Health Transformation Programme Turkey

Infrastructure Development for Healthcare Services Financial Management

e-health Components

Salih Gures

Agenda

• Some Figures About Turkey• Health Transformation Programme National Health Insurance

Fund project e-health components

Some Figures about Türkiye...

Population

72,974,927 (June 2005 est.)

Area

780,580 sq km

GNP Per Capita $~4,828 USD (2005)

Total Health Expenditures

Health Expenditures (2005) US$

GNP ~ 454 Billion

Total H.E. ~ 30

Billion

Total H.E./GNP ~

7,18% Per capita

~ 425 US$

Distribution of Health Expenditures

The Health Transformation Programme NHIF

• is the national strategy for health reform.• The reforms envisage:

– Streamlining the health financing system;– Increasing managerial autonomy of public-sector providers;– Integrating primary care through systematized family

medicine– Eliminating fragmentation of policy responsibilities

The Health Transformation Programme

UniversalUniversalHealthHealth

InsuranceInsurance01/01/200901/01/2009

Current Health FinancingCurrent Health FinancingSchemesSchemes

GERFGERF

SSKSSK

PrivatePrivateInsuranceInsurance

BAĞ-KURBAĞ-KUR

GreenGreenCardCard

SpecialSpecialFundsFunds

Financing Side

The Health Transformation Programme

Public HospitalsPublic HospitalsMinistry of HealthMinistry of Health

SSKSSKOther MinistriesOther Ministries

Other Public InstitutionsOther Public InstitutionsMilitaryMilitary

UniversitiesUniversities

Other PublicOther Publicand Privateand PrivateProvidersProviders primary&primary&

Ambulatory CareAmbulatory CareMoH Health CentersMoH Health Centers

Private ProvidersPrivate Providers

Other HospitalsOther HospitalsPrivatePrivate

FoundationsFoundationsMinoritiesMinorities

MunicipalitiesMunicipalitiesPublic HospitalsPublic Hospitals

Ministry of HealthMinistry of HealthMilitaryMilitary

UniversitiesUniversities

primary&primary&Ambulatory CareAmbulatory Care

MoH Health CentersMoH Health CentersPrivate ProvidersPrivate ProvidersFamily PhysiciansFamily Physicians

Other PublicOther Publicand Privateand PrivateProvidersProviders

Other HospitalsOther HospitalsPrivatePrivate

FoundationsFoundationsMinoritiesMinorities

MunicipalitiesMunicipalities

Services Side

The Health Transformation Programme

UniversalUniversalHealthHealth

InsuranceInsurance

FamilyFamilyPhysiciansPhysicians

Other primary&Other primary&Ambulatory CareAmbulatory Care

ProvidersProviders

Other PublicOther Publicand Privateand PrivateProvidersProviders

HospitalsHospitals

PharmaciesPharmacies

Contracts

New System as of Jan, 2009

Main Stakeholders of the Projects

Financer of the Project

• Ministry of Finance

Owners of the Project

• Ministry of Finance

• Ministry of Health

• Ministry of Labor and Social Security (National Health Insurance Fund)

Manager of the Project

• Hacettepe University

National Registries...

• Health Services Providers Registry

(1200 Hospitals, 4500 Clinics Total 23.000 Service Provides)• Physican Registry

(78.553 Physican) • Medical Devices and Consumables Registry

(2500 Firms, 437.385 Devices) • Drug DataBase 6.800 Drugs

(237 Drug company, 6849 Drugs)• Medical Data Dictionary

(SNOMED-CT, ICD-10TRM, ACHI, ATC, GMDN, UNSPS....National Codes )

2005 Mali Yılı Bütçe Uygulama Talimatı

( Sıra No : 4-5-6 ) (Tedavi Yardımı)

