Study tour for government health insurance leaders to Belgium

Transcription

1 Study tour for government health leaders to Belgium Background of the assignment The HSCSP and the EU funded project The Health Sector Capacity Support Project (HSCSP) is an EU contribution to strengthening the institutional capacity for the good governance in the health sector and for improved health service delivery in Vietnam. The HSCSP is designed to assist government-owned reforms towards sectorwide management, paving the way to a programme-based approach for cooperation between the MoH and EU and other interested Development Partners (DPs). The HSCSP focuses on the design and testing of tools for the Ministry of Health (MoH) and Provincial Departments of Health (DoH) of three pilot provinces being, Bac Giang, Bac Ninh, and Ha Nam, and information exchange for fifteen additional partnering provinces. The Overall Objective of the HSCSP is (Ministry of Health, 2012): Improved health status of the people in Vietnam, in particular those who are poor and near-poor, as a contribution to poverty reduction and attainment of health-related Millennium Development Goals (MDG). The specific objectives of the HSCSP are to "strengthen the capacity of the Ministry of Health (MoH), provincial Departments of Health (DoH) and key sector stakeholders in health in the following four result area of: 1. sector policy (including health financing) formulation, planning and budgeting; 2. management (including public finance management) and regulation; 3. coordination between the MoH and other important Government's Agencies (e.g. Ministry of Finance (MoF), Ministry of Planning and Investment (MPI), and Vietnam Social Security (VSS), also between the MoH and its provincial and district administrations on the one side and international partner organizations and donors on the other; and 4. delivery of quality health services with the main focus on primary health care and preventive medicine. The health (HI) is one of the key elements to achieve universal health coverage. Social Health (SHI) has been implemented in Vietnam since In 2008, the national assembly have issued the law on HI with the goal of universal coverage. Currently, and with the support of HSCSP, the MoH collaborate with Vietnam Social Security (VSS) and other ministries to amend the Law towards resolving a number of difficulties and issues that arose while implementing the HI policies. The issues that need to be changed are mainly related to the benefit package, the copayment provisions, payment mechanisms between health funds and the health service suppliers. To amend the HI Law, The MoH has established a Formulation Committee chaired by the Minister of Health, with members that are representative of other ministries as Government Offices, Committee on Social Affairs of the National Assembly, Ministry of Finance (MoF), Ministry of Justice, and the VSS, and related departments of the MoH. In which the Department of HI of MoH is the key contact point of the Formulation Committee. 1

2 The study tour is a work Package aiming at providing senior health leaders with an opportunity to see the governance, management, procedures and function of a health system in another country. Objectives of the study tour As part of the activities contributing to the first result area, sector policy (including health financing) formulation, planning and budgeting, the purpose of the study tour is to strengthen the capacity of Health Insurance Department through amendment of the Health Insurance Law and Circular. This activity will provide support for ministry leaders (MoH, Ministry of Planning and Investment, MoF), and senior health managers at Central and provincial levels to acquire insight on health in a foreign country, Belgium, which has a long history of implementing social health society, having a fully built, and comprehensive legal system. A group of about 8 members of the HI law formulation committee are invited to participate in the study tour. This activity will help the members analysing the Belgian health system and implementation, drawing conclusions from the lessons learnt and identifying appropriate amendments to the HI law with regards to governance, policies, management, procedures, benefit packages e.g. Participants to the study tour - Tống Thị Song Hương: Director - Department of Health Insurance, Ministry of Health - Bùi Thị Ánh: Expert - Department of Health Insurance, Ministry of Health - Lê Việt Hương : Vice Director - Department of Health Insurance, Ministry of Health - Phạm Thị Minh Nga : Deputy Head of Finance and Administration Division, Department of Finance and Planning, Ministry of Health - Đào Văn Dũng: Director - Department of Social Affairs, Central Committee of Propaganda - Nguyễn Lệ Thủy: Vice Director - Department of Law, Government Office - Nguyễn Đức Thụ: Director of Department of Social Affairs, National Assembly - Phạm Lương Sơn: Chairman - Committee of Health Insurance Policy, Vietnam Social Security - Ngô Quốc Huy: HSCSP staff Institutions to visit National Institute for Health and Disability Insurance () and COOPAMI The NIHDI is a federal institution that, just like the health funds, plays an important part in health care and incapacity for work benefits. The NIHDI organizes, manages and supervises the correct application of that «compulsory» in Belgium. The NIHDI is supervised by the Minister of Social Affairs. The NIHDI establishes the rules for the reimbursement and determines the tariffs of the health care services and medicines. Its role is: Organize reimbursement of medical costs Elaborate legislation and regulation Monitor the evolution of health care spending Inform health care providers, sickness funds and the insured, and to ensure they apply the legislation and regulation correctly 2

