1. MSAs could provide some financial relief for citizens who currently face high out-of-pocket expenditures for health care.
2. However, medical professionals have concerns that increased co-payments resulting from MSAs could act as a barrier to access for some.
3. Private health insurance has had limited success in Lithuania due to a mismatch between the limited risks covered and high premiums charged versus citizens' actual health expenditures.
4. Both MSAs and private insurance face obstacles in Lithuania related to lack of experience with these models, uncertainty about benefits for consumers
The EU wind energy sector installed 11.6 gigawatts (GW) of capacity in 2012, bringing the total wind power capacity to 105.6 GW, according to the 2012 annual statistics launched by the European Wind Energy Association (EWEA).
This updated edition of Pure Power once again shows the huge contribution wind energy already makes – and will increasingly make – to meeting Europe’s electricity demand and strengthening its economy, and to avoiding polluting and costly fuel and carbon. Contents: Wind energy currently meets 5.3% of the EU’s electricity consumption from an installed capacity of 84.3 GW. The European Wind Energy Association’s scenarios show that wind energy in 2020 should meet 15.7% of EU electricity demand from 230 GW, and by 2030, 28.5% from 400 GW. Indeed, EWEA believes wind energy can provide half of Europe’s power by 2050, with the remainder from other renewable sources. To ensure the continued buoyancy of the wind energy sector and the path to 100% renewables in 2050, EU renewables legislation is needed now for the period after 2020. This should follow the successful legislation so far by setting an ambitious, binding renewables target for 2030.
info efisiensi pendidikan yad, dan bgmn sinergi antara oecd country dan asia tenggara, perlu di sikapi dan di persiapkan dan di bandingkan antar negara, tapi perlu ke hati2an, krn negara oecd stagnan saat ini dlm bidang ekonomi...
Towards an EU-Strategy on Mental Health. Jurgen Scheftlein. Presentation of the Strategy in Mental Health National Health System (Madrid, Ministry of Health and Consumer Affairs, 2007)
The EU wind energy sector installed 11.6 gigawatts (GW) of capacity in 2012, bringing the total wind power capacity to 105.6 GW, according to the 2012 annual statistics launched by the European Wind Energy Association (EWEA).
This updated edition of Pure Power once again shows the huge contribution wind energy already makes – and will increasingly make – to meeting Europe’s electricity demand and strengthening its economy, and to avoiding polluting and costly fuel and carbon. Contents: Wind energy currently meets 5.3% of the EU’s electricity consumption from an installed capacity of 84.3 GW. The European Wind Energy Association’s scenarios show that wind energy in 2020 should meet 15.7% of EU electricity demand from 230 GW, and by 2030, 28.5% from 400 GW. Indeed, EWEA believes wind energy can provide half of Europe’s power by 2050, with the remainder from other renewable sources. To ensure the continued buoyancy of the wind energy sector and the path to 100% renewables in 2050, EU renewables legislation is needed now for the period after 2020. This should follow the successful legislation so far by setting an ambitious, binding renewables target for 2030.
info efisiensi pendidikan yad, dan bgmn sinergi antara oecd country dan asia tenggara, perlu di sikapi dan di persiapkan dan di bandingkan antar negara, tapi perlu ke hati2an, krn negara oecd stagnan saat ini dlm bidang ekonomi...
Towards an EU-Strategy on Mental Health. Jurgen Scheftlein. Presentation of the Strategy in Mental Health National Health System (Madrid, Ministry of Health and Consumer Affairs, 2007)
2012 m. Lietuvoje savižudybių skaičius palyginus su 2011 m. sumažėjo 91 atveju. Pagal Higienos instituto Sveikatos informacijos centro parengto leidinio „Mirties priežastys 2012 (išankstiniai duomenys) duomenis 2012 m. Lietuvoje nusižudė 927 asmenys: 753 vyrai ir 174 moterys.
