Cost control mechanisms in Estonian health insurance system
|
|
|
- Bernard Hudson
- 10 years ago
- Views:
Transcription
1 Cost control mechanisms in Estonian health insurance system Triin Habicht Head of Department of Health Care Estonian Health Insurance Fund 15 th European Health Forum Gastein, October 3-6, 2012
2 Population: 1,34 million ALE at birth 76years (2010) Health Expenditure (2010) 6.3 % of GDP Per person (US$895) Public expenditure 78.9 % Social health insurance 68.2% Social health insurance coverage 95-96% of population Estonia at glance
3 Estonian Health Insurance Fund (EHIF) single payer, public law, public ownership Contract Health care provider private law, public or private ownership
4 Collection of Funds and Purchasing Services EHIF expenditures form 86.4% of total public health expenditures and 65.0% of total health expenditures (in 2009) Main source of EHIF revenues (about 99%) is a social health insurance tax (13% payroll tax) about 5 % of population is uninsured EHIF purchases most of health care to insured, except ambulance care The collected funds are pooled centrally Pharmaceutical reimbursements and temporary sick leave benefits are administered centrally Health care services funds are allocated among four EHIF regions based on capitation 4
5 Purchasing process of EHIF EHIF s 4-year budget planning principles and EHIF s 4-year development plan Changes in health service prices and benefit package Pooling in EHIF EHIF s annual budget Capitation based allocations to EHIF regions Selection of partners Negotiations about contract volumes (regional basis) Annual capped cost and volume contracts; 5-year framework contracts for strategic hospitals, 3-year for others Quarterly contract, queue and budget monitoring and utilisation review Planning by specialities (running and next year perspective) Framework contract conditions negotiated and agreed among EHIF and Estonian Hospital Union or Estonian Society of Family Physicians Adjustments of contract if necessary
6 EHIF s 4-year budget planning principles and EHIF s 4-year development plan Pooling in EHIF EHIF s annual budget Capitation based allocations to EHIF regions BUDGET PLANNING Planning by specialities (running and next year perspective)
7 Budget planning 4-year budget planning principles Bases on MoF forecast on health insurance tax revenues Gives the forecast of the financial sustainability in 4-year perspective Sets priorities for expenditure side (expenditures are seen rather need than revenue driven) Basis for annual budget Establishment of the annual budget Priorities according to EHIF s development plan Has to be balanced, EHIF is not allowed to take obligations without budget to cover Budget for health care services: cases x average cost =amount Basis for contracting with service providers
8 BY LAW Solvency reserve EHIF reserves policy 6% of total budget To balance macroeconomic risks Needs government approval Risk reserve 2% of health insurance budgetto balance the risks of health insurance obligations Needs EHIF s supervisory board approval EHIF INITATIVE Surplus Difference between forecasted revenues and expenditures Needs EHIF s supervisory board approval (<30% of total surplus, <7% of previous period s health care services budget)
9 EHIF revenues, expenditures and reserves Source: EHIF,
10 Long term sustainability
11 Source: EHIF, EHIF revenues
12 EHIF s budget in 2012 Type of expenditures Budget (plan, million euro) % Health services % Prevention programs 7 1% Primary care 72 9% Specialist care % Long-term care 17 2% Dental care 19 2% Health promotion 1 0% Pharmaceuticals (out-patient) % Temporary sick leave benefits 88 11% Other monetary benefits 9 1% Other expenditures 16 2% Health insurance expenditures in total % EHIF administrative costs 8,0 1% Expenditures in total % Cost-control mechanisms apply Openobligations Source: EHIF,
13 CONTRACTING, TARIFF SETTING Changes in health service prices and benefit package Selection of partners Negotiations about contract volumes (regional basis) Annual capped cost and volume contracts; 5-year framework contracts for strategic hospitals, 3-year for others Quarterly contract, queue and budget monitoring and utilisation review Framework contract conditions negotiated and agreed among EHIF and Estonian Hospital Union or Estonian Society of Family Physicians Adjustments of contract if necessary
14 Contractingand tariff setting EHIF is not required to enter into a contract with all providers Financial part of the contract is negotiated annually Cost and volumes by specialties and by care types as outpatient,daycare, inpatient are negotiated Contract is agreed by quarters to ensure stability of care provision over the year Services provided over the contract volume are covered on certain conditions but only 30% of costs Health care service prices and benefit package is approved by Government Tariffs are same to all providers Mix of payment methods is used (DRG, FFS, capitation, P4P) In addition to cost-effectiveness analysis budget impact analysis has to be done for all changes in prices and benefit package -> no changes if there are no funds to cover that
15 Lessons learned from Estonia You can t spend money you don t have Full responsibility over spending Longer perspective budget strategy Mandatory reserves and ability to retain revenues that are not spent Control your expenditures Careful contract planning and monitoring with regular negotiations with providers Payment methods that support efficiency Transparent but regulated pricing IT systems are essential to support planning and monitoring process But, long term sustainability is a bit more than just controlling your expenditures 15
