia and Asia: China, Corea, Taiwan and Japan. Mainly components for radio, TV, cars and oil products. </li></ul><ul><li>Exports 3 757,3 mil. € (July 2010) The main industry sectors are car manufacturing and electrical engineering . Since 2007, Slovakia has been the world's largest producer of cars per capita, [63] with a total of 571,071 cars manufactured in the country in 2007 alone. [63] There are currently three automobile assembly plants: Volkswagen 's in Bratislava , PSA Peugeot Citroen 's in Trnava and Kia Motors ' Žilina Plant .From electrical engineering companies, Sony has a factory at Nitra for LCD TV manufacturing, Samsung at Galanta for computer monitors and television sets manufacturing. </li></ul>
  4. 5. The Slovak health system is a system in progress <ul><li>Major health reform in the period 2002-2006 introduced a new approach based on managed competition. </li></ul><ul><li>Although large improvements since the 1990s were made (e.g. in life expectancy and infant mortality), health outcomes are generally still substantially worse than the averages for the EU-15 but close to the other Visegrad 4 countries. </li></ul><ul><li>Per capita health spending (in PPP) was around half the EU15 average. A large share of these resources were absorbed by pharmaceutical spending (28% in 2008, compared to 16% in OECD countries). </li></ul>
  5. 6. www.hpi.sk Healthcare Surveillance Authority Healthcare Insurance company Healthcare providers Ministry of Health Municipalities Government Professional Associations admission licence admission Insured person payer Healthcare provided Payment of insurance application inspection inspection contract
  6. 7. 1 HIC 2 HIC www.hpi.sk 67% 33% Healthcare insurance companies Healthcare providers Ministry of Health Gov. Municipalities Ministry of Transportation, Post and Telecommunication Private owners Common HIC Healthcare Surveillance Authority Departmental healthcare facilities Pharmacies Outpatient rooms Hospitals Emergency services Specialized hospitals University and faculty hospitals Ministry of Defense Ministry of Interior Affairs General HIC hospitals Outpatient clinics Emergency services Outpatient clinics Private HIC inspection inspection
  7. 8. The Ministry of Health <ul><li>The Public Health Authority </li></ul><ul><li>The National Institute for Drug Control </li></ul><ul><li>The National Emergency Centre </li></ul><ul><li>The National Centre for Health Information </li></ul><ul><li>The National Institution for Transfusion and Blood suplies </li></ul><ul><li>The Slovak Medical University </li></ul>
  8. 9. Health Indicators in Slovakia <ul><li>Average life expectancy grows (2001-2010 1,35year ) </li></ul><ul><li>Still high infant mortality rate: 5,86 per 1000 live births </li></ul><ul><li>Increase of Diabetes mellitus </li></ul><ul><li>Main causes of death (2008) : </li></ul><ul><li>1. Cardiovascular diseases (52,9%) </li></ul><ul><li>2. Cancer (22,1%) </li></ul><ul><li>3. External causes (5,9%) </li></ul><ul><li>Therefore aims of National Health Policy are focused on 4 priorities: </li></ul><ul><li>Cardiovascular diseases, oncological diseases, obesity and overweight, </li></ul><ul><li>Tobacco and Alcohol, </li></ul><ul><li>Enviroment and Health, </li></ul><ul><li>Children </li></ul><ul><li>The Public Health Authority is responsible for state administration and coordination of Public Health in Slovakia. </li></ul>
  9. 10. Self-Governing Regions <ul><li>Issue permits for healthcare facilities </li></ul><ul><li>Managment of local network </li></ul><ul><li>Take over responsibilities of healthcare providers </li></ul><ul><li>Sanctions: finance penalties or revocation of license </li></ul>
  10. 11. NCHI, 2010 23 Košice 25 Prešov 25 Banská Bystrica 13 Žilina 16 Nitra 12 Trenčín 9 Trnava 24 Bratislava 147 Slovakia In-patient Hospitals Area 2009
  11. 12. Physicians and nurses World Health Statistics WHO,2010) 67245 (158) 13141 (31) Ireland 35757 (66) 16868 (31) Slovakia Nurses and midwifes (per 10 000 population) Physicians (per 10 000 population) 2000-2009
  12. 13. Health Economics
  13. 14. Health expenditure as a share (%) of GDP in the WHO European Region, 2008, WHO estimates Slovakia 7,8% Ireland 8,7%
  14. 15. Health expenditure in US$PPP per capita in the WHO European Region, 2008, WHO estimates Source: WHO, Health for All Database, updated July 2010 Slovakia 1717 USD Ireland 3676 USD
  15. 16. Total Expenditure on Health (% of GDP) in 2007(2009) <ul><li>Public sources 4,9%(5,8%) </li></ul><ul><li>Public health insurance 4,7%(5,2%) </li></ul><ul><li>Debt Settlement 0,0%(0,3%) </li></ul><ul><li>MoH (eurofunds incl) 0,2%(0,3%) </li></ul><ul><li>Private sources 1,5%(1,8%) </li></ul><ul><li>Total sources 6,4%(7,6%) </li></ul><ul><li>Expenditure 7,7%(7,3%) </li></ul>portal.statistics.sk
  16. 17. Healthcare expenditure (2009) <ul><li>Drugs and medical aids 32% </li></ul><ul><li>Drugs 29% </li></ul><ul><li>Ambulatory care 35% </li></ul><ul><li>Primary care 8% </li></ul><ul><li>Specialists 12% </li></ul><ul><li>Dentists 3% </li></ul><ul><li>Diagnostics and labs 12% </li></ul><ul><li>Hospitals 24% </li></ul>
  17. 18. How to be more effective?