Pagal Higienos instituto Sveikatos informacijos centro (HISIC) ir Pasaulinės sveikatos organizacijos (PSO) duomenis grafinę prezentaciją parengė Sveikatos ekonomikos centras.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2012 m. Lietuvoje savižudybių skaičius palyginus su 2011 m. sumažėjo 91 atveju. Pagal Higienos instituto Sveikatos informacijos centro parengto leidinio „Mirties priežastys 2012 (išankstiniai duomenys) duomenis 2012 m. Lietuvoje nusižudė 927 asmenys: 753 vyrai ir 174 moterys.
Pagal Higienos instituto Sveikatos informacijos centro (HISIC) ir Pasaulinės sveikatos organizacijos (PSO) duomenis grafinę prezentaciją parengė Sveikatos ekonomikos centras.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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How to Give Better Lectures: Some Tips for Doctors
SEC Tallinn 2011-03-15
1. New Developments in Lithuanian
Health Care System
Romualdas Buivydas
Gediminas Černiauskas
Sveikatos ekonomikos centras
(SEC, Health economics centre)
Tallinn, 2011, March 16
Seminar „Private Health Insurance and Medical Savings Accounts –
defining the benefit package“
7. What exactly has been discussed in Lithuania
about private health insurance and MSAs?
• Since year 1996 in Government’s programs
are included proposal to develop SHI in
Lithuania
• Discussions about MSA started in 2007
• First draft proposals about MSA discussed in
the Government at the fall of 2008
• Revised version of the draft of SHI and MSA
has been developed in mid 2010
8. Supplementary Health Insurance in EU (1)
Private insurance expenditure as percentage of Current health care expenditure
EUROSTAT (2007 or last available)
16
13,52 13,45
14
12
9,59
10
Percentage
8
6,2 6,19 6,08
5,6
6 4,87
4,29
4
2,61
2,24
1,8 1,71
2 1,18
0,58 0,42 0,41 0,3 0,22 0,22 0,21
0
Germany
Hungary
Poland
Spain
Finland
Sweden
France
Portugal*
Latvia*
Luxembourg**
Bulgaria
Romania
Slovakia
Slovenia
Netherlands
Cyprus
Austria*
Denmark
Lithuania
Estonia
Czech Republic
Belgium
9. Supplementary Health Insurance in EU (2)
Private insurance expenditure as part of total private helth expenditure
EUROSTAT, (2007 or last available)
70%
63,94%
60%
50% 46,57%
42,32%
40%
34,52%
30% 22,53%
21,24%
21,23%
18,97%
20% 14,91%
10,71%
10,54%
10% 8,77% 6,78%
3,97%
1,98% 1,47% 1,45% 1,25% 1,18% 1,09% 0,96%
0%
Germany
Hungary
Poland
Sweden
Portugal
Spain
Luxembourg
Finland
France
Netherlands
Austria
Latvia
Lithuania
Czech Republic
Bulgaria
Slovakia
Belgium
Slovenia
Cyprus
Denmark
Estonia
Romania
10. Supplementary Health Insurance in EU
Conclusions (3)
• Supplementary health insurance (SHI) in EU member states mainely is
an addition to main schemes of social health insurance or NHS type
systems with an aim to reduce weaknesses inherited by these main
schemes
• International practice is indicating some preconditions for massive
introduction of SHI:
– Relatively big co-payments for health services (Ireland, France, Slovenia)
– Tax subsidies (Ireland, Austria, Germany, Slovenia, Spain)
– Insurance of certain groups of population by public funding (Germany)
– Certain obligatory measures (France, Slovenia)
Countries with SHI close to or above of 10 percent of total health
expenditures do have at least 3 of these preconditions
11. What have been the main obstacles for the
implementation?
For traditional SHI:
• Health care risks not covered by Statutory
HI are of limited attraction for private
insurance companies (risks mainly
predictable and small)
• Insurance plans provided by private
companies are of limited attraction to
corporate clients (premiums are high,
benefits not clear)
12. No match between supply and demand of
commercial SHI
Why Lithuanian people do not want to be insured by SHI?
I II III IV V VI VII VIII IX X
Citizens expenditure for
HC per year in Litas 69,6 135,6 164,4 223,2 231,6 325,2 399,6 436,8 595,2 1147,2
(2008 m.)
