Introduction of Complex Capitation Standard Rate (CCSR) in outpatient care
organizations
Network public MOs, rendering OPP
polyclinics-361
CPMSH -15
PD of dispensary with beds -130
TB dispensary-51Oncologic-17
Dermatovenerologic-20Psychoneurologic-18Endocrinological -1
Narcological -19Cardiologic dispensary -4
Women’s health centres under obstetric
organizations-26Perinatal centres-16
Maternity hospitals-10
OC-1086
Total- 2206
Outpatient-polyclinic organizations– 612 PD and OCof hospital organizations – 1304
Municipal polyclinics – 119
CDC – 3
Child polyclinics– 14
CPMSH – 17
CRP, RP, VP – 36
OC – 409
Network of МОs, rendering PHC, on the situation on January 1, 2013
OC – 1082
PD of city hospitals– 20
PD of CRH, RH, VH – 192
CPMSH - 10
MW without rooms – 128МS, village first-aid station
- 4311
Private OPO 1082
City184 Village179
MP 122
CP14 RP 29CPMSH 9 CDC 3
OC12
MH 24
CRH133
RH 12
VH 5
Total number of organizations 363
Independent organizations, rendering PHC
Medical organizations, providing CDS
Outpatient-polyclinic organizations -174 Polyclinic departments (PD) of hospital organizations - 225
RP - 25
Pediatric polyclinics
- 14
CDC -11
Municipal polyclinics- 124
Total- 399
PD of regional hospitals - 12
PD of regional pediatric hospitals - 16
PD of CRH, RH - 158 PD of VH - 9
PD of cityhospitals - 30
NETWORK OF ORGANIZATIONS, PROVIDING PHC. EXAMPLE OF ZHAMBYL REGION.
NETWORK OF ORGANIZATIONS, PROVIDING PHC. EXAMPLE OF KARAGANDA REGION
Objective: Improving availability and quality of primary medical and sanitary care by introducing economic incentives
Tasks:1. Stimulating preventing direction in work of PMSC organizations2. Expanding the range of primary medical and sanitary help services3. Provision of rational and effective usage of means dedicated for outpatient-polyclinic and hospital care4. Increasing payment of PMSC workers by introducing economic incentive mechanisms
Tasks and objectives
Stimulating preventing direction in work of PMSC organizations
Covering not lesser than 70% of target group of assigned population with screening assays
Increasing the number of diseases detected at early stage Decreasing the number of chronic non-contagious
diseases and their complications by integrating the chronic diseases management program
Systematic explanatory and promotion work with population on disease preventing and forming healthy lifestyle
Expanding the range of primary medical and sanitary care services
1. Delegation of consultative and practical skills on most frequent diseases from dedicated experts (subject matter experts) to the specialists of PMSC :
cardiology– hypertension, CHD endocrinology– hypothyroidism, diabetes
gastroenterology– ulcer, gastritis, duodenitis and hepatitis
ophthalmology – conjunctivitis
neurology – acute cerebrovascular disease, root disorders
pulmonology– pneumonia, COPD, bronchial asthma
obstetrics and gynecology – pregnancy follow-up
2. Expanding SMW powers and independence : - independent admission of patients including case follow-up of dispensary patients;
- being able to use basic practical skills in surgery and obstetrics and gynecology;
- providing services for house-calls;
- prenatal nursing, postnatal nursing, nursing of healthy children younger that 1 year, patients with chronic diseases;
- consulting on disease prevention and healthy lifestyle, social and psychological help
Provision of rational and effective usage of means dedicated for outpatient-polyclinic and hospital care
Decreasing the number of unreasonable hospitalizations to twenty-four hour hospitals
Decreasing CDS consumption Decreasing the number of emergency calls in
PMSC organizations working hours
Increasing payment of PMSC workers by introducing economic incentive mechanisms
Introduction of differentiated payment for doctors’ and SMW work for:
expanding the list of consultative and diagnostic and practical skills expanding prevention direction of work (covering not lesser than
70% of assigned population with preventive activities) reaching basic indicators of productivity of PMSC activity
Primary medical and sanitary care
Premedical, qualified medical care without twenty-four hour medical observation, including complex of available medical services, provided at the levels of person, family and society:
1) diagnostics and treatment of most common ailments, as well as of traumas, poisonings and other emergencies;
2) sanitary and anti-epidemic (preventive) activities in sites of diseases;
3) hygienic education of population, family, maternity, paternity and child welfare services;
4) explanatory work on safe water supply and nutrition
Article 45 of Code on Health and Healthcare System
Expanding functions of PHC:
• premedical, qualified medical care,• examining patients for detecting ailments at an early stage, • appointment for hospitalization,• chronically ill patients for preventive medical examination, •rehabilitation treatment,•provision of medicines.
