UNIVERSAL HEALTH INSURANCE AND HEALTH TRANSFORMATION PROJECT IN HEALTH

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UNIVERSAL HEALTH INSURANCE AND HEALTH
TRANSFORMATION PROJECT IN HEALTH

• A.Tuncay TEKSÖZ
• President of Social Security Institution
• 1 April 2006
• Istanbul

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Presentation Plan

• Main Components of the Health Transformation
  Project
• Main Components of the Social Security Reform
• General Health Insurance
• The Relation between General Health Insurance and
  Health Transformation Project and Expectations

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Main Components of the Health Transformation
Project

• A Planning and Supervising Ministry of Health
• A General Health Insurance Bringing Everybody
  Under the Same Umbrella
• A Widespread, Easily Accessible and Smiling
  Health Service System
• Reinforced Primary Health Services and Family
  Medicine
• Effective and Gradual Referral Chain
• Health Organizations that have Administrative and
  Financial Autonomy
• Human Power in Health Equipped with Knowledge and
  Skills, Working with High Motivation
• Educational and Scientific Institutions to
  Bolster the System
• Quality and Accreditation for Quality and
  Effective Health Services
• Institutional Structuring in Rational Drug and
  Supplies Management
• National Institution for Drugs
• Institution for Medical Devices
• Access to Effective Information in the Decision
  Making Process Health Information System

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Four Main Components of the Social Security Reform

• Component 1 Social Insurances
• Component 2 General Health Insurance
• Component 3 Social Benefits and Non-Premium
  Payments
• Component 4 The New Organizational Structure

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UNIVERSAL HEALTH INSURANCE
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Why a Single Financing Institution?

• Inequality in rights and responsibilities
• Inequality in financing
• Failure to cover the entire population
• Scattered Organizational Structure
• No Information-Based Common Health Service Usage
  Database Available
• Inadequacy in monitoring and evaluation

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WHAT DOES UHI DESIGN BRING? (In terms of people
covered)

• All the citizens starting with birth
• Foreigners that have been residing in Turkey for
  more than 1 year
• Stateless people and asylum-seekers
• Privates and non-commissioned officers as well as
  detainees and convicts are out of coverage

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WHAT DOES UHI DESIGN BRING? (In terms of health
services)

• All citizens enjoy equal rights
• Priority for preventive health services
• Expansion in the scope of health benefits
• Possibility for treatment abroad in cases where
  the treatment cannot be performed in Turkey

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WHAT DOES UHI DESIGN BRING? (In terms of the
Conditions of Health Benefits)

• The condition for self-payers of premium not to
  have any premium debts
• EXCEPTIONS
• 18 years of age and below
• Emergency situations
• People in need of medical care
• Contagious Diseases
• Maternity
• Personal Preventive Health Services
• Work Accident and Professional Diseases
• States of disaster and war
• States of strike and lockout

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Co-payments(For Outpatient)

• Treatment - 2 YTL
• Drug - 10 to 20
• Orthesis Prosthesis - 10 to 20
• If there is no referral, increase at a rate of
  50 in the Participation Share
• Flexible and limited contribution share for
  examination, medication and prostheses
• EXCEPTIONS
• Examinations by Family Physician
• Work Accident and Professional Disease
• Chronic Diseases
• Personal Preventive Health Services
• Control Examination
• Vitally important "orthesis, prosthesis, recovery
  tools and gears"

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Referral Chain and Costs to be Covered by the
Institution

• Contracted
  Non-Contracted
• (May not receive the difference)
  (May receive the
• 
  difference)
• Referral Available 100 70
• No Referral 70 50

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WHAT DOES UHI DESIGN BRING?(In terms of Health
Service Delivery)

• No Health Service Delivery
• Financing the primary level service based on
  family medicine
• Obligation to follow the referral chain
• Service purchasing from public and private in a
  competitive environment
• Electronic provision in service delivery

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WHAT DOES UHI DESIGN BRING? (In Terms of Finance)

• The fund to be allocated to health is assured
• Premium according to the income level, health
  benefit according to the need
• Payment by the state of the premiums for those
  who do not have the power to pay
• Premium ratios do not rise, (For Pension Fund,
  fall from 20 to 12,5)

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Expected Developments in the Health Sector after
UHI

• Preventive health will gain importance and
  priority
• Cost Control and Quality will be considered
  together
• Different Payment Models will be on the agenda
• Individual based control mechanisms will be
  established
• Financing problems will remain as updated

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Where are we? As of March 2006 ...

• Draft Laws on Social Security Agency and
  Social Insurance and General Health Insurance
  are in the agenda of General Assembly of
  Parliament.
• Preparation of the secondary legislation in
  compliance with new laws is initiated.
• The urgent tasks to be fulfilled subsequent to
  the enactment of the Agency Law are planned.

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RELATION OF THE UNIVERSAL HEALTH INSURANCE AND
THE HEALTH TRANSFORMATION PROJECT
ANDEXPECTATIONS
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Relation of the Universal Health Insurance and
Health Transformation Project

• Financial sustainability of the system depends
  on the co-formation of the Health Transformation
  Program and GSS (General Health Insurance) and
  the establishment of an efficient health service
  provision structure. Thus, the following
  components of HTP are also of critical importance
  for GSS
• Primary Health Services and Family Medicine
  System
• Gradated Health Service Delivery
• Human Power in Health Equipped with Knowledge and
  Skills and Working with HIgh Motivation
• Integration of Management Information Systems
  between the Health Service Delivery and Financing
  
• Quality in Service Purchasing and Encouragement
  of Accredited Institutions
• Authorization, Licensing and Auditing of Health
  Service Provider Institutions and Health
  Professionals
• Setting up of National Medication and Device
  Institutions
• Management of Autonomous Health Institutions

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UHI Total Cost Projection (GDP )
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UHI Financial Deficit Projection GDP ()
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Improving Productivity in Health Service Provision

• Strategic Purchasing for
• Preventive Health Services
• Family Medicine
• Autonomous Hospital Administration
• Chain of Referral
• Health Service Usage Database
• Cost Control Mechanism