Average SHI premium
per person per year in 1108,2
Litas
13. Supplementary Health Insurance.
Situation in Lithuania
Supplementary HI market in Lithuania
120 100,00%
90,00%
Premiums, benefits sum per year, mil. Litas
Benefits/premiums ratio, percentage
100
80,00%
70,00%
80
60,00%
53,47%
60 50,00%
40,00%
40
35,83%
30,00%
32,29%
31,80%
29,60%
27,88%
27,24%
27,42%
20,00%
20
10,00%
0 0,00%
2002 m. 2003 m. 2004 m. 2005 m. 2006 m. 2007 m. 2008 m. 2009 m.
Benefits/premiums ratio, percentage Premiums sum per year, mil. Litas Benefits sum per year, mil. Litas
14. What have been the main obstacles for the
implementation? (2)
For MSA:
• Limited experience world-wide, almost no
practical experience in Europe
• Limited and uncertain gains for consumers
• Ministry of Finance is suspicious about new
financial products
• Insurance industry is opposing the product
partially regulated by the State
15. Are the people ready for such a system?
• Medical society is in favor
• General public would prefer MSA to SHI,
but support is limited
• Politicians are lost in between
16. What services should be excluded from the state’s
benefit package, should there be any changes and
what could be the methodology for doing that?
• Main stream thinking in Lithuania is to use
MSA as a certain relieve of currently
existing financial burden
• Medical personnel do have second thoughts
about significant co-payments, but they are
not able to convince politicians to support
this “greedy” approach
17. What problems would implementing MSAs or
Private Health Insurance solve in the system?
18. Supplementary Health Insurance in EU (4)
Different objectives had been indicated as a rational for the design of SHI. The
practise presented evidence in favour of just some of these objectives
Objectives Conclusions regarding precision of the objective
Expansion of SHI is leading to reduction of Only partially true Public expenditures may even grow because of tax and
public health care expenditures budget subsidies and demand inflated by SHI
Competition created by SHI will improve quality Partially true, depend on conditions, Competition is between private insurance
and effectiveness of health services companies mainly about engagement of rich and healthy. Companies usually
are too weak to have any influence on quality of care. They can’t manage
investments in to quality
Improve efficiency and transparency of using Not true. Cross subsidies between obligatory and supplementary schemes may
recourses in health sector. make transparency even lower
Increase of consumer choice what regards Partially t true. Monopoly of obligatory health insurance is effected but results
insurance company and provider of health care. what regards competition are quite marginal. Consumers are lacking
knowledge to make informed choices, individuals have limited rights to choose
under group insurance purchased by employers.
Revenues of health sector is going to increase Partially true. Certain countries do managed to improve moderately health care
financing by SHI
Better accessibility and less waiting lists. Partially true. Insured may gain but not insured may face even less accessibility
and more waiting lists
Less informal payments No clear evidence
Better assurances ageist financial risks Partially true. Insured may gain but not insured may face even more risks.
Increased responsibility of people regarding the Not true. Tax subsidies, group insurance practices make responsibly usually
personal health . marginal.
19. What are the main aspects of assessing the
implementation of such a system?
• Actual demand of a new product
• Financial and political sustainability of new
scheme
20. Potential for MSA/SHI
Private expenditure, mil. Litas
2500
2000
1500
1000 1999,8
1792,8
1640,2
1546,1
1341,1
1141,4
500
0
2004 2005 2006 2007 2008 2009
Private household expenditure for HC SHI expenditure
21. Proposals directed towards SHI market expansion
• To better compensate health expenditures of the
inhabitants, work must be concentrated in
following direction:
– Promotion of commercial supplementary (voluntary)
health insurance, to guarantee protection from large
financial loss due to illness.
– Utilization of international experience what regards the
medical saving accounts in Lithuania
22. Proposals directed towards SHI market expansion
Commercial health insurance
Main parameters
– Annual contributions are 200-400 Litas
– Number of insured in 3 years growing up to
1,5-2 millions. At least 100 000 per plan
– Administrative costs are up to 7 percent to
contributions
– Individual and group insurance
– Almost equal premiums
23. Proposals directed towards SHI market expansion
Model of medical saving accounts
Plan of the scheme
– All goods sold in pharmacies
– Health services not covered by the statutory
scheme
– Owner of the account may use his savings to
buy SHI from commercial insurance
– Accounts may be used for coverage of financial
expenditures of relatives and other persons
24. Proposals directed towards SHI market expansion
Model of medical saving accounts
Contributions
– May be paid by a person or his/her employer.