• making requirements for doctor and SMW training stricter • SMW status reinforcement• extending the staff size of SMW and keeping the relation between them in balance• improving the level of doctor and SMW training• improving the level and the quality of care workers’ and psychologists’ work• increasing payments by integrating differentiated payment for doctors’ and SMW work for expanding their functions and achieving targeted results
Problems:Capitation standard rate for 2000-2200 population
Complex capitation standard rate
assigned population using PHC
assigned population using PHC, primarily with preventive purposes
• decreasing the number of common chronic manageable diseases (CMD) at PHC level• systematic, explanatory, promotion work with population on disease prevention and forming healthy lifestyle• transferring focus from ill patients onto protection of healthy population• delegation of powers from dedicated expert to the specialists of PHC • expanding SMW powers and independence• strengthening social orientation of PHC
Existing functions of PHC:
• lack of doctors• lines in polyclinics• poor quality of medical care
Solutions:
Pilot studies results
on the example of pilot MO – municipal polyclinic №8 of Аstana – general practitioners’ actual salary rose 2.2 times, therapists – 2.0 times and pediatrists – 1.6 times, nurses actual salary rose 2.3 times; therapist nurses – 2.1 times; pediatrists nurses – 1.6 times
MP №8 General practice Therapy Pediatrics
Salary calculations
Base salary
Additional salary
Total Base salary
Additional salary
Total Base salary
Additional salary
Total
Doctor 85000 102330 187330 80000 85850 165850 80000 52180 132180
Nurse 65000 87280 152280 60000 68680 128680 60000 37060 97060
General practice Therapy PediatricsSalary calculations
Actual (without AGC)
With AGC (CCSR = 1196,98)
With AGC (CCSR= 1221,12)
Actual (without AGC)
With AGC (CCSR = 1196,98)
With AGC (CCSR= 1221,12)
Actual (without AGC)
With AGC (CCSR = 1196,98)
With AGC (CCSR= 1221,12)
Doctor 110428 166122 328922 110428 143095 283328 110428 130461 258313
Nurse 70941 109775 217354 70941 87224 172704 70941 91468 181106
on the example of pilot MO – Taiynshyn CRH, NKR – general practitioners’ actual salary rose 2.9 times, therapists – 2.5 times and pediatrists – 2.3 times, nurses actual salary rose 3 times; therapist nurses – 2.4 times; pediatrists nurses – 2.5 times (CCSR equals to 1221,12)
основной фонд ЗП - 215000 тг
44%дополнительный фонд ЗП -
276890 тг56%
CCSR fund distribution (on the example of MP №8)
491890 tenge– one division’s salary fund per month (1 doctor– 2-3 SMW), consists of:
215000 – base actual salary (as of today on actual basis)
276890 – additional actual salary (per 1 doctor and 2 SMW)
(+) For reaching lowest acceptable level of indicators
(-) In case of not reaching or partially reaching lowest acceptable level of indicators, financial means are redirected to divisions with better results (of lowest acceptable level)
Additional salary fund – 276890 KZT 56%Base salary fund – 215000 KZT 44%
Expenses structure (on the example of pilot organization – municipal polyclinic №8, Astana)
Действующий ПН 624
34,20%
34,30%
0,00%
8,40%
1,10%
2,30%
19,70%
0,0%
0,0%
Заработная платаКДУЗаработная платаПМСПдополнительно
Прочие товары
КоммунальныеуслугиПрочие услуги
Админ.хоз.и др.зат.