  18. 19. Elections in June 2010 <ul><li>Change from left of centre parties government to right of centre parties government (SDKÚ, KDH, SaS and Most-Híd) </li></ul><ul><li>Ministry of Health under Christian Democratic Movement liability </li></ul><ul><li>Minister of Health: Ivan Uhliarik, MD </li></ul>
  19. 20. Main challenges <ul><li>E-health </li></ul><ul><li>Expert forum „Health 2020“ </li></ul><ul><li>Standardisation of therapeutic and diagnostic methods </li></ul><ul><li>Human resources (2800 physicians in EU) </li></ul><ul><li>Support of research and development </li></ul><ul><li>Well-Informed patient </li></ul><ul><li>National Programmes focused on Prevention </li></ul>Government Manifesto
  20. 21. Main challenges for providers <ul><li>Transformation of contributory hospitals to joint-stock companies </li></ul><ul><li>Accreditation of health-care facilities </li></ul><ul><li>E-health </li></ul><ul><li>Strengthening of urgent healthcare chain </li></ul><ul><li>Ethics and transparency between HIC and providers </li></ul><ul><li>Human resources </li></ul><ul><li>Support of: nursing provided at home , one-day surgery, outpatient services </li></ul><ul><li>Prescription based on active substance </li></ul><ul><li>Implementation of Diagnosis-related group-system </li></ul><ul><li>Minimal network: based on number of beds – 10-15% reduction , urgent hospital network, terminal hospital network - cancellation </li></ul>Government Manifesto
  21. 22. Main challenges for HIC <ul><li>Reduction of broad basic benefit package </li></ul><ul><li>E-health </li></ul><ul><li>Ethics and transparency between HIC and providers </li></ul><ul><li>Standardisation of therapeutic and diagnostic methods </li></ul><ul><li>Degressive margin for drugs </li></ul><ul><li>Support of nursing provided at home </li></ul><ul><li>Implementation of Diagnosis-related group-system </li></ul><ul><li>Additional insurance </li></ul>Government Manifesto
  22. 23. What we have done? <ul><li>First hospitals were selected for transformation </li></ul><ul><li>Conceptual framework for urgent healthcare chain is prepared for Government´s approval </li></ul><ul><li>Price referencing - 2nd lowest price in EU </li></ul><ul><li>Reimbursment decision is the competence of MoH and its reimbursment committees based on drug effectiveness, safety data and pharmacoeconomic analysis </li></ul><ul><li>Catalogue of healthcare performances </li></ul>
  23. 24. Next steps for further improvements Report on Current Healthcare in Slovakia, in process GP - Payments per capita Outpatient specialists – DRG Inpatient healthcare - DRG Payment mechanisms University hospital in Bratislava Hospitals Reform of Funds Basic benefit package Financing Future options Area
  24. 25. Our strategy is well known but... <ul><li>Healthy population </li></ul><ul><li>= </li></ul><ul><li>Good economics </li></ul><ul><li>= </li></ul><ul><li>Worthwile target for all </li></ul><ul><li>(government, citizens, employers) </li></ul>
  25. 26. <ul><li>Thank you for your attention! </li></ul><ul><li>[email_address] </li></ul><ul><li>www.health.gov.sk </li></ul>

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