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Mariela Busic  - Croatia - Monday 28 - Financing the Donation and Transplantation Process
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Mariela Busic - Croatia - Monday 28 - Financing the Donation and Transplantation Process

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Mariela Busic  - Croatia - Monday 28 - Financing the Donation and Transplantation Process Mariela Busic - Croatia - Monday 28 - Financing the Donation and Transplantation Process Presentation Transcript

  • The Financing model in Croatia and South East European countries Mirela Bušić, MD National transplant coordinator, Croatia
  •  
  • The Balkan peninsula The term Balkan is painted in a negative meaning: violence, religious and ethnic intolerance, the overall backwardness, corruption and division. So this word is being avoid on the border areas and often is considered derogatory
  • MINISTRY OF HEALTH AND SOCIAL WELFARE
  • South Eastern Europe
    • FOUR DEFINITIONS:
    • The 'traditional Balkans‘
    • the European territories of the former Ottoman Empire,
    • larger space promoted by the European Union from 1999.
    • European Union co-funded regional development model that adds Austria, the eastern Regions of Italy and south-western Ukraine.
    Source: Wikipedia
  • The ‘traditional Balkans' model
    • Region got name from the Balkan mountains (in
    • Bulgaria the Stara Planina) .T he name "Balkan“
    • comes from the Turkish word for mountain.
    • The Balkans is not so much of the unit because
    • of the mountain ranges as it is a result of the
    • common and often violent history.
    • This history is primarily marked by centuries of
    • struggle with the Ottoman Empire, as well as
    • interpersonal conflict in the 20th century.
    • Albania , Bosnia and Herzegovina , Kosovo , Bulgaria , Greece , Macedonia and Montenegro
    • Croatia (1/2) and Serbia (2/3) (partially)
    • Romani a, Slovenia and Turkey (optionally)
    Source: Wikipedia
  •  
  • HISTORICAL, CULTURAL AND ECONOMICAL BACKGROUND
    • It is very different region in terms of
    • culture, history and business developmen t
    • New social, political and economic
    • challnges appeared with the fall of
    • totalitarian regimes in the region and the
    • dissolution of USSR and Yugoslavia
    • SEE countires have experienced important
    • changes in the past 20years
    stable economic growth in recent years but still l arge differences in the economic framework
  • Demographic indicators of SEE Region (Source: www.who.int and national reports) Member             101 2053014 20273 SLOVENIA Candidate 10,8 ~68,7 49,95 50,05 59,5 40,5 79,54 2 045 262 25 713 MACEDONIA SAA 12,1 ~67,2 49,8 50,2 62 38 44,89 620 145 13 812 MONTENEGRO SAA NA NA NA NA 51,58 48,42 96,78 7 498 000 77 474 SERBIA Memeber 14,5 61,3 48,8 51,2 53,3 46,7 90,87 21 673 328 238 500 ROMANIA - ~13,6 ~62,5 48 52 41,4 58,6 106,71 3 606 800 33 800 MOLDOVA Candidate median age: 39,97y 48 52 58 42 78,48 4 437 460 56 542 CROATIA Memeber 17 NA 48,6 51,4 69,4 30,60 70,68 7 845 841 111 000 BULGARIA SAA 12,16 62,79 48,85 51,15 43,9 ~56,0 76,15 3 828 397 51 209 BIH SAA 7,52 53,56 49,8 50,2 44,5 55,5 109,12 3 126 153 28 648 ALBANIA >65y 20–64y Male % Female % EU status Age (%) Gender Urban % Rural % Density People /sq km Population Size (Sq km) Country
  •  
  • Economic indicators of SEE region (2008) (Source: www.who.int) - 2877,46 9,01 36 663,1 EU - 1968,94 7,56 25 512,6 EUROPE 0,849 3836 10,1 49 739,1 AUSTRIA 0,828 2183 7,8 26 910,7 SLOVENIA 0,695 702 7 4 662,52 MACEDONIA 0,771 1319 9,5 7 262,43 MONTENEGRO 0,733 838 9,8 6 646,96 SERBIA 0,765 665 4,7 9 299,74 ROMANIA 0,622 318 10,7 1 695,97 MOLDOVA 0,766 1496 7,8 15 636,60 CROATIA 0,741 910 7,3 6 798,13 BULGARIA 0,71 867 10,3 4 906,18 BOSNIA AND HERZEGOVINA 0,713 543 6,9 4125,82 ALBANIA Human Development Index (HDI) Total health expenditure, PPP$ per capita Total health expenditure as % of GDP GDP US$ per capita COUNTRY
  • (Source: www.who.int)
  • (Source: www.who.int)
  • (Source: www.who.int and www.ont.es/publicationes)
  • (Source: www.who.int) 519,3 7,15 38,22 SPAIN 618,42 7,74 55,5 EU 635,24 10,57 43,73 BELGIUM 563,08 6,89 33,58 AUSTRIA 625,13 9,25 66,22 SLOVENIA 1033,73 6,27 199,63 MACEDONIA 971,55 10,01 144,82 SERBIA 948,01 12,3 167,02 ROMANIA 1260,98 12,95 195,4 MOLDOVA 846,17 11,46 71,77 MONTENEGRO 813,07 12,8 113,68 CROATIA 995,39 13,35 186,58 BULGARIA 1008,36 3,46 133,92 BIH 810,24 12,74 151,45 ALBANIA SDR, all causes, all ages SDR, transport accidents, all ages SDR, cerebrovascular diseases, all ages MORTALITY- BASED INDICATORS (per 100 000) last available COUNTRY