лаборатория
резерв
КПН 900
21,2%
27,4%
12,7%
5,2%
2,1%
3,1%
14,6%
3,3%
10,4%Заработная платаКДУЗаработная платаПМСПдополнительно
Прочие товары
КоммунальныеуслугиПрочие услуги
Админ.хоз и др затр.
Лаборатория
Резерв
Действующий ПН 624
51%49%
ПМСП
КДП
КПН 900
45,7%
12,6%
41,7%
ПМСП
КДП
Высвободившаяся сумма
Relation between PHC/CDPexpenses on the example of pilot MO MP №8 of Astana
Additional 95 tenge per one assigned person per month
Differentiation of PHC and CDP services, included to CCR (896 KZT)
PHC – 55 services(596 KZT)
Doctor admissions
General clinic examinations
Biochemical examinations
ECG
Bacteriologic examinations
Immunoprophylaxis
Procedures and operations
CDP – all the other services including high-cost services (300 KZT)
Specialized doctors admissions
Extended biochemical examinations
Radiologic examinations
Ultrasound
Function studies
Procedures and operations
Primary surgical treatment of wounds, cast application/removal
High-cost services (are limited by the local executive bodies) for certain population classes
PCR, angiography, PET, CT, medicogenetic examinations and others in accordance with the GVFMC
PHC volume within the GVFMCService name For healthy persons For patients with
acute forms of chronic diseases
For children under 18 For pregnant women
Prevention Carrying out activities on health protection and promotion, informing population on healthy lifestyle, healthy nutrition, planning family
Teaching sanitary-hygienic skills of teeth and mucous tunic of mouth care
Preventive medical surveys of targeted population groups in accordance with the order set by the authorized body
Doing preventive injections against infections and infestations, according to the National Calendar of Immunization
Children, including infants nursing
Nursing of the pregnant
Sanitary and anti-epidemic (preventive) activities in sites of contagious diseases
Teaching patients and their family members to self-control, self, and mutual care
Trainings in prophylactic rooms, health promotion schools.
Telephone consultation of people, taking part in ailments management program (AMP)
Sociomedical and psychological services on prescription.
Primary prevention Dispensary admission and case follow-up. Primary and secondary prevention of illnesses for dispensary cases.
Service name For healthy persons For patients with acute forms of chronic diseases
For children under 18 For pregnant women
Diagnostics Admission and consultation
Admission and service at home
Laboratory and diagnostic examinations with PHC specialist referral at hand
General blood and urine test
Vaginal smear microscopy
Vaginal smear microscopy and vagina sanitation
Sputum analysis for TB detection (smear microscopy)
HIV-infection and Wassermann reaction blood sampling
Microreaction, statoscopy
Material sampling for microbiologic examinations
Biochemical examinations: blood clotting time, bleeding time, bile pigments in urine, cholesterol, tryglycerides, blood sugar (express-methods with test system usage )
Electrocardiogram
Fluorography Fluorography from 15 years
Treatment First aid when necessary
Medication treatment prescription: intravenous, intramuscular, hypodermic injection on prescription; immobilization (application of gauze bandage casts, splints) on prescription
Paid medical services are rendered when PHC is done on patient’s initiative, as well as without PHC specialists’ referrals, basing on the agreement, concluded between the patient and the healthcare subject
PHC volume within the GVFMC
Expected results
Expanding PHC availability by private PHC organizations network expansion, as well as on the base of PPP
Increasing the number of finished cases of visits for medical care at PHC level (not lesser than 70%)
Provision of PHC development priority Transfer of focus from hospital care onto outpatient
services
Thank you for your attention!
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