Transplantation in Macedonia – challenges
in program financing and budgeting
Maja Parnardzieva Zmejkova, MA - HIFM CEO
21 June 2011
Contents
1
Health Insurance Fund
2
Transplantation prices and contracts
3
Action Plan
4
Steps in Developing
5
3
Conclusion
2
Republic of Macedonia
Population: 2.06 million citizens
HIF insured population: 1.8 million
citizens
Area: 25 713 km2
GDP in 2010: $9.1 billion USD
Government healthcare insurance fund
(4.6 of GDP)
Life expectancy at birth:
–
Men 73 years
–
Women 77 years
Mandatory health insurance system
Insurance premium stipulated by law (7.3
% from the gross salary)
3
Health Contribution Rate
• Rate for employed persons is 7,3%
(+0,5%) from gross salary
20%
17%
15.50%
15%
15%
15%
14%
14%
13.50%
13.25%
12.30%
9%
10%
7.30%
5%
6%
3.40%
0%
Source: WHO
Source: WHO (2010)
Албанија
Бугарија
Латвија
Белорусија
Романија
Украина
Македонија
Израел
Естонија
Турција
Унгарија
Литванија
Молдавија
Полска
Словачка
Грција
Црна Гора
Србија
Луксембург
Хрватска
Чешка
Финска
Швајцарија
Босна и Херцеговина
Словенија
Шпанија
Италија
Португалија
Ирска
Шведска
Норвешка
Белгија
Велика Британија
Австрија
Германија
Франција
Холандија
Данска
Cross country comparison % of total public
health expenditures to GDP
10.00
8.00
6.00
4.00
2.00
0.00
Health System Institutions
 The Ministry of Health creates the health policy at the national
level and legal health framework.
 Health Insurance Fund of Macedonia is an exclusive provider
of the compulsory health insurance. The Fund is defined as a
purchaser of health services provided by the health care network.
 The health care network consisted from public and private
health providers
6
Health care network
The health care network is consisted from the
public and private health providers who
negotiate the delivery of their health services at
the primary, secondary and tertiary levels.
 Primary HC - 2646, private health providers
 Secondary HC – 207, private and public health providers
 Tertiary HC – 33, public health providers
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Health Insurance Fund
Revenues 2012
Employed
Maternity Leave
Budget transfer
Pensioners
Other
Copayments
Unemployed
Uninsured
1%
1%
1%
7%
7%
6%
55%
22%
371 mil EUR
8
Health Insurance Fund
Expenditures 2012
Health Services
Leaves
Orthopedic
Administration
Treatments abroad
2%
Transplantations
2 mil EUR
1% 1%
11%
Medications for
transplantations
Dialysis
14 mil EUR
85%
0.4 million EUR
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Dialysis
• 1,399 patients
• 16,178 treatments p.a.
• 14 mil EUR p.a
Distribution of patients in 19 dialysis
centers
Centers for dialysis in
Macedonia
DRG Prices
2010 and 2011
Analysis of the transplantation surgery with the clinics and increased prices:





A01Z Transplantation of pancreas 10,380 EUR
A07Z Alogenic Transplantation of Bone Marrow 12,400 EUR
A08B Autologic Transplantation of Bone Marrow 8,700 EUR
A09A Transplantation of kidney with pancreas 15,900 EUR
A09B Transplantation of kidney w/out pancreas 11,200 EUR
Currently
Prepared new DRG prices for the associated surgery:






A10Z Transplantation of cornea 1,140 EUR
A11Z Donor preparation, multiorgan and tissue explantation 5,170 EUR
A12Z Donor preparation and multiorgan explantation 4,900 EUR
A13Z Donor preparation and organ explantation 5,035 EUR
A14Z Donor preparation and cornea explantation/ eyeball one and/or both 255 EUR
A42Z Serologic analysis of donor organs/tissues 205 EUR
11
Dialysis vs Transplantation
• Dialysis price 80
EUR
• One patient on
dialysis annually
12,400 EUR
12500
12000
11500
11000
10500
Annualy
Transplantation Dialysis
• Transplantation
price
11,200 EUR
Transplantation and Health
Insurance Fund
Current
Up coming
• Waiting list for Living Donor
• Establishing national
kidney transplantation – 32
program in transplantation
persons
• National registry for
• Non existing Deceased Donor
donation and waiting list for
transplant program
kidney transplantation
• In 2011 there were 32
• Developing Donation from
transplantations in RM:
Deceased Donors
• Transparent waiting list for
•
10 - kidney transplantation, o/w 2 children
kidney transplantation from
•
1 - children liver transplantation
living donor
•
22 - bone marrow transplantation
• Program for permanent
education
13
Conditional Contracting
For surgery

Clinic for Urology
 Clinic for Children Surgery
 Clinic for Hematology
For HLA analyses


Institute for Transfusion
Institute with the Medical Faculty
14
Action Plan 2012

Change in the Law for transplantations and enacting
13 bylaws
 Appointing the national coordinator
 Preparation of clinical pathways
 Accreditation of laboratories
 Creation of donors registry
 Software for the transplantation waiting list
 Education
 National Campaign for Transplantation
15
Coordination
Action plan
Ideas and joint work
Fund
Ministry of
Health
Public health
care
institutions and
Experts
NGO,
Religious
and
political
authorities
16
Expected results
•
•
•
•
•
•
•
Enabled legal framework
Adequate prices
Coordinated clinics
Increased number of transplantations
Creation of the donors registry
Joining the Eurotransplant
Cooperation with other countries
17
Conclusion
Acquisition from Transplantations
Quality of life - long-term survival with a high
quality of life
Economic benefit - national health care budget
expenditure savings.
Organ transplantation is the most costeffective and humane treatment for end stage 18
renal failure.
Most valuable sentence
The most valuable sentence in
``Croatian donation
network``
»Sve što može poslužiti životu,
grijeh je pokopati.«
Pope Johan Paul II
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THANK YOU FOR YOUR
ATTENTION
Website: www.fzo.org.mk
E-mail: majap@fzo.org.mk
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