Your SlideShare is downloading. ×
0
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
13. mch voucher scheme and hospital equity fund
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

13. mch voucher scheme and hospital equity fund

102

Published on

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
102
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • (timeline of reimbursement, from both organization and individual views, and reimbursement rate)
  • Transcript

    • 1. MCH Voucher Scheme and Hospital Equity Fund : An Update Financing Schemes : Health System Strengthening Dissemination on Implementation of Health Systems Strengthening in (20) Townships MOH Meeting Room, Nay Pyi Taw, Myanmar, 6th August 2012
    • 2.  Financial barriers is a fundamental problem in improving access for mothers and children during health systems assessments  HSS funds have been identified to remove these financial barriers  In Yedarshay, the concept of “Maternal and Child Health Voucher Scheme” (MVS) has been developed to improve access by the poor to life saving pregnancy treatment services related referral and
    • 3.  All poor pregnant women and the newly born infants especially those residing in hard-to-reach areas  Health care providers as regards rural and urban
    • 4.  (4) AN Care  Normal delivery with SBA at home or at health center  Management of complications  Food cost, lodging cost, travel cost and direct medical care cost covered by Hospital Equity Fund  (1) PN care
    • 5. Summary: budget for MCH Voucher Scheme Point of service delivery 4 ANC +PNC For pregnant women For providers Delivery For pregnant women Total For providers Services at home 1,000 k 4,000 k +1,500 k 5,000 k 11,000 k 22,500 k Service at health facilities 8,000 k 4,000 k 10,000 k 10,000 k 32,000 k
    • 6. Estimated service uptake according to the revised plan ANC with SBA Baseline Revised plan Delivery with SBA 73% 51% 93% - 100% 59% - 67%
    • 7. V V V Outreach Management agency V Multiple voucher distributors Administrative burden V V V Village V V V V V V Over utilization Yedashe Township Hospital V V Health facilities MoH
    • 8. Financial management process
    • 9. Healthcare providers Health facilities • Register pregnant women. • Provide MCH services stated in the benefit package to pregnant women with the vouchers. • Submit the providing services forms (P1), summary of the service provision forms (P2), and vouchers to management agency for reimbursement on a monthly basis.
    • 10. Management agency M2i Distributors Distributors Monthly V1 i • Verify the documents submitted by voucher distributors and healthcare providers (V1 vs P1) . • Disburse the expenditures to distributors and healthcare providers without delays (2 weeks), along with the summary of the disbursement forms (M1). • Report the activities and financial statement Monthly to the MoH on a quarterly basis (M2). • Performance evaluation Management Agency Not more than 2 weeks P1 i P2 i M1 i Health facilities
    • 11. Monitoring and Evaluation Levels Process Outputs/outcomes Immediate Intermediate Final Health Economics Population • Number of voucher distribution • Awareness • Attitude • Trust • Utilisation of MCH services • Proportion of voucher reimbursement • Maternal/ Infant morbidity & mortality • Value for money Providers • Satisfaction • Participation • Adherence to the protocol • Awareness • Attitude • Trust • Quantity & quality of services provided • Capacity building - • Financial space Household/ individual • Satisfaction • Awareness • Attitude • Trust • Knowledge • Utilisation of MCH services • High risk pregnancies received proper care • Reduction of household expenditures + Program performance evaluation
    • 12. What is the high priority measures? • Monitoring for service utilization – Number of vouchers distributed – Number of voucher utilization Source of data: from VD1 and P1 form Source of data: from VD1 and P1 form • Adherence to the protocol – Completeness, average and range of disbursement process Source of data: from P1 and M1 form, monitor q 3-6 months if possible Source of data: from P1 and M1 form, monitor q 3-6 months if possible
    • 13. • Cost of programme implementation – Reimbursement cost of providing ANC at home/health facility – Reimbursement cost of providing delivery at home/health facility – Reimbursement cost of providing PNC at home/health facility Source of data: from reimbursement records Source of data: from reimbursement records
