IMPLEMENTING HEALTH FINANCING REFORM IN AZERBAIJAN – FOCUS ON TB CARE

Tural Gulu State Agency for Mandatory Health Insurance Azerbaijan

• Rich healthcare data shall be generated from logging all transactions

• Greater provider productivity through reimbursement per service delivered

• Out of pocket payments will be decreased

• Incentives for more private investments into health provision to increase supply

• Stricter provider licensing to participate in insurance system will raise quality

• MHI to introduce payment mechanisms which reward quality care

• Public healthcare expenditure as a share of total government budget needs to remain reasonable

• Placing an undue burden on individuals to finance MHI similarly not feasible

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Main Goals of MHI Introduction Explanation and Rationale

Increase Access to Care

Elevate Quality of Care

Improve Transparency

Ensure Sustainability of Costs

Main Goals of MHI in Azerbaijan

Voulntary health

insurance

FOREIGN DONORS EMPLOYERS POPULATION

Public budget, OOP

Providers in MoH System

Private health providers Drug stores

Service providers belonging to other

govt. bodies

Service providers

Public budget, OOP, private insurance co-s OOP, private

insurance co-s OOP, private insurance co-s

Ministry of Health

Other public bodies (PA, ARW, MIA, SCS, MJ,

ME etc.)

Private Insurance Companies

Purchasing services

PUBLIC BUDGET

General taxes

Risk pooling

Revenue collection

Funding sources

OOP Local Executive Powers

District/city/rural health facilities

Public budget, OOP

General taxes

Current health financing system

Proposed health financing system

Rayon/city/rural health facilities

MHI contributions by economically active people (including

employees’)

FOREIGN DONORS POPULATION EMPLOYERS

Providers in MoH System Drug stores Private health

providers

Service providers belonging to other

govt. bodies müəssisələri

Service providers

MANDATORY HEALTH INSURNCE AGENSY (FUND) Private

insurance companies

Purchasing services

GOVERNMENT

VHI for complementary

services

Risk pooling

Revenue collection

Funding sources

MHI contributions for employees

OOP

MHI allocations for economically inactive and low

income groups

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8%

Healthcare Expenditures by Segments (% 2014)

Overall health expenditure level of 5-6% of GDP is on the lower end internationally

Total health spend is however in line with comparable countries (Belarus, Uzbekistan, Latvia, Poland, Estonia) with a legacy of “Semashko” style health systems

The low public funding level and very high private out-of-pocket funding is however problematic

The absence of more pre-paid and pooled health financing exposes individuals to financial risk in the event of disease

Source: http://data.worldbank.org/indicator/SH.XPD.PUBL/countries/AZ

Comments

$2,558 mio

$843 mio

$306 mio

6.05.55.4

5.05.3

2014 2013 2012 2011 2010

80%79%77%78%78%

20%21%23%22%22%

2014 2013 2012 2011 2010

Private Public

Others

8%

Public 20%

Out-of-pocket 72%

Total Healthcare Expenditures as % of GDP

Breakdown of Healthcare Expenditure

Out-of-pocket payments

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Budgets

Capitation

Bundled Payments

Fee-for-Service

Pay-for-Performance

Inpatient Outpatient PHC

Hospitals submit DRG claims based on standard grouper

Providers submit itemized claims but subject to referral / pre-approval

Providers receive age-adjusted capitation based on registered members

Quality indicators as basis for payment to be defined at later stage

Payment mechanisms

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Pilot Phase Rollout Steady State

General Government Budget

Health taxes

Premiums

Member Co-Payments

The state budget will initially need to shoulder incremental costs – once the system has proven functional and demonstrated its value, member health fees and dedicated “health taxes” can be raised to decrease direct

government budget contributions to the overall required premium volume

Required premium for pilots

Required premium during roll-out

Required premium in steady state

Health financing over time

Roadmap for MHI Rollout among Members

Pilot Phase (2017) Rollout (2018-2019) Steady State (2020+)

Two pilot regions initially selected • Yevlakh (~126,000 population) • Mingachevir city (~102,000

population) Provides critical mass with

combined 230,000 members Allows for comparison between

pilots Tests system in both rural and

urban landscape

Further roll-out based on administrative structure of Azerbaijan

Regional approach – first completing roll-out in regions of the pilots (Quba-Khachmaz and Aran) in 2018

Subsequently coverage of all other regions by end of 2019 / 2020

Full roll-out completed by end of the year 2020

MHI operational at the national level

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Roll-out of the MHI system

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Status Quo MHI Roll Out Steady Operations / End of NHP

• 11 National Healthcare Programs are currently offered by the MoH covering 11 social meaningful diseases

• Total funding for the NHP in 2015 was around 20 % of THE

• Patients registered under the NHP are entitled for free drugs, physician consultations and treatment for the selected diseases

All National Health Programs to be integrated in the MHI Fund by 2020

• Gradual transfer of NHP funding to the MHI Fund

• The MHI Fund will continue to cover the same benefits to all its members as currently offered to registered members under NHP

• Network providers will bill MHI for services rendered rather than receiving funding from NHP following the transition

• All NHPs to be integrated in the MHI Fund at the date of expiry of the programs – Year 2020

• Members will continue to have access to the specialized care centers for treatment (as they will become part of the MHI network)

Integration of National Healthcare Programs (NHP)

National Healthcare Programs

• Incidence – 42 cases per 100 000 (3989 cases) in 2015

• Prevalence – 101 registered TB patients per 100 000 (9695 cases) in 2015

• TB care is provided in TB hospitals, TB dispancers, policlinics, tb cabinet

• 27 TB hospitals & dispancers with 1915 beds (4.3 % of all hospital beds)

• Low bed occupancy rate, high average length of stay

• NHP - Program of Actions for TB control: Purchase of medicines, bandages supplies and materials

• Global Fund grant: Purchase of medicines, bandages supplies and materials for MDR TB and financial incentives for doctors and patients

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TB Care in Azerbaijan

• Discussions are ongoing to include TB care in the Basic Benefits Package

• Merging TB hospitals & dispancers to central hospitals as departments

• Shifting inpatient care to outpatients care

• Strengthening PHC to provide TB care

• Developing new payment mechanisms (per case) for provided TB care within the hospitals

• WHO agreed to provide technical support and send mission to Azerbaijan in early 2017

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Proposed reforms in TB Care

THANK YOU FOR YOUR ATTENTION!

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