16 Thank you for your attention!
Health Care in Estonia. Kadri Eisenschmidt Health Care and Communications Department Estonian Health Insurance Fund 01.02.2016
Health Care in Estonia Kadri Eisenschmidt Health Care and Communications Department Estonian Health Insurance Fund 01.02.2016 Health insurance in Estonia Estonian health insurance is a social insurance
Swe den Structure, delive ry, administration He althcare Financing Me chanisms and Health Expenditures Quality of Bene fits, C hoice, Access
Sweden Single payer, universal healthcare system, with 21 county councils as the primary payer (reimburser) Administration of healthcare plan is decentralized in the hands of the county councils Central
Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
Social health protection : Comparison between Belgium and Thailand. Thomas Rousseau COOPAMI-NIHDI
Social health protection : Comparison between Belgium and Thailand Thomas Rousseau COOPAMI-NIHDI 3.11.2014 Overview 1. Comparison between Belgium and Thailand 2. The Belgium system more in detail Overview
Fiscal independence of the health insurance system. Anneli Ratnik State Budget Department, Chief specialist
Fiscal independence of the health insurance system Anneli Ratnik State Budget Department, Chief specialist Main sources of health financing Estonian health system is largely publicly financed through an
Management/Non-union Employees, Accountability Officers and Elected Officials Compensation and Benefits
EX14.7 STAFF REPORT ACTION REQUIRED Management/Non-union Employees, Accountability Officers and Elected Officials Compensation and Benefits Date: March 31, 2016 To: From: Wards: Employee & Labour Relations
THE HEALTH CARE SYSTEMS OF GERMANY AND SWITZERLAND. Merely slouching towards Regulated Competition
WWS 597 Reinhardt THE HEALTH CARE SYSTEMS OF GERMANY AND SWITZERLAND Merely slouching towards Regulated Competition SOCIAL INSURANCE WITH PRIVATE PURCHASING THE FINANCING OF HEALTH CARE OWNERSHIP OF PROVIDERS
The State of Health Care Integration in Estonia
The State of Health Care Integration in Estonia A Review of Estonia s Quality Assurance System for Health Care The World Bank Group February 2015 Table of Contents I. Objectives and Analytical Framework...1
Hospital Financing Overview
Texas Hospital Association 1108 Lavaca, Suite 700, Austin, TX, 78701-2180 www.tha.org Hospital Financing Overview Under federal law, hospitals are required to provide care to anyone who seeks it in their
Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont
Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Prepared for: The Vermont HRSA State Planning Grant, Office of Vermont Health Access
Comparative Health Care Systems. Folland et al Chapters 22
Comparative Health Care Systems. Folland et al Chapters 22 Chris Auld Economics 317 March 23, 2012 Health Care Systems. There are many different forms of health care delivery in place in different countries.
Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare
December 2010 Using Partial Capitation as an Alternative to Shared Savings to Support Accountable Care Organizations in Medicare CONTENTS Background... 2 Problems with the Shared Savings Model... 2 How
The Alphabet Soup of Managed Care Organizations: Provider Perspective
Session 16: The Alphabet Soup of Managed Care Organizations: Provider Perspective Society of Actuaries 1997 Annual Meeting Monday, October 27 10:30 a.m. - 12:00 noon Timothy M. Ross $ MSO HCFA PB M CISN
X International Conference on Wearable Micro and Nano Technologies for Personalized Health Tallinn, Swissôtel, June 26 28, 2013
Electronic Data Enablers for Quality Care and Personalized Perspective of Estonian Insurance Fund Tanel Ross, Chairman of the Management Board, Estonian Insurance Fund Thursday, June 27 Ladies and gentlemen,
Federal Health Care Reform: Implications for Hospital and Physician partnerships. Walter Kopp Medical Management Services
Federal Health Care Reform: Implications for Hospital and Physician partnerships Walter Kopp Medical Management Services Outline Overview of federal health reform legislation Implications for Care delivery
Executive Summary. Jason Lakin and Vivian Magero, 1 International Budget Partnership May 2012
Budget Brief No. 14 Healthy Ambitions? Kenya s National Hospital Insurance Fund (NHIF) Must Become More Transparent if it is to Anchor Universal Health Coverage Jason Lakin and Vivian Magero, 1 International
6101 - DEPARTMENT OF ADMINISTRATION 21-HEALTH CARE & BENEFITS DIVISION
Program Description The Health Care and Benefits Division provides state employees, retirees, members of the Legislature, judges and judicial branch employees, and their dependents with group benefits
New Trends In the Brazilian Healthcare Market. Rafael Vasconcellos,MD UHG
New Trends In the Brazilian Healthcare Market Rafael Vasconcellos,MD UHG Summary Overview Brazilian Healthcare Market Numbers Public System Private System Interaction Between Public X Private Innovations
Appendix C. Adapting BEA s National and Industry Accounts for a Health Care Satellite Account. Brent R. Moulton, Brian C. Moyer, and Ana Aizcorbe
Appendix C Adapting BEA s National and Industry Accounts for a Health Care Satellite Account Brent R. Moulton, Brian C. Moyer, and Ana Aizcorbe INTRODUCTION The Bureau of Economic Analysis (BEA) covers
Children s Special Health Care Services and Michigan s High Risk Pool Issue Brief March 2012
Children s Special Health Care Services and Michigan s High Risk Pool Issue Brief March 2012 Executive Findings The Michigan Department of Community Health, Children s Special Health Care Services Division
An Act To Protect Consumers and Small Business Owners from Rising Health Care Costs Be it enacted by the People of the State of Maine as follows:
PLEASE NOTE: Legislative Information cannot perform research, provide legal advice, or interpret Maine law. For legal assistance, please contact a qualified attorney. An Act To Protect Consumers and Small
Achieving Competitive Advantage Through Supply Chain Excellence. Jim Webb, Senior Vice President of Operations, Provista
Achieving Competitive Advantage Through Supply Chain Excellence Jim Webb, Senior Vice President of Operations, Provista Presentation objectives Competitive Forces Sources of Competitive Advantage Focus
Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.
Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
DESCRIPTIONS OF HEALTH CARE SYSTEMS: GERMANY AND THE NETHERLANDS
DESCRIPTIONS OF HEALTH CARE SYSTEMS: GERMANY AND THE NETHERLANDS The German Health Care System Reinhard Busse, M.D. M.P.H. Professor of Health Care Management Berlin University of Technology & Charité
Public and private health insurance: where to mark to boundaries? June 16, 2009 Kranjska Gora, Slovenia Valérie Paris - OECD
Public and private health insurance: where to mark to boundaries? June 16, 2009 Kranjska Gora, Slovenia Valérie Paris - OECD 1 Outline of the presentation Respective roles of public and private funding
University of Mississippi Medical Center. Access Management. Patient Access Specialists II
Financial Terminology in Access Management University of Mississippi Medical Center Access Management Patient Access Specialists II As a Patient Access Specialist You are the FIRST STAGE in the Revenue
HEALTH INSURANCE IN LATVIA
HEALTH INSURANCE IN LATVIA Elina Tilta, Gaida Pettere At the present moment the health care system in Latvia is in transition period. During the Soviet time it was free of charge but at the present much
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012--
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012-- On Friday, December 23, 2011, President Obama signed into law
Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff
Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff Ibrahim Shehata April 27, 2006 Background Health expenditure is dominated by household direct out-ofpocket payments
2019 Healthcare That Works for All
2019 Healthcare That Works for All This paper is one of a series describing what a decade of successful change in healthcare could look like in 2019. Each paper focuses on one aspect of healthcare. To
Single Payer Systems: Equity in Access to Care
Single Payer Systems: Equity in Access to Care Lynn A. Blewett University of Minnesota, School of Public Health The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform Journal of
Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
A BILL. To provide a single, universal, comprehensive health insurance benefit for all residents of Illinois, and for other purposes.