    • 14. What is the priority measures? • Costs of programme implementation – – – – – – Costs of voucher production Costs of distribution of voucher Costs of voucher reimbursement system Costs of administrative tasks Costs of communication campaigns Costs of human resource training Source of data: from management agency Source of data: from management agency
    • 15. What is the priority measures? • Costs of programme implementation (HEF) – Reimbursement cost of complication management – Reimbursement cost of providing caesarean section including medicines – Reimbursement cost of transportation to referral facility Source of data: from reimbursement records Source of data: from reimbursement records
    • 16. Performance evaluation Indicators Sources of data Voucher distribution/ utilization rate (also by services) V1 and P1 Payment by items (Medical cost, incentive cost, administration cost) M2 Time to completed disbursement process ( Completeness, average and range) P1 and M1 Reimbursement of the provider requests (% full amount, gap) P2 and M1 Frequency of internal account audits (6 months) MoH staff audit Satisfaction of the financial process? Survey (Pregnant women, distributors and healthcare providers)
    • 17. Hospital Equity Fund (or) Patient Referral Fund for poor mothers and children GAVI HSS
    • 18. Health systems assessments conducted in Myanmar between 2009 and 2011 in 20 HSS Townships • Financial barriers to access- have been identified as a fundamental problem in improving access for mothers and children • HSS funds have been identified in order to assisting with removing these financial barriers. • In the Township of Lewe, the concept of a “Patient Referral Fund” has been put forward in the CTHP to improve access by the poor to life saving referral and treatment services at the Township Hospital.
    • 19. HEF Objectives: • To enhance access by the poor mothers and children to hospital based services, through provision of targeted medical allowance for emergency transport and emergency and life saving procedures at the Township Hospital. Expected Outcomes/Output • With this fund support, could save the lives of poor mothers and children, – who are difficult to access to hospital (physically or economically) – by getting timely referral and treatment,
    • 20. Beneficiaries • All emergency patients (mothers and children under 5 pre identified as poor) with life threatening conditions (this includes classifications of mothers or children as being at “high risk” of a life threatening condition). • Mothers and pregnant women and children 0 – 5 of a specified income level (post identification for eligibility) at entrance of hospital
    • 21. Benefits Package • Emergency procedures (such as cesarean section and other life saving procedure) • Management of Complicated delivery (eclampsia, obstructed delivery, APH and PPH and abortion related complications) • Other life saving emergencies (e.g. RTA and snake bites and others) • Management of Child hood acute illness (e.g. peummonia, diarhhoea, dengue and malaria or other acute condition)
    • 22. Details of Benefits • Reimbursement of medicines and related costs (procedures) and transport and food costs • 5 – 10 days stay in hospital with one attendant • Total reimbursement not exceeding 100,000 kyats for the whole benefit package • The option should be considered for forwarding part of the referral fund to selected RHC for emergency transport, to be overseen by the RHC supervisory committee.
    • 23. HEF Fund Holders According to the guideline flow of this Hospital Equity Fund will be supervised by budgetary sub-committee under the township health committee. The Budgetary sub-committee is organized by – • Local well wisher who involve in the township health committee - Chairman • Gazette officer from the District/Township Health Department - Member (1) • Local well wisher - Member (2) • District/Township Medical Officer - Secretary • Accountant
    • 24. Assessment of Eligibility for Benefits • Eligibility for benefits should be based on pre identification of income/asset status. • This should be accessed through – Using social mapping methods, – community leaders, local authorities and elders should assess and select the village areas and households with the “most poor status.” – Through package tour by group of BHS for identification of poor mothers and children