– The scheme may have additional revenues
Public financial support;
– For taxed income earners. Tax free regime for contributions
up to 400 per year
– Alternative: 15 percent budget subsidy for contributions up
to 400 Litas per year. Tax subsidies cancelled
Administrative costs
– Up to 4 percent of contributions
25. Comparison of Ratio of Average Consumption
Expenditures by Households between 10 and 1
Deciles with Life Expectancy
Comparison of Ratio of Average Consumption Expenditures by Households between 10
and 1 Deciles with Life Expectancy
72,4
72,2 72,14
72,05
Life expectancy in yeras (1997-2008)
71,99
72,0
71,94
71,79
71,76
71,8
71,66
71,6
71,39
71,4 71,32
71,12
71,2 71,08
70,92
71,0
y = -0,8204x + 78,367
70,8
70,6
7,5 7,7 7,9 8,1 8,3 8,5 8,7 8,9 9,1 9,3 9,5
Ratio of Average Consumption Expenditures by Households between 10 (richest) and 1 (poorest)
Deciles (1997-2008)
Correlation between these two data sets is (-)0,873
26. Questionnaires about SHI and co-
payments
Citizens – representative
Medical personnel, Managers of HC institutions,
Insurers – qualitative
27. What you like or dislike in Lithuanian HC
system? (points form 0 to 4)
1. What you like or dislike in Lithuanian HC system? (points form 0
to 4)
Accessability of services Citizens
3,00
2,50 Medical personnel (135)
2,00
Managem ent of HC system 1,50 Solidarity in HC system HC institutions
Managers of
1,00 (36)
0,50 Insurers (7)
0,00
List of services Quality of HC services
Quality of provision of services in
HC institutions
28. What level of solidarity you accept most?
(one answer), percentage
2.What level of solidarity you accept most? (one answer), percentage
80,0% 75,0%
70,0% 67,0% 66,7% Citizens
Medical personnel (135)
60,0%
50,0% Managers of HC institutions (36)
50,0% Insurers (7)
40,0%
28,4%
30,0% 23,0%
20,0% 16,7% 17,2%16,7%16,7%
8,3% 7,0%
10,0% 4,0% 4,5%
0,0% 0,0%
0,0%
All permanent citizens are equal and Government should guaranty same Citizens, who pay more taxes and Have no opinion
should receive the same HC services. level and quality HC services only to insurance premiums should receive
those who pay taxes or are socially more services than those for whom
supported persons. pay Government.
29. Are you insured by supplementary voluntary
health insurance?
4. Are you insured by supplementary voluntary health insurance?
80,0%
72,2%
70,0% Citizens
Medical personnel (135)
60,0% 57,0%
Managers of HC institutions (36)
52,2%
50,0%
43,3%
40,0%
30,0%
25,0% 25,0%
20,0% 17,0%
10,0%
4,5%
2,8%
0,0%
Yes, or would like to be insured No, and do not intend to be insured I do not know what it is
30. What benefits SHI provide/may provide
(up to 3 answers)
6. What benefits SHI provide/may provide (up to 3 answers)
120,0%
Citizens
100,0%
100,0% Medical personnel (135)
Managers of HC institutions (36)
80,0% Insurers (7)
72,2%
60,0% 53,0%
50,0% 50,0%
47,4%
43,0% 44,4% 41,7%
38,0% 38,0% 38,9%
40,0% 33,3% 33,3%
29,6% 29,6% 28,0%
24,4%
21,5% 20,0% 20,7%
19,4%
20,0% 13,0% 14,0%
11,1% 11,9%
11,1% 11,0%
0,0% 0,0% 0,0% 0,0%
0,0%
HC serv ices Improv ed quality of Higher quality of Less corruption in Vanish monopoly of Guarantee, that if you Higher salaries for More effectiv e use of
prov ided in time serv ice prov ision serv ices HC institution Statutory Health fell seriously ill, will medical personnel financial means in