657 sayılı Devlet Memurları Kanununun 5234 sayılı Kanunla değişik 209 uncu maddesi, 5434 sayılı T.C. Emekli Sandığı Kanununun geçici 139 uncu maddesi, 178 sayılı Kanun Hükmünde Kararnamenin 10 uncu maddesine 5234 sayılı Kanunla eklenen (p) ve (r) bendleri, Devlet Memurlarının Tedavi Yardımı ve Cenaze Giderleri Yönetmeliği (Bundan sonra Yönetmelik olarak ifade edilecektir.) ile Emekli ve Malullük Aylığı Bağlanmış Olanlarla Bunların Kanunen Bakmakla Yükümlü Bulundukları Aile Fertleri, Dul ve Yetim Aylığı Alanların Muayene ile Tedavileri Hakkında Yönetmelik hükümleri çerçevesinde kamu personeli ve emeklileri ile bunların bakmakla yükümlü bulundukları aile fertlerinin sağlık kurum ve kuruluşlarında yapılan tedavi ücretleri ve tedavi yardımına ilişkin işlemlerde, kurumlararası uygulama birliğini sağlamak amacıyla aşağıda belirtilen esaslar kararlaştırılmıştır. 1. Kapsam

Bu Talimat hükümleri;

a) 657 sayılı Devlet Memurları Kanununun 1 inci ve ek geçici 9 ile 16 ncı maddeleri kapsamına giren personel ile bunların bakmakla yükümlü bulundukları aile fertleri,

b) 2914 sayılı Yükseköğretim Personel Kanunu, 2802 sayılı Hakimler ve Savcılar Kanunu ve 211 sayılı Türk Silahlı Kuvvetleri İç Hizmet Kanunu kapsamında bulunan personel (Erbaş ve erler bu Talimat hükümleri haricindedir. Erbaş ve er reçeteleri ile ilgili olarak şahıslara mali külfet getirmemek koşuluyla gerekli düzenlemeler Milli Savunma Bakanlığınca yapılacaktır) ile bunların bakmakla yükümlü bulundukları aile fertleri, c) 5434 sayılı T.C. Emekli Sandığı Kanununun geçici 139 uncu maddesi gereğince (Yönetmeliklerindeki özel hükümler saklı kalmak kaydıyla) tedavi giderleri karşılanan kişiler,

EK-8

SIRA NO

KODU İŞLEM ADI AÇIKLAMA PUANBİRİM FİYAT (YTL)

1 1. YATAK ÜCRETLERİ2 510,010 1. sınıf banyolu tek yataklı odalar yemek,yatak,hasta vizit hizmetlerini kapsar 45 26.69

3 510,0201. Sınıf: Tek yataklı banyosuz veya iki yataklı banyolu odalar

yemek,yatak,hasta vizit hizmetlerini kapsar 31 18.64

4 510,030 2. Sınıf: İki yataklı odalar yemek,yatak,hasta vizit hizmetlerini kapsar 24 14.415 510,040 3. Sınıf: Üç yataklı odalar yemek,yatak,hasta vizit hizmetlerini kapsar 20 11.86

6 510,0504. Sınıf: Genel hasta odaları (4 ve daha fazla yatak)

yemek,yatak,hasta vizit hizmetlerini kapsar 14 8.31

7 510,060A. Sınıfı özel oda (suitli, müstakil, banyolu, telefonlu)

yemek,yatak,hasta vizit hizmetlerini kapsar 70 41.53

8 510,070 Küvoz (günlük) yemek,yatak,hasta vizit hizmetlerini kapsar 45 26.699 510,080 Prematüre veya yeni doğan devamlı bakım yemek,yatak,hasta vizit hizmetlerini kapsar 75 44.49

10 510,090 Yoğun bakım yemek,yatak,hasta vizit hizmetlerini kapsar 150 88.9811 510,100 Steril oda (kemik iliği nakli için) yemek,yatak,hasta vizit hizmetlerini kapsar 200 118.6412 510,110 İzole radyoaktif tedavi odası yemek,yatak,hasta vizit hizmetlerini kapsar 75 44.49

13 510,120Gündüz yatak ücreti (Psikiyatri, Diyaliz, Acil, Göz hastalıkları v.b)

tedaviler, ayaktan ameliyat, kemoterapi ve girişimsel radyolojik işlemler için

10 5.93

14 510,125 Kronik hasta ilave yatak ücretidahili branşlardaki servislerde, reanimasyon ve yoğun bakım ünitelerinde

5 2.97

15 2. HEKİM MUAYENELERİ VE RAPORLAR16 520,010 Konsültasyon ücretleri (her bir hekim için) 10 5.9317 520,020 Acil poliklinik muayene ücreti 24 14.5018 520,030 Normal poliklinik muayene ücretleri 24 14.5019 520,040 Randevulu öğretim üyeleri özel muayene ücreti 24 14.50

