Info 7 Strategic Plan of the Dom zdravlja Subotica presented Prof. Dr. Vesna Bjegovic-Mikanović, professor of health management at the Faculty of Medice, University of Belgrade and expert on the project Support to the Implementation of Capitation Payment Primary Health Care Serbia attended the presentation of the Strategic Plan for 2010 to 2015 at the Dom zdravlja (DZ) Subotica which was held on 19th November Subotica. Prof. Dr. Bjegovic-Mikanovic commended the Strategic Plan of DZ Subotica and held lecture on the troduction of capitation which was attended by employees of DZ Subotica. She stressed that the reform of fi nancg of Primary Health Care lead to signifi cant changes the relationship between doctors and patients. Management of your DZ prepared an excellent plan. Capitation will lead to big changes and better doctors will have creased salaries, but no one will lose the salary, said Dr. Bjegovic-Mikanovic. In November Prof. Michael Jones, expert on our project visited several DZs order to revise strategic plans (Zajecar, Cuprija, Vozdovac, Zemun, Sabac, Sremska Mitrovica, Nis, Pozarevac, Kragujevac and Pancevo). Prof. Jones together with Prof. Dr. Bjegovic-Mikanovic held semars for strategic planng durg June and July 2009. In this issue Management of DZ Subotica prepared the Strategic Plan which dicated that the ma strategic programs will be promotion of preventive health services, promotion of healthy lifestyles, organizg educational programs for employees and registration of users of health care by chosen doctors. The plan was presented by Director of DZ Dr. Ruzica Crnjakovic, Dr. Ljiljana Miljacki, Head of GP and Ivanka Beokovic, assistant director for fance. Strategic Plan of DZ Subotica About Capitation By Vukas Radulovic and Zoran Kaljevic Semar about Capitation Support to the to the Implementation of of Capitation Payment Primary Health Care Serbia Support A Project to the funded Implementation by by the the European of Capitation Union Payment Primary Health Care Serbia A Project funded by the European Union Republic of Serbia MINISTRY MINISTRY OF OF HEALTH HEALTH
Serbia: Toward performance based fancg primary health care Vukas Radulovic, B.Sc.E.E, Executive director of Health Insurance Fund of Serbia and Zoran Kaljevic, M.Sc.E.E. CIO of Health Insurance Fund of Serbia method is reflected the impossibility to exceed the budgeted funds. The weakness of this fundg method is not distguishg between those who work better, more and with more quality. To put it more simply, if a physician exames 10 and the other one 70 patients average on a daily basis, there is no mechanism for rewardg the one who works better than the other one sce they will be paid the same and guaranteed salary. It is simply destimulatg. Developed western countries troduced the capitation model of payment of primary healthcare services mostly to establish the mechanism for controllg costs situations when service-based payment was runng out of control. Former communist countries had completely different startg pots and thus the reasons for decidg for capitation payment model, and Serbia was not the exception either. The health surance system Serbia is organized on the basis of Bismarck solidarity model. There is one stitution Serbia, the Health Insurance Fund of Serbia (HIF) which is a national and non-profit organization for health surance. The HIF is funded through health surance contribution payment fancg healthcare services for around 7 million surees Serbia. Unfortunately, the funds allocated for healthcare are rather modest and with 280 EUR per capita Serbia is among the countries at the bottom of the list of the European countries. Healthcare fundg is lear and on the basis of the determed budget accordance with items determed advance such as salaries, medices, sanitation material, energents and the similar. Physicians salaries and the salaries of healthcare professionals general are defed accordg to salary classes determed by professional qualifications, and smaller adjustments are possible only on the basis of years of service, managerial bonus and clical title. The advantage of this fundg Vukas Radulovic While the western countries used the capitation for switchg from one to another output-based payment system, the idea of troducg the capitation Serbia is the idea to switch from the put-based to some sort of performance-based payment system. It is the payment system which the ones whose performance exceeds the average should be recognized and rewarded. The HIF developed a powerful formation system as a preparation for capitation and agreed on the electronic format of an voice for rendered services with all healthcare services providers. As of 1st January 2009, the HIF collects the formation with respect to each healthcare service (over 10 million a month) cludg a physician that rendered it, Support Podrška Support to primeni the to the Implementation kapitacije u primarnoj of Capitation of Capitation zdravstvenoj Payment Payment zaštiti Primary u Primary Srbiji Health Health Care Care Serbia Serbia A Projekat Project A Project fi funded nansira funded by Evropska by the the European European unija Union Union МИНИСТАРСТВО ЗДРАВЉА