Synopsis: This bill expands comprehensive health coverage to all Illinois residents using a single-payer statewide insurance system. Doctors and hospitals remain private, and patients retain their choice
GLOSSARY OF INSURANCE TERMINOLOGY
GLOSSARY OF INSURANCE TERMINOLOGY Administrative Services Only (ASO) An arrangement whereby an organization (usually an employer) hires an outside firm to perform specific administrative services, usually
Transitional reinsurance program results in significant new costs for group health plans
Transitional reinsurance program results in significant new costs for group health plans The Department of Health and Human Services (HHS) has issued additional guidance on the three-year transitional
SWECARE FOUNDATION. Uniting the Swedish health care sector for increased international competitiveness
SWECARE FOUNDATION Uniting the Swedish health care sector for increased international competitiveness SWEDEN IN BRIEF Population: approx. 9 800 000 (2015) GDP/capita: approx. EUR 43 300 (2015) Unemployment
Cost Effectiveness, Reimbursement and Medical Devices. Colin Hopley M.Eng MBA MPH
Cost Effectiveness, Reimbursement and Medical Devices Colin Hopley M.Eng MBA MPH Agenda Health Care Environment Policy options - Health Technology Assessment (HTA) - Reimbursement Influence of innovation
Summary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals
Summary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals I. Children s Health Insurance Program (CHIP) Reauthorization Act of 2009 A. Funding for CHIP. The
Chapter 7 Acute Care Inpatient/Outpatient Hospital Services
Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care
Snapshot Report on Russia s Healthcare Infrastructure Industry
Snapshot Report on Russia s Healthcare Infrastructure Industry According to UK Trade & Investment report, Russia will spend US$ 15bn in next 2 years to modernize its healthcare system. (Source: UK Trade
Using Cost Accounting Data to Develop Capitation Rates
Using Cost Accounting Data to Develop Capitation Rates By: Mark E. Toso, CPA, President Anne Farmer, Vice President TriNet Healthcare Consultants, Inc. A capitation payment arrangement can be an effective
PharmaCare is BC s public drug insurance program that assists BC residents in paying for eligible prescription drugs and designated medical supplies.
PHARMANET AND PHARMACARE DATA DICTIONARY Date Range: September 1, 1995 to present date, data is provided by calendar year Data Source: BC Ministry of Health Description The PharmaNet system is an online,
COUNTRY UPDATE ORGANISATION OF THE HEALTH CARE SYSTEM IN AUSTRALIA
COUNTRY UPDATE ORGANISATION OF THE HEALTH CARE SYSTEM IN AUSTRALIA 1. Organisation Briefly outline the structural provision of health care. The Australian health system is complex, with many types and
Medicare Economics. Part A (Hospital Insurance) Funding
Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),
TOWARDS UNIVERSAL HEALTHCARE COVERAGE LESSONS FROM THE HEALTH EQUITY & FINANCIAL PROTECTION IN ASIA PROJECT
TOWARDS UNIVERSAL HEALTHCARE COVERAGE LESSONS FROM THE HEALTH EQUITY & FINANCIAL PROTECTION IN ASIA PROJECT Eddy van Doorslaer Institute for Health Policy & Management & School of Economics Erasmus University
Approaches for Cost and Price Assessment in the Danish Health Sector
Approaches for Cost and Price Assessment in the Danish Health Sector A description of the approaches used in practice in the Danish health sector to cost and price health services Lone Bilde Anni Ankjær-Jensen
Study of Hospital Funding and Payment Methodologies for Florida Medicaid
Study of Hospital Funding and Payment Methodologies for Florida Medicaid Prepared for: Florida Agency for Health Care Administration January 15, 2015 navigant.com/healthcare Navigant Table of Contents
What can China learn from Hungarian healthcare reform?
Student Research Projects/Outputs No.031 What can China learn from Hungarian healthcare reform? Stephanie XU MBA 2009 China Europe International Business School 699, Hong Feng Road Pudong, Shanghai People
member of from diagnosis to cure Eucomed Six Key Principles for the Efficient and Sustainable Funding & Reimbursement of Medical Devices
Eucomed Six Key Principles for the Efficient and Sustainable Funding & Reimbursement of Medical Devices Contents Executive Summary 2 Introduction 3 1. Transparency 4 2. Predictability & Consistency 5 3.