20 520,050 Sağlık kurulu rapor ücretleriİlaç ve malzeme temini için bir rapor ve bir muayene ücreti ödenir

10 5.93

21 520,060 Tek hekim rapor ücretleri 7 4.1522 520,070 Genel anestezi altında muayene 75 44.4923 520,080 1.Basamak poliklinik muayene ücreti 1. Basamak sağlık kuruluşları 14 8.50

24 520,0901. inci Basamaktan sevk halinde poliklinik muayene ücreti

6 3.39

25 3. GENEL UYGULAMALAR-GİRİŞİMLER26 530,010 Anne sütü sağılması 1 0.5927 530,020 Apse veya hematom drenajı, derin 150 88.9828 530,030 Apse veya hematom drenajı, yüzeyel 50 29.66

RESMİ SAĞLIK KURUMLARI FİYAT TARİFESİ

ATTACHMENT-1/D

REFERRAL FORM FOR TOMOGRAPHY, MR, ETC., ADVANCED DIAGNOSTIC PROCEDURES

..............................HASTANESİ BAŞTABİBLİĞİ / MESUL MÜDÜRLÜĞÜNE SAYI: ...../..../ 20..

İLGİLİ MAKAMA Hastanemiz...................................Polikliniğine................................tarihinde...............................protokol numarası ile başvuran.............................numaralı Resmi/Emekli hasta..............................için..................................................................................................tanısı ile..................................................tetkiki gerekmektedir. HASTAYA DAHA ÖNCE HASTANEMİZDE YAPILAN TETKİK VE TAHLİLLER 1- ................................................................................................................ 2- ................................................................................................................ 3- ................................................................................................................ 4- ................................................................................................................ TIBBİ GEREKÇE:........................................................................................ ....................................................................................................................... ...................................................................................................................... SEVK NEDENİ: Cihazın Bulunmaması (acil şartı aranmayacaktır) Cihazın Arızalı Olması Radyoloji Uzmanı Bulunmaması Hasta Yoğunluğu nedeniyle ilgili tetkik hastanemizde yapılamamaktadır.. Tetkik ve tahlillerin sonucuna göre bu tetkikin acilen yapılması tıbben zorunlu olduğundan; dışarıya sevki uygundur.

Tetkiki İsteyen Tetkiki Yapan İlgili Dal Uzmanı İlgili Dal Uzmanı

İmza-Kaşe İmza-Kaşe

(Bulunmaması halinde boş bırakılacak)

UYGUNDUR

BAŞTABİP

ATTACMENT-2/D

Public No:

Updated Barcode Product Name

Previous Barcode-1

Previous Barcode-2

License Date

If price is MORE

than 3.24 YTL

(including VAT)

If price is LESS

than 3.24 YTL

(including VAT)

A B C D E F H I J K L OA00001 8699606690276 %10 DEX 1.000 ML (POLIFARMA SETLI SISE) E208A 11% 11.00% 4.00% 3.5%A00002 8699535690446 %10 DEX 1.000 ML SOL (KANSUK TORBA) E208A 11% 11.00% 4.00% 3.5%A00003 8699606690283 %10 DEX 1.000 ML SOL (POLIFARMA SETLI SISE) E208A 11% 11.00% 4.00% 3.5%A00004 8699606690900 %10 DEX 1.000 ML SOL (POLIFARMA SETLI TORBA) E208A 11% 11.00% 4.00% 3.5%