time and place, a recipient and type of services. In addition, five years ago, a similar system was developed, which pharmacies now use to voice medices dispensed on the basis of around 5,5 million prescriptions a month for the medices prescribed by primary healthcare physicians. These data represent the basis for measurg and comparg the performance of physicians Serbia. As of 1st January 2010, a health professional salary will consist of two parts: a fixed and variable part the proportion of 70:30 %. The fixed part will clude all that the classification on the basis of salary classes used to clude to-date, while a variable part will depend on the performance. performance appraisal would be easier to conduct. The category of registration means the number of patients that have chosen a particular physician, while the category of rationality means the average value of prescribed prescription drugs per suree. The category of efficiency cludes the number of services rendered, while the category of quality cludes the number of preventive versus the total number of examations. It is clear that each category could clude more dicators on the basis of which the performance appraisal could be made, but we must start from the most important ones. Each category was previously adjusted agast corrective factors such as for example, years, and certa limitations were troduced as well. The key issue is that the HIF did not want to set any limits and standards durg the assessment and it simply let the physicians impose them on their own. The performance appraisal of physicians agast the categories is actually comparg the physicians with each other. Thus the physicians each category get a higher performance appraisal because their performance exceeds the average performance compared to all the physicians that category. The sum of grades per categories is the basis for the calculation of a variable part of the salary. This is just the first step and we are lookg forward to changes after decades of waitg for changes this field. Zoran Kaljevic The performance will be assessed 4 categories: registration, rationality, efficiency and quality. One key dicator is chosen for each of the categories that will be monitored so that the Support Podrška Support to primeni the to the Implementation kapitacije Implementation u primarnoj of Capitation of Capitation zdravstvenoj Payment Payment zaštiti Primary u Primary Srbiji Health Health Care Care Serbia Serbia A Projekat Project A Project fi funded nansira funded by Evropska the by the European European unija Union Union МИНИСТАРСТВО ЗДРАВЉА
Semars on capitation With the project activities, the last a series of semars dedicated to troduction of health care fi nancg and payment to health care providers to management teams for Primary Health Care (PHC) was held Belgrade on November, 6th 2009. Radulovic, Executive Director of the Health Insurance Fund. In addition to the general fi nancg system, the trag focused on the fi nancg of PHC and the methodology of Capitation payment as well as practice and performance of doctors PHC and some comparison of different countries. Management teams from DZ Vozdovac, Valjevo, Zemun, Kikda, Pozarevac, Pancevo, Sabac i Cuprija participated the trag. Participants are enabled to recognize the (potential and actual) effects of payment systems and fi nancial centives for physicians for implementation of capitation. They were provided the opportunity for further analysis of specifi c case studies related to the upcomg changes their stitutions. Lecturers and structors these trag sessions were Prof. Dr. Vesna Bjegovic- Mikanovic, professor of health management at the Faculty of Medice, University of Belgrade and project expert, Mr. George Boulton, a Project Expert and Mr. Vukas Support Podrška Support to primeni the to the Implementation kapitacije u primarnoj of Capitation of Capitation zdravstvenoj Payment Payment zaštiti Primary u Primary Srbiji Health Health Care Care Serbia Serbia A Projekat Project A Project fi funded nansira funded by Evropska the by the European European unija Union Union МИНИСТАРСТВО ЗДРАВЉА
Data fi gures on the surees Source: Health Insurance Fund statisticsoctober 2009. Pilot DZs 100,00% 90,00% 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% 42,2% Dom zdravlja Zvezdara 53,2% 52,0% 53,3% 52,0% 48,3% 49,6% 50,5% 47,2% 47,6% Dom zdravlja Pančevo Dom zdravlja Ćuprija Dom zdravlja Kruševac Dom zdravlja Užice Dom zdravlja Subotica Population Dom zdravlja Kikda Dom zdravlja Čačak Dom zdravlja Požarevac Dom zdravlja Kragujevac Number of surees - Jan. '08 66,1% 64,2% 62,7% 57,9% 59,1% 60,5% 60,9% 61,0% 61,7% 55,7% 56,9% 58,6% Dom zdravlja Zaječar Dom zdravlja Zemun Dom zdravlja Šabac Dom zdravlja Leskovac Dom zdravlja Smederevo Percentage of surees Dom zdravlja Sombor Dom zdravlja Sremska Mitrovica Dom zdravlja Pirot Dom zdravlja Niš Dom zdravlja Palilula Number of surees - October '09 Patient registration, January 2008 - October 2009 Dom zdravlja Vranje 70,1% Dom zdravlja Novi Beograd Januay 2008 October 2009 75,4% 73,7% 75,7% Dom zdravlja Novi Sad Dom zdravlja Voždovac Number of surees - October '09 Dom zdravlja Vračar 80,8%81,9% Dom zdravlja Valjevo Dom zdravlja Kraljevo 92,9% Dom zdravlja Savski Venac Percentage of surees Dom zdravlja Zvezdara 132.621 8.228 6,20% 134.911 56.923 42,19% Dom zdravlja Pančevo 127.162 21.688 17,06% 113.675 53.667 47,21% Dom zdravlja Ćuprija 33.567 5.747 17,12% 28.992 13.798 47,59% Dom zdravlja Kruševac 131.368 11.194 8,52% 116.724 56.347 48,27% Dom zdravlja Užice 313.396 69.771 22,26% 278.159 138.018 49,62% Dom zdravlja Subotica 148.401 34.442 23,21% 133.987 67.649 50,49% Dom zdravlja Kikda 67.002 8.231 12,28% 58.015 30.170 52,00% Dom zdravlja Čačak 177.131 43.221 24,40% 160.876 83.670 52,01% Dom zdravlja Požarevac 117.476 17.494 14,89% 100.092 53.277 53,23% Dom zdravlja Kragujevac 175.802 20.518 11,67% 169.902 90.572 53,31% Dom zdravlja Zaječar 65.969 16.380 24,83% 57.577 32.047 55,66% Dom zdravlja Zemun 191.645 6.304 3,29% 185.944 105.819 56,91% Dom zdravlja Šabac 122.893 29.235 23,79% 108.927 63.106 57,93% Dom zdravlja Leskovac 156.252 14.065 9,00% 131.128 76.872 58,62% 7.489.162 1.250.284 16,69% 6.690.536 3.951.204 59,06% Dom zdravlja Smederevo 109.809 19.638 17,88% 101.288 61.325 60,55% Dom zdravlja Sombor 97.263 13.393 13,77% 83.533 50.839 60,86% Dom zdravlja Sremska Mitrovica 85.902 7.753 9,03% 75.598 46.110 60,99% Dom zdravlja Pirot 63.791 18.230 28,58% 55.718 34.404 61,75% Dom zdravlja Niš 250.518 61.440 24,53% 200.084 125.364 62,66% Dom zdravlja Palilula 155.902 18.169 11,65% 159.499 102.476 64,25% Dom zdravlja Vranje 93.660 0 0,00% 78.921 52.129 66,05% Dom zdravlja Novi Beograd 217.773 9.410 4,32% 195.656 137.168 70,11% Dom zdravlja Novi Sad 299.294 73.741 24,64% 313.870 231.409 73,73% Dom zdravlja Voždovac 151.768 33.764 22,25% 145.143 109.384 75,36% Dom zdravlja Vračar 58.386 14.272 24,44% 55.549 42.075 75,74% Dom zdravlja Valjevo 96.761 46.731 48,30% 84.502 68.245 80,76% Dom zdravlja Kraljevo 121.707 67.996 55,87% 111.337 91.156 81,87% Dom zdravlja Savski Venac 42.505 20.187 47,49% 39.870 37.022 92,86% Total Pilot DZs 3.805.724 711.242 18,69% 3.479.477 2.111.041 60,67% Support Podrška Support to primeni the to the Implementation kapitacije u primarnoj of Capitation of Capitation zdravstvenoj Payment Payment zaštiti Primary u Primary Srbiji Health Health Care Care Serbia Serbia A Projekat Project A Project fi funded nansira funded by Evropska the by the European European unija Union Union МИНИСТАРСТВО ЗДРАВЉА
KOSOVO I METOHIJA Subotica Kikda Srem. Mitrovica Šabac Smederevo Užice Kraljevo Kruševac Zaječar Pirot Vranje Zemun Voždovac Savski Venac Sombor Novi Sad Pančevo Valjevo Požarevac Čačak Kragujevac Ćuprija Niš Leskovac Vračar Zvezdara Palilula Novi Beograd CONTACT Support to the Implementation of Capitation Primary Health Care Serbia Pasterova 2, 11129 Belgrade, Serbia P. O. Box 55, Post Offi ce 102 Tel +381 11 2687 470 Fax +381 11 206 2068 e-mail: fo@kapitacija.org www.kapitacija.org The contents of this publication are the sole responsibility of Support to the Implementation of Capitation Payment Primary Health Care Serbia and can no way be taken to refl ect the views of the European Union. Support Support to to the the Implementation Implementation of of Capitation Capitation Payment Payment Primary Primary Health u zaštiti u Srbiji Health Care Care Serbia Podrška primeni kapitacije u primarnoj zdravstvenoj zaštiti u Srbiji Serbia A Projekat A Project Project funded fi fi funded by nansira by the Evropska the European European Union unija unija Union Republic Република of Serbia Србија МИНИСТАРСТВО ЗДРАВЉА