insurance system be no lack of HC system
financing for
treatment
31. Should State financially support SHI?
7. Should State financially support SHI?
70,0% 66,7%
Citizens
58,0%
60,0% Medical personnel (135)
Managers of HC institutions (36)
50,0% 47,2%
Insurers (7)
39,4% 38,9% 37,9%
40,0%
33,3%
30,0% 27,0%
22,7%
20,0% 15,0% 13,9%
10,0%
0,0%
0,0%
Yes Yes, partly (by tax exem ptions) No
32. What should be reimbursed by SHI?
8. What should be reimbursed by SHI?
120,0% Citizens
100,0% 100,0% Medical personnel (135)
100,0%
Managers of HC institutions (36)
Insurers (7)
80,0%
66,7% 66,7% 63,9%
61,0% 60,0%
59,0%
60,0% 55,6%
50,0%
44,4% 45,0%
35,6% 36,1% 37,0% 36,1%
40,0% 30,4%
29,0% 27,8%
21,0%
20,0% 21,5%
16,7% 16,0%
20,0%
0,0%
Pharmaceuticals Odontology treatment and Invoices from public HC Invoices form private HC Expenses for SPA Additional expenses for
dental prostheses institutions for out of institutions. treatments. higher quality for services,
pocket payments for not guaranteed by State
services or co-payments. (single bed boom in
hospital, treatment without
waiting list, specialist
consultation without
referral)
33. Do you support SHI system development?
9. Do you support SHI system development?
80,0%
Citizens
69,4%
70,0% Medical personnel (135)
Managers of HC institutions (36)
60,0%
49,0% 47,7%
50,0%
40,0%
40,0%
30,0% 27,8%
25,0% 26,0%
20,0%
12,3%
10,0%
2,8%
0,0%
Yes, agree Agree with condition, that for those, No, not agree
who are not insured by SHI, HC
service provision will be not worse
34. What premium for SHI per year you agree to pay?
10. What premium for SHI per year you agree to pay?
70,0%
Citizens
59,0% Medical personnel (135)
60,0%
Managers of HC institutions (36)
50,0% 45,7% Insurers (7)
44,4%
41,7%
40,0% 35,0%
31,8% 33,3% 33,3%
30,0%
20,0% 17,1% 16,7% 16,7%
8,3%
10,0% 5,6%
4,0% 3,1%
1,0% 2,3%
1,0%
0,0%
0,0% 0,0% 0,2% 0,0%
0,0%
0,0%
Not agree to pay 1-200 litų 201-500 litų 501- 1000 litų 1001-2000 litų 2001- 3000 litų
any premiums
35. For which group of Lithuanian population
SHI is/will be most needed?
11. For which group of Lithuanian population SHI is/will be most needed?
120,0%
100,0% Citizens
100,0% Medical personnel (135)
86,1% Managers of HC institutions (36)
80,0% Insurers (7)
59,0%60,8%
60,0%
40,0%
20,0% 16,2% 15,0% 16,0%
10,0% 11,1% 10,8% 12,3%
2,8%
0,0% 0,0% 0,0% 0,0%
0,0%
For majority of Lithuanian For rich people For socially supported Nobody
population people
36. If you agree to pay additionally for SHI, what
methods are most convenient for you?
(possible few answers)
12. If you agree to pay additionally for SHI, what methods are most convenient for
you? (possible few ansvers)
70,0%
Citizens 61,1%
58,3%
60,0% Medical personnel (135) 57,0%
53,3%
Managers of HC institutions (36)
50,0%
40,0%
30,0%
30,0%
23,0% 23,0%
20,0%
11,1% 12,0%
10,0% 7,0% 5,9% 5,6%
0,0%
Agree to pay higher premium to Would like to be insured by SHI Collect money in special health saving Do not agree to pay additionally for
Statutory Health Insurance accounts. health insurance
37. If you agree to be insured by SHI, what type
premiums payment you prefer?