A00005 8699606690894%10 DEX 1.000 ML SOL (POLIFARMA SETSIZ TORBA) E208A 11% 11.00% 4.00% 3.5%

A00006 8699535690422 %10 DEX 100 ML SOL (KANSUK TORBA) E208A 11% 11.00% 4.00% 3.5%A00007 8699606690825 %10 DEX 100 ML SOL (POLI SETLI TORBA) E208A 11% 11.00% 4.00% 3.5%A00008 8699606690818 %10 DEX 100 ML SOL (POLI SETSIZ TORBA) E208A 11% 11.00% 4.00% 3.5%A00010 8699788691535 %10 DEX 150 ML SOL (BIOSEL SETSIZ TORBA) 8699788691733 E208A 11% 11.00% 4.00% 3.5%A00011 8699556690135 %10 DEX 150 ML SOL (ECZ SETLI TORBA) E208A 11% 11.00% 4.00% 3.5%A00014 8699606690849 %10 DEX 150 ML SOL (POLI SETLI TORBA) E208A 11% 11.00% 4.00% 3.5%A00015 8699606690832 %10 DEX 150 ML SOL (POLI SETSIZ TORBA) E208A 11% 11.00% 4.00% 3.5%A00016 8699606690238 %10 DEX 250 ML (POLIFARMA SETLI SISE) E208A 11% 11.00% 4.00% 3.5%A00017 8699606690245 %10 DEX 250 ML (POLIFARMA SETSIZ SISE) E208A 11% 11.00% 4.00% 3.5%A00018 8699535690460 %10 DEX 250 ML SOL (KANSUK TORBA) E208A 11% 11.00% 4.00% 3.5%A00019 8699606690863 %10 DEX 250 ML SOL (POLI SETLI TORBA) E208A 11% 11.00% 4.00% 3.5%A00020 8699606690856 %10 DEX 250 ML SOL (POLI SETSIZ TORBA) E208A 11% 11.00% 4.00% 3.5%A00021 8699535690415 %10 DEX 50 ML SOL (KANSUK TORBA) E208A 11% 11.00% 4.00% 3.5%A00023 8699788694192 %10 DEX 500 ML SOL (BIOSEL SETSIZ TORBA) 8699788698190 E208A 11% 11.00% 4.00% 3.5%A00024 8699788695021 %10 DEX 500 ML SOL (BIOSEL SETSIZ) 8699788690026 E208A 11% 11.00% 4.00% 3.5%

REIMBURSABLE DRUGSOLD NHIF Medical

Procedures

NEW NHIF

e-Medical Procedures Derived from ACHI

23.296 medical services providers tüm liste

78.553 doctor (07.1.2008)

(Approximately 92.000 doctor exist in Turkey so some still not registered yet)

National Device and Drug DataBase

2.255+ Company 437.385+ Medical DevicesInternational Standart Dbase

08 01 2008 08 01 2008

Medical Data Dictionary Centrally Combines All

Codes and Classfications in the Country

6800 DrugInternational Standard Rulebase Database

Standards Being Used• DIAGNOSIS AND PROCEDURES• ICD-10• ICD-10-AM• ACHI• ICHI

• DRUG MANAGEMENT• EAN/UCC • ATC (Anatomical, Therapeutic,

Chemical)• NFC (New Form Code)• INN (International Nonproprietary

Names)• CAS (Chemical Abstract Registery

Services)• UoM (Unit of Measurement)

MEDICAL MATERIAL MANAGEMENT

EAN/UCC HIBCC (Health Industry Business Communications Council) UNSPSC (United Nations Standard Products and Services Code)

GMDN (Global Medical Device Nomenclature)

UMDNS (Universal Medical DeviceNomenclature System)

MEDULA

•MEDULA is a nation-wide integrated system between MEDULA is a nation-wide integrated system between General Health Insurance (NHIF) and health care General Health Insurance (NHIF) and health care providers forproviders for

•for collecting e-invoice (inclused medical trx.) for collecting e-invoice (inclused medical trx.) information electronically information electronically •and for re-imbursements of servicesand for re-imbursements of services

via online and/or web services without intervening via online and/or web services without intervening internal business processes of providers.internal business processes of providers.

•MEDULA is a nation-wide integrated system between MEDULA is a nation-wide integrated system between General Health Insurance (NHIF) and health care General Health Insurance (NHIF) and health care providers forproviders for

•for collecting e-invoice (inclused medical trx.) for collecting e-invoice (inclused medical trx.) information electronically information electronically •and for re-imbursements of servicesand for re-imbursements of services

via online and/or web services without intervening via online and/or web services without intervening internal business processes of providers.internal business processes of providers.