  • (Source: www.who.int) 487,88 377,85 246,82 318,55 1,23 SPAIN 823,64 330,46 372,47 528,88 2,15 EU — 296,60 419,11 654,71 1,22 BELGIUM 760,75 476,84 557,11 766,10 1,55 AUSTRIA 801,53 240,66 370,95 459,72 — SLOVENIA — 262,95 303,55 449,6 2,15 MACEDONIA 577,83 284,20 296,03 540,54 0,89 SERBIA 566,18 225,82 462,35 662,33 1,18 ROMANIA 750,34 313,02 493,83 615,27 2,10 MOLDOVA 511,93 207,43 306,08 385,88 1,27 MONTENEGRO 511,03 266,71 336,01 537,49 0,68 CROATIA 421,36 368,99 507,65 659,72 2,10 BULGARIA 483,77 167,87 327,53 341,26 0,85 BIH 389,90 115,36 245,30 275,64 — ALBANIA Nurses Physicians Acute care hospital beds Hospital beds Acute (short stay) hospitals HEALTH CARE RESOURCES (per 100000) last available COUNTRY
  • SEE countries; Organ donation and transplantation rate 2010 (Source: www.ont.es/publicaciones) 9,5 11,5 30,5 53,5 20,5 SLOVENIA 0 2,8 9,33 12,13 5,06 SERBIA 0,33 2,76 10,71 13,81 3,33 ROMANIA 0 0 0 0 0 MONTENEGRO 0 0 0 0 0 MOLDOVA 0 0 5,87 5,87 0 MACEDONIA 0 0 0 0 0 KOSOVO 0,4 2,2 12,1 17,4 3,9 GREECE 8,2 23,9 55,5 89 30,7 CROATIA 0,71 2,14 7,14 10 2,85 BULGARIA 0 0 2,16 2,16 0 BIH - RS 0 0,43 5,65 6,09 0,43 BIH - F 0 0 6,4 6,4 0 ALBANIA Tx heart pmp Tx liver pmp Tx kidney pmp Total transplants pmp Deceased organ donors pmp Country
  • (Source: www.ont.es/publicationes)
  • (Source: www.ont.es/publicationes)
  • Structure of organ donation and transplantation system in SEE countries 2010 E – establishing under way NTO – nationa ltransplant organisation OPO – organ procurement organisation NTC – national transplant coordinator Yes Yes   Yes Yes Yes   NA   Yes   Yes SLOVENIA No E No     NA No No  No E MACEDONIA No E No    No No No  E E MONTENEGRO No Yes Y es  Yes No No  E Yes SERBIA No Yes Y es    Yes Yes yes     Yes Yes ROMANIA No Yes No    Yes Yes No    Yes   Yes MOLDOVA Yes Yes Y es    Yes Yes NA   Yes Yes CROATIA No   Yes Y es  Yes  Yes NA     Yes No BULGARIA No   No No Yes  Yes No  No No BIH RS No No Yes *   No  No No  No No BIH F No   No No  No No No  No No ALBANIA ET member NTC Deceased donation program Allocation rule In-house coordinator OPO NTO Competent Authority Country 
  • ORGAN DONATION AND TRANSPLANTATION IN SEE
    • Deceased donation is still underdeveloped in the most of the SEE countries but at the same time highly developed in Croatia and Sloveni)
    • L iving donation is developed but in a very limited number, as a suplement therapy
    • Access to the transplantaion services is very limited in the region with a huge differences amoung the countries (such as Croatia who is world lider in kidney and liver tx rate and countries with no transplantations Montenegro, Albania, Kosovo).
  • FINANCING ORGAN DONATION AND TRANSPLANTATION IN SEE
    • Financing of the transplantation service varies between the countries,
    • model and sources depending on the organization of the system;
    • The health insurance funds reimbursing the hospitals for organ donor& transplants (the reimbursment donor cost varies from 4.000 in Serbia, 7000 in Croatia to 9.000 Euros in Slovenia).Addtional fund alloted for support of donation&tx
    • Restricted funds alloted for organ donation&tx (state budget, MoH, Health inssurance) in Romania and Bulgaria .
    • No specific cost for transplantation an no funds specifficly alloted for donation and transplantation ( Moldova, BiH, Macedonia, Montenegro)
  • FINANCING MODEL IN CROATIA
    • Ever since 1998 it was decided to secure (allocate) additional funds to
    • support organ donation and transplantation activities specifically for the
    • payment of ;
    • Coordinators Network ,
    • procurement & tissue typing teams
    • donor management cost and transplantation services costs,
    • funeral (transport )cost of the body of the donor
  • Financing Organ donation and transplantation in Croatia Source: Croatian Institute for Health Insurance report
  • CROATIA: Hospital reimbursement for donor management cost (by Croatian Health Insurance Institute) Source: Croatian Institute for Health Insurance report
  • Transplantation cost in Croatia Reimbursement to tx centers by Health Insurance Institute Source: Croatian Institute for Health Insurance report
  • Volume and utilization of the additional funds Croatian MoH budget Source: Goverment budget - Mohsw
  • Conclusion Comparing the available data regarding the current financing mechanisms for the tx system, different models are present; some proven to be optimal (such as Croatian and Slovenian), some limited, and some with no financial support. This last can be explained with the fact that not all of the Ministries of Health have acknowledged organ transplantation as a priority in the public health field, mainly due to the very low economic indicators and health care expanditure available.
  •