Germany's Statutory Health Insurance:
Germany's Statutory Health Insurance: Structures, Challenges, Benefits Dr. Norbert Klusen CEO of Techniker Krankenkasse (TK), Hamburg American & German Healthcare Forum 2010, University of Minnesota Minneapolis,
The Future of Rural Health: The MMA As a Change Agent
The Future of Rural Health: The MMA As a Change Agent Keith J. Mueller, Ph.D. Professor and Director RUPRI University of Nebraska Medical Center Prepared for Presentation at the All Programs Meeting of
Comparison of California Health Coverage Expansion Proposals
Note: A comparison of the Senate Republican proposal for the special session, CalCare Plus will be available shortly. Californians to Be Covered 1 Consumers/ Individuals Treatment of Self-Employed Employers
GENERAL GOVERNMENT ADMINISTRATION EXECUTIVE RECORDS RETENTION AND DISPOSITION SCHEDULES (ERRDS) ERRDS, HEALTH POLICY COMMISSION
TITLE 1 CHAPTER 18 PART 669 GENERAL GOVERNMENT ADMINISTRATION EXECUTIVE RECORDS RETENTION AND DISPOSITION SCHEDULES (ERRDS) ERRDS, HEALTH POLICY COMMISSION 1.18.669.1 ISSUING AGENCY: New Mexico Commission
Market Access for Medical Technology & Pharmaceutical Companies An Organizational Priority in Times of Economic Austerity and Reform
Market Access for Medical Technology & Pharmaceutical Companies An Organizational Priority in Times of Economic Austerity and Reform By Joakim Steen Mikkelsen, Managing Healthcare Counselor, Embassy of
2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010
2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services
The Factors Fueling Rising Health Care Costs 2008
The Factors Fueling Rising Health Care Costs 2008 Prepared for America s Health Insurance Plans, December 2008 2008 America s Health Insurance Plans Table of Contents Executive Summary.............................................................2
Chapter 4 Health Care
Social Security in Japan 2014 Chapter 4 Health Care 4.1 Introduction The health care service system in Japan is delivered by mandatory, non-profit public health insurance systems, and not by the service
Annex 7. Fact Sheet Estonia
Annex 7. Fact Sheet Estonia 1. Generalities: Some history of the agricultural risk and crisis management policies, programs and tools. Population: 1, 36 million inhabitants GDP 2004 9,4 billion Euro; Inflation
Introduction. Plan sponsors include employers, unions, trust funds, associations and government agencies, and are also referred to as payors.
Maintaining the Affordability of the Prescription Drug Benefit: How Managed Care Organizations Secure Price Concessions from Pharmaceutical Manufacturers Introduction The purpose of this paper is to explain
SUMMARY FIGURE 1: FORECASTED PMPY NET DRUG SPEND ACROSS THE PHARMACY AND MEDICAL BENEFIT FOR COMMERCIAL PLAN SPONSORS $1,800 $1,600 $1,400 $845 $1,200
SUMMARY Specialty drugs, which are drugs manufactured through biologic processes, are in the midst of a tremendous boom. With an annual yearly cost trend that sits at 17% currently and is expected to grow
Technical Note: Comparison of Methodologies between Total Health Care Expenditures and State Health Expenditure Accounts
Center for Health Information and Analysis Technical Note: Comparison of Methodologies between Total Health Care Expenditures and State Health Expenditure Accounts October 2014 Executive Summary This
US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform
US Hospital Information Systems Overview and Outlook, 2013 2020 Managing Information in an Era of Reform December 2014 Contents Section Slide Number Executive Summary 11 Market Background 19 The EHR Landscape
Health Insurance Reform at a Glance Implementation Timeline
Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
Employee Benefit Research Institute 2121 K Street, NW, Suite 600 Washington, DC 20037
FACTS from EBRI Employee Benefit Research Institute 2121 K Street, NW, Suite 600 Washington, DC 20037 Employment-Based Health Care Benefits and Self-Funded Employment-Based Plans: An Overview April 2000