13. If you agree to be insured by SHI, what type premiums payment you prefer?
90,0% 83,3%
80,0% Citizens
Medical personnel (135)
70,0%
Managers of HC institutions (36)
60,0% Insurers (7)
50,0%
42,7%41,7%
40,0% 33,0%
32,0%
29,0% 27,8%
30,0%
22,2% 20,6%
19,8%
20,0% 16,8% 16,7%
8,3%
10,0% 6,0%
0,0% 0,0%
0,0%
Equal for everyone Healthier should pay less Volnurable persons Have no opinion
should pay less
38. If you agree to be insured by SHI, what type of
insurers you will trust mostly?
(possible few answers)
14. If you agree to be insured by SHI, what type of insurers you will trust mostly? (possible
few ansvers)
40,0% Citizens
Medical personnel (135) 35,0%
35,0% 33,0%
Managers of HC institutions (36) 31,9%
30,6%
30,0% 27,8% 27,8% 27,8%
25,0% 22,0%22,2%
20,0%
19,0%
20,0%
16,3%
15,0% 13,3%
11,1%
9,0%
10,0%
5,0%
0,0%
Private insurance Non profit HC providers State institutions Have no opinion
com panies institutions
39. If co-payments will be introduced for services
provided by State institutions, what option you
will prefer?
15. If copayments will be introduced for services provided by State institutions, what option you
will prefere?
80,0%
Citizens 71,4%
70,0% Medical personnel (135)
60,0%
60,0%
Managers of HC institutions (36)
Insurers (7)
48,9%
50,0%
40,0%
33,3% 33,3%
29,3%
30,0%
22,9%
21,0%
20,0% 16,5% 16,7% 16,7%
14,0%
10,0% 5,0% 5,3% 5,7%
0,0%
0,0%
All without exceptions should pay co- Volnurable people should not pay any Co-payments should be only for some Any additional co-payments should be
payments co-payments services introduced
40. Who should pay SHI premiums? (population,
percentage)
Who should pay SHI premiums? (population, percentage)
40,0%
37,0%
35,0%
30,0%
30,0%
27,0%
25,0% 23,0%
20,0%
15,0%
10,0%
5,0%
0,0%
State Everyone personally Em ployer Have no opinion
41. Will you agree to pay official co-payments for
better quality and better accessibility of HC
services? (population, percentage)
Will you agree to pay official co-payments for better quality and better accesability
of HC services? (population, percentage)
60,0%
51,0%
50,0%
40,0%
30,0%
22,0%
20,0% 15,0%
10,0%
8,0%
10,0%
0,0%
Not agree Yes, via SHI, if Yes, even if co- Yes, via SHI, if I do not know
premiums will be payments I should premiums should be
paid by employer pay myself paid from my
personal money
42. MSA business plan
How MSA may influence citizens expenditure for health care and for savings
2012. 2013 2014 2015
Number of insured 300.000 800.000 1.500.000 2.000.000
Average premium, litas 200 250 300 350
Amount of money for premiums per
year, mln. litas 60 200 450 700
Existing HC household expenditures
compensation, mln. litas 30 100 225 350
Annual increase of HC spending per
year, mln. litų 15 70 135 280
Amount of money saved in MSA, mln.
litas 15 45 135 205
43. Supplementary Health Insurance.
Situation in Lithuania
Insurance Supervision commision of the Republic of Lithuania
HC related insurance results, mil. Litas
2002 2003 2004 2005 2006 2007 2008 2009
Insurance premiums 39,19 41,34 44,64 55,45 69,75 87,13 103,55 84,05
Supplementary Health Insurance 25,92 18,17
Other Health Insurance 77,63 65,88
Health insurance ans insurance from
accidents 39,19 41,34 44,64 55,45 69,75 87,13
2002 2003 2004 2005 2006 2007 2008 2009
Insurance benefits 10,68 13,35 14,20 15,20 20,65 24,29 37,11 44,94
Supplementary Health Insurance 15,53 24,10
Other Health Insurance 21,57 20,84
Health insurance ans insurance from
accidents 10,68 13,35 14,20 15,20 20,65 24,29