3 Organize the negotiations between the different actors involved in compulsory health Coopami is a cooperation platform that supports countries that wish to develop or modernize a universal, unified and sustainable social protection in the interest of the population. The platform COOPAMI, which was created within the NIHDI, brings together individuals and organizations from Belgium with a specific expertise in the field of social protection. Websites: National Institute for Health and Disability Insurance: FPS Social Security: The Belgian healthcare knowledge centre (KCE) The KCE is a federal institution operating since Its mission is to produce studies and reports to advice policy-makers when deciding on health care and health. The KCE is not itself involved in making decisions and certainly not in their implementation. Its role is to point the way to the best possible solutions. It does so in a context of optimal access to health care of high quality and taking into account increasing demand and budgetary limitations. The KCE is active in three major research fields: Analysis of clinical practices and development of recommendations of good practice (Good Clinical Practice) Assessment of health technologies and drugs (Health Technology Assessment) Healthcare financing and organization (Health Services Research) Website The B. Health Care Knowledge Centre: University hospital, Liege (CHU-Sart Tilman, Liège) As a Public hospital, the university hospital of Liège is offering high quality hospital care to all patients. It is the unique University hospital of Wallonia (South part of Belgium) associated with a faculty of medicine including the complete cycle. As an academic hospital, he covers three specific missions: Clinical activity, including support for complex, specific or new, pathologies Clinical research: the development and evaluation of new techniques, Clinical education The CHU of Liège is represented in numerous structures for expertise and support to decision making decision, at the level of the Ministry of public health or of the NIHDI, as well as in groups, societies and committees at local, national and international levels. The University hospital, Liège University and Liège province are engaged in a partnership with the health services of Hô Chi Minh-Ville (HCMV) VIETNAM. Website: 3

4 Medical house: Maison Médicale du Maelbeek The usual entry point to the health system in Belgium is generalist ambulatory care in close-to-client settings (this is different from specialized clinics, hospital outpatient departments and emergency services). A medical house is an integrated health centre created at the initiative of general practitioners, physiotherapists, nurses. They decide to organise all their work to provide frontline care continuously. Their actions are aimed at a comprehensive approach, integrating curative, preventive and promotive approaches to health. About patients receive care in 115 Medical houses in Belgium. Most of the Medical houses developed an alternative system of financing health care. Patients do not pay providers; the pay a fixed lump sum each month to cover the basic package of care including medical care, nursing care and physiotherapy. Coordination of the study tour AEDES will ensure the study tour coordination. Technical coordination: Dr Isaline Greindl Technical support health economy: Matthieu Antony Logistic Mrs. Sophie Kasiers 4

5 Provisional schedule of the study tour in Belgium: 11/05/14-18/05/14 Summary Sunday 11/05 Monday 12/05 Tuesday 13/05 Wednesday 14/05 Thursday 15/05 Friday 16/05 Saturday 17/05 9H00 Arrival in Introduction Introduction to The medical First line health Visit of the Debriefing Brussels sessions. the Belgian evaluation and services in university meeting 12H00 Expectations of health care inspection Belgium: Visit Hospital. CHU participants.. department of a family de Liège Introduction to Policy and Data base on health centre the Belgian health health Or KCE Health care. system relating to primary care Place