MEDULA

•Turkish National Health Insurance Fund MEDULA Turkish National Health Insurance Fund MEDULA systemsystem

•Web User Interface OnlineWeb User Interface Online 17800 Pharmacies, 5600 GP, 4500 Med. Centres17800 Pharmacies, 5600 GP, 4500 Med. Centres•Web Services OfflineWeb Services Offline 1200 Govmt. Hospitals, 338 Private Hospitals1200 Govmt. Hospitals, 338 Private Hospitals

•An e-invoicing legislation has been passed by An e-invoicing legislation has been passed by Parliament so no paper will be needed in 2009 Parliament so no paper will be needed in 2009

•Turkish National Health Insurance Fund MEDULA Turkish National Health Insurance Fund MEDULA systemsystem

•Web User Interface OnlineWeb User Interface Online 17800 Pharmacies, 5600 GP, 4500 Med. Centres17800 Pharmacies, 5600 GP, 4500 Med. Centres•Web Services OfflineWeb Services Offline 1200 Govmt. Hospitals, 338 Private Hospitals1200 Govmt. Hospitals, 338 Private Hospitals

•An e-invoicing legislation has been passed by An e-invoicing legislation has been passed by Parliament so no paper will be needed in 2009 Parliament so no paper will be needed in 2009

Online Running System NHIF MEDULA

HealthcareProviders

Application

HealthcareProviders

Application

PharmacyApplication

PharmacyApplication

Accural &Reimbursement

Application

Accural &Reimbursement

Application

DiagnosisLaboratoryApplication

DiagnosisLaboratoryApplication

Family PractionersApplication

Family PractionersApplication

HealthcareInformation

Systems

HealthcareInformation

Systems

PharmacyAutomation

Systems

PharmacyAutomation

Systems

AmbulatoryServices

AmbulatoryServices

Diagnosis/LaboratorySystemS

Diagnosis/LaboratorySystemS

Family Practioners

SystemS

Family Practioners

SystemS

WEB SERVICES

WEB SERVICES

WEB INTERFACE

WEB INTERFACE

E-HEALTH SOLUTIONS

Patient DatabasePatient

DatabaseHealth

Transactions Database

Health Transactions

Database

Healthcare ProvidersDatabase

Healthcare ProvidersDatabase

Physican DataBase

Physican DataBase

Administrative Rule Base

Administrative Rule Base

Medical KnowledgeMedical

Knowledge

Drug/DeviceDatabase

Drug/DeviceDatabase Contract

ManagemetContract

Managemet

Provision &Rule EnginesProvision &

Rule Engines

ELECTRONIC CLAIM PROCESSING

Medical Data

Dictionery

Medical Data

Dictionery

HUMAN RESOURCES

HUMAN RESOURCES

PROCUREMENT&

INVENTORY

PROCUREMENT&

INVENTORY

INSURANCEPREMIUM

COLLECTION

INSURANCEPREMIUM

COLLECTION

ACCURAL&

REIMBURSEMENT

ACCURAL&

REIMBURSEMENT

NATIONAL HEALTH

PROGRAMS

NATIONAL HEALTH

PROGRAMS

ELIGIBILITY &CONTRACT

MANAGEMENT

ELIGIBILITY &CONTRACT

MANAGEMENT

DOCUMENT & WORKFLOW DOCUMENT & WORKFLOW

STRATEGIC RESOURCE PLANNING &HEALTH ECONOMICS

STRATEGIC RESOURCE PLANNING &HEALTH ECONOMICS

DECISION SUPPORT &NATIONAL HEALTH STATISTICS

DECISION SUPPORT &NATIONAL HEALTH STATISTICS

HEALTH INFORMATION SYSTEMHEALTH INFORMATION SYSTEM

DATA EXCHANGE

Secondary Care

Pharmacy

Diagnosis/Laboratory

GeneralPractionner

NHIFNHIF

MoHMoH

MoFMoF

ELECTRONIC HEALTH RECORD for PAYMENT

MEDULAMEDULA

Patient DatabasePatient

DatabaseHealth

Transactions Database

Health Transactions

Database

Healthcare Providers/Doctors

Database

Healthcare Providers/Doctors

Database

AccuralTransactions

Database

AccuralTransactions

Database

Drug /DeviceKnowledge

Base

Drug /DeviceKnowledge

BaseMedical

Rule BaseMedical

Rule BaseAdministrative

Rule BaseAdministrative

Rule BaseContract Database

Contract Database

MEDULA Pharma Major Outcomes

• Reduction in the number of prescriptions (5 %)

• Reduction in the drug consumption (20-35 %)

• Merger of Claim Processing Units (58722)

• Reduction in the health expenses (5-25 %)

• Reduction in the outsourced lab and rad. tests happening due to LMHOM Syndrome

• Reduction of unnecessary health services use

• Detection of uncontrolled expensive drug usage

MORE THAN WORDS...

