republic of macedonia health system -overview and challenges- minister of health bujar osmani, md...
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REPUBLIC OF MACEDONIAHEALTH SYSTEM
-OVERVIEW AND CHALLENGES-
Minister of HealthBujar Osmani, MD
SEECP Health Ministerial Meeting“Achievements and challenges of strengthening health system performance
through addressing inequalities in health services in South Eastern Europe”
Chisinau, 7 November, 2008
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Socio Economic Indicators
Population: 2,036,855 Administrative division: 84 municipalities Capital: Skopje Ethnicity/languages: Macedonian 64,18%, Albanian
25,17%, Turkish 4%, Roma 2%,Serb 2%, Vlachos 2%, Other 1%
Religions: Orthodox Christian 67%, Muslims 30% Literacy rate: 94% Unemployment rate: 37% GDP per capita: $ 2200 Health expenditure of GDP: 6 %
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Health System Organization
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Number of inhabitants per 1 Doctor by health regions in Republic of Macedonia in 2006
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Number of inhabitants per 1 Dentist by health regions in Republic of Macedonia in 2006
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Health Indicators
Life expectancy at birth: 73.4 Natality - rate per 1000: 11.0 Infant mortality rate: 12.8 Maternal death per 100,000
live births: 11.0 Mortality rate – per 1000: 9.0
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The Distribution of Leading Causes for Death
circulatory diseases 599,1 /per 100 000 malignant neoplasms 265,1 /per 100
000 respiratory diseases 41,6 /per 100 000 injuries 32,9/per 100
000
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Priorities of the Health System Reforms
Improving health status Efficacy of the health system Providing quality of services Strengthening public health Planning of the human resources Providing health quality assurance Improving health care financing Improving accessibility and quality of
pharmaceuticals E-health
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Strengthening Legal Framework-enhancing human rights in health and medicine-
Umbrella laws: Law on Health Care Law on Protection of
Patient Rights Law on Mental Health Law on Health
Insurance
MINISTRY OF HEALTH
CHAMBER
EDUCATIONAL SYSTEM
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Strengthening health system financing
FACTS (main resources): Contributions- 97,80% Participation-services/drugs Budget /Public Health Programs
REFORMS (respond to the population needs): Basic package of services Upgrading financing of the public health/programs Increasing of the HIF autonomy/management of HIF HIF-strategic purchaser of services/contracting with
the HC providers
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Introducing E-Health Informatics system in the Health Insurance Fund Implementation of the Hospital info systems in
the chosen hospitals /possibility to broaden up on national level)
Development of the unique registers( unified code systems)
Implementation of the info systems by the chosen doctors in order to provide electronic information and exchange of information
Establishing of the E-health card Diagnostic related group (DRG) as a standard
system for medicinal and financial reporting Electronic health dossier
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Investments in Health
1. National efforts: Government has assigned 40 million euros for
purchasing new medical equipment for the state owned health institutions
Investments in hospital infrastructure are decided upon /loan/
Savings as investment (hospitals autonomy, hospital health care management improved, privatization in the primary level of health care)
2. Public-private partnerships encouraged3. Foreign investments encouraged
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Patient centered health care-through acknowledging the value of providers (medical professionals)
-socio-economic effects of transition on healthcare workforce at national level-
Working conditions, healthcare services - rapid changes
New technologies, high demands for realization Loss of job, concurrence, restriction of funding,
restructuring and privatization of the healthcare Global health threats, migration
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Stress factor Examined group
Control group
p
Working with “uncritical behavior” patients
109 (51,7%)
17 (43,6%)
0,35
Working with infectious diseases 126 (59,7%)
15 (38,5%)
0,00149
Low estimation 150 (71,1%)
26 (66,7%)
0,5807
Low opportunity for professional success 132 (62,6%)
18 (46,2%)
0,0559
Lack in work-organization 134 (63,5%)
22 (56,4%)
0,4012
Frequency of workplace stress factors in Examined and Control group of Healthcare workers ( N=250 subjects), Institute of OH, WHO CC, 2006
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THROUGHT EDUCATION – TO PATIENT SAFETY FOR ALL
Medical education development at all levels, in different profiles
Medical faculty, school of public health, faculty of dentistry, faculty of nursing …
3 cycles education according to bologna declaration
Harmonisation of curricula New programs, new teaching and learning
methods Mobility of students and teachers Free movement of research and scientific ideas
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Thank you