    • 25. Reporting and Auditing • Support can be provided through the Hospital Supervisory Committee and Township Auditors Office for Reporting. A Patient Referral Fund (PRF) Report form should be completed detailing: • Name and address of beneficiary • Medical Condition • Benefits provided (Medicines, Food and Transport, procedures) • Attachment of pre identification questionnaire • Signatures of patient/family of patient and of Chair of Hospital Supervisory Committee or other non medical member.
    • 26. Estimated Budget for one patient: • Transportation cost for emergency referral of patient = 35,000 Ks • Treatment cost (Drug cost + other treatment cost) = 40,000 Ks • Perdiem – 3,500 Ks x 8 days (during the hospital stay) = 28,000 Ks 103,000 Ks • For 1 township = (6-7) patients/mth x 12 mths = 80 patients for one year • For 1 township = 103,000 Ks/pt x 80 patients = 8,240,000 Ks
    • 27. HEF funds distributed to 20 townships in May 2012 Budget used status as of July 2012 • Townships that have not started using HEF= 5 • Townships that have used HEF = 15
    • 28. Kawt Hmu Township, May 2012 SN Patient's Name Age/ Sex Treatment Cost 1 Daw Kyin Mya, APH 46, F Em. LSCS Drug costTA – DA (pt+1) -2x2000x7D= Total - 2 Su Su Hlaing, Breech presentation 24, F Em. LSCS Drug costDA (pt+1) -2x2000x7D Total - 31625 28000 59625 3 Ma Myint Thein Hydraminos, baby congenital abn 31, F Em. LSCS Drug costTA – DA (pt+1) -2x2000x7D Total - 20900 30000 28000 78900 4 Nu Nu Win 30, F Normal labour Drug costDA (pt+1) -2x2000x4D Total - 6725 16000 22725 Total (kyats) 31625 35000 28000 94625 255,875
    • 29. Kawt Hmu Township, May 2012 SN Patient's Name Age/ Sex Treatment Cost 1 Pyae Pyae Aung 4, F Acute GE Drug costDA (pt) -1x2000x3D= Total - 1525 6000 7525 2 Phyo Ainga 4 mth, F Acute GE Drug costDA (pt+1) -2x2000x3D Total - 4300 12000 16300 3 Saint San Yae 3 1/2, F Acute Viral infection Drug costDA (pt+1) -2x2000x3D Total - 2100 12000 14100 Total Grand Total (kyats) 37,925 293,800
    • 30. Ngaputaw Township, May 2012 SN Patient's Name 1 Naw Aye Thaw 2 Ma Khin Hmwe Grand Total Age/ Sex ,F ,F Treatment Cost (kyats) Normal Labour Drug costDA (pt) -2x3000x7D= Total - 46925 42000 88925 Normal Labour Drug cost- 55925 144850
    • 31. HEF Expenditure for May S N Townships No of Patient DA TA Drug Cost Total Cost (kyats) 1.Kawthmu 7 130000 2.Ngaputaw 2 42000 Total 172000 65000 293350 102850 65000 98350 144850 201200 438200 Unit Cost: 48,689
    • 32. HEF Expenditure for June S N Townships No of Patient DA TA Drug Cost Total Cost (kyats) 1Bamaw 5 147000 115000 219500 481500 2Shwegu 7 196000 64000 173000 433000 3Hlaingbwe 4Mudon 4 6 66500 133000 69000 210000 166445 157000 301945 500000 5Kyaingtong 6NyaungShwe 3 3 2 84000 88885 70000 66500 87250 24000 67400 241250 179385 67400 2 6 1 3 5 68000 126000 0 84000 20000 12000 0 105000 62950 138000 57405 111000 95860 150950 276000 57405 300000 95860 47 993,385 1,359,810 3,084,695 7Hsipaw 8Kawthmu 9Htilin 10YeOo 11Myeik 12Ngaputaw Total 731,500 Unit Cost: 65,632
    • 33. HEF Expenditure for July S N Townships 1Bamaw 2Shwegu 3Demawsoe 4Hlaingbwe 5Hakha 6Thaton 7Mudon 8Kyaingtong 9Hsipaw 10Kawthmu 11Htilin 12YaeOo 13Myeik 14Ngaputaw Total No of Patient DA TA Drug Cost Total Cost 12 12 1 3 3 2 7 252,000 291,000 28,000 59,500 80,500 58,000 136,500 247,000 165,000 10,000 50,000 76,000 45,000 175,000 498,800 111,000 37,000 113,600 128,500 128,500 160,220 (kyats) 997,800 567,000 75,000 223,100 285,000 231,500 471,720 3 2 8 1 2 10 10,500 52,000 126,000 5,000 45,000 160,000 38,500 20,000 1,152,500 55,000 32,700 29,250 232,000 44,394 74,000 190,095 48,200 126,250 518,000 44,394 167,500 210,095 1,780,059 3,965,559 66 1,033,000 Unit Cost:60,084
    • 34. HEF Expenditure Total For 3 months SN Townships No of Patient DA TA Drug Cost Total Cost (kyats) 1Bamaw 2Shwegu 3Demawsoe 4Hlaingbwe 5Hakha 6Thaton 7Mudon 17 19 1 7 3 2 13 399,000 487,000 28,000 126,000 80,500 58,000 269,500 362,000 229,000 10,000 119,000 76,000 45,000 385,000 718,300 284,000 37,000 280,045 128,500 128,500 317,220 1,479,300 1,000,000 75,000 525,045 285,000 231,500 971,720 3 3 84,000 88,885 70,000 66,500 87,250 24,000 241,250 179,385 5 10,500 5,000 100,100 115,600 11Kawthmu 12Htilin 11 14 250,000 252,000 130,000 172,000 190,550 370,000 570,550 794,000 13YaeOo 14Myeik 15Ngaputaw 2 5 17 0 122,500 62,000 0 160,000 0 101,799 185,000 388,805 101,799 467,500 450,805 122 2,317,885 1,829,500 3,341,069 7,488,454 8Kyaingtong 9NyaungShwe 10Hsipaw Total
    • 35. Challenges • Identification of poor (pre assessment) • Identification of poor (post assessment- easy for 25 and 50 bedded hospital, - difficult for 100 & 200 bedded hospitals -management by OB Gyn • Poor but need elective LSCS • Poor in non emergency??? • Sustainability
    • 36. Thank You

    ×