Drug Query By Doctor ID.... HEALTH INFORMATION SYSTEM Drug Query by Doctor IDStart Date : '01-11-2004 00:00 End Date : 30-11-2004 23:59 Doctor ID : 32413

No Drug Name Unit Price Quantity Total (YTL)

1 CALCIUM SANDOZ FORTE EFERVESAN TABLET 10 TB 4,16 7 29,12

2 DEVAPEN FLAKON 800.000 IU 1 FLK 1,55 5 7,75

3 ASPIRIN-PLUS C EFERVESAN TABLET 10 TB 3,27 3 9,81

4 CEFATIN 500 LAKTABLET 500 MG 10 TB 51,22 3 153,66

5 AUGMENTIN-BID SÜSPANSİYON 400/57 70 ML 19,61 2 39,22

6 FLIXONASE AQUEOUS NASAL SPREY 120 DOZ 19,21 2 38,42

7 HYZAAR 50 MG FİLM TABLET 28 TB 41,86 2 83,72

8 GYNO-TRAVOGEN OVUL 600 MG 1 OVUL 7,14 2 14,28

9 CEFRADUR KAPSÜL 500 MG 14 CAP 13,19 2 26,38

10 BELOC ZOK KONTROLLU SALIMLI FİLM TABLET 50 MG 20 TB 7,23 2 14,46

11 BEN-GAY POMAD 50 GR 2,68 2 5,36

12 MADECASSOL POMAD 40MG/G 40 GR 6,55 2 13,10

13 OTRIVINE DOZ AYARLI SPREY 10 ML 4,37 2 8,74

14 ONADRON AMPUL 4MG/ML 2 ML 1 AMP 1,27 2 2,54

15 VOLTAREN EMULGEL 50 G 7,25 2 14,50

16 FOSAMAX TABLET 70 MG 4 TB 56,12 2 112,24

17 VOLTAREN SR FİLM TABLET 75 MG 20 TB 11,30 1 11,30

18 ZIMAKS SÜSPANSİYON 100MG/5ML 50 ML 9,41 1 9,41

19 ATOR FİLM TABLET 10 MG 30 TB 32,11 1 32,11

20 SINOMARIN 150 ML BURUN SPREYİ 16,50 1 16,50

21 PHYSIOLOGICA GIFRER SERUM FIZYOLOJIK DAMLA %0.9 5 ML 8 TÜP 5,10 1 5,10

93 DUOCID SÜSPANSİYON 250 MG/5ML 70 ML 27,44 1 27,44

94 BIOMENT-BID FİLM TABLET 1000 MG 14 TB 26,54 1 26,54

95 ELOSALIC POMAD 45 GR 25,71 1 25,71

96 GYNOFLOR 12 VAJİNAL TABLET 21,42 1 21,42

97 BITERAL LAKTABLET 250 MG 20 TB 18,80 1 18,80

98 COMBICID FİLM TABLET 375 MG 10 TB 16,19 1 16,19

99 BENEXOL LAK TABLET 50 TB 13,66 1 13,66

100 AZOMAX FİLM TABLET 500 MG 3 TB 13,58 1 13,58

101 BACTRIM FORT TABLET 20 TB 13,39 1 13,39

102 FRAGMIN TEK DOZ ENJEKTOR 5000 IU/0.2 ML 10 ENJ (PHARMACIA) 46,76 1 46,76

103 INFANRIX-IPV+HIB AŞI O.5 ML 1 ENJEKTOR 43,94 1 43,94

104 OTRIVINE SPREY %0.1 10 ML 3,44 1 3,44

105 CENTRUM FİLM TABLET 30 TB 18,95 1 18,95

106 ACTONEL FILM TABLET 35 MG 4 TB 66,33 1 66,33

Total 132,00 1.811,46

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