| Lesson learnt from Romania |
Advantages |
Drawbacks/bottlenecks |
| Legal prerequisites to support mandatory health insurance |
- A compact legislative package allowing to introduce health insurance system with support of all power branches
- Ministry of Health initiative under the pressure of the community and health workers |
- inconsistency, insufficiency, and contradictions (limitations on autonomy of health insurance fund and health providers)
- limitations on the authority of health workers' collegium |
| Contracting system for different type of services |
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| Inpatient services |
- Introduction of the DRG system starting from 2003
- Introduction of block contracts |
- payment per bed-day (chronic patients)
- too large quantity of in-patient beds |
| Outpatient services |
- Division of primary and secondary ambulatory care fulfilled
- The differentiated system of payment for specialized care and para-clinic services
- Cooperation between doctors specialists and family doctors |
- insufficient control over service provision that leads to increasing expenditures for health care payment |
| Family practitioners services |
- family doctor - doorway to the healthcare system
- complex national system of family doctors is introduced
- payment system for family doctors' work is developed including per capita payment for services
- introduction of private family medicine |
- low payments for family doctors' work
- insufficient supply with health care equipment for family doctors
- insufficient motivation of family doctors to prophylactic works
- absence of benefit crediting to family doctors for procurement of healthcare equipment and premises |
| pharmaceuticals |
- introduction of card system for compensation of people's expenses for pharmaceuticals
- introduction of centralized system of procurement through the insurance system
- control and monitoring on the utilization of finances for pharmaceuticals |
- - dissatisfactory cooperation with district houses |
| Set up functional autonomous institutions |
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| hospitals |
- hospitals received larger autonomy than before the reform
- the administrative board assigned the hospital manager
- possibility of receiving new sources of financing |
- autonomous financial management is impossible
- limitations in changes introduction to hospital structure
- doctors are assigned exclusively by MOH's approval |
| family practitioners |
- enlarging sources of financing for health care provision
- competitiveness
- possibility for free choice of a doctor
- improving quality of health care
- doctor approaching the population |
- financial problems at the beginning
- increasing reporting |
| New payment mechanisms and reporting system |
- per capita method of payment for health services is stimulating the doctor to actively involve the population
- fee for service and by DRG is stimulating the doctor
- differentiation of payment for treatment of chronic patients (by lower tariffs) of other categories
- reporting is being provided in real time
- opportunity for comparative analysis |
- increasing the reporting documentation and reports
- opportunity to decrease the quality of health care with considerable increase of number of patients
- absence of stimulus to improve the nurses' work |
| Management information system |
creation of effective control system on healthcare provision and financing on the national level |
- incompleteness of the system, leading to creation of various district systems
- insufficient level of system's intellectuality |
| Human resources policy and training |
- retaining work places by means of re-specialization of district therapists and pediatrists
- expanding functions and powers of professional associations
- managerial training of family doctors
- creation of competitive environment among doctors |
- скорочення посад медсестер
- несвоєчасна менеджерська підготовка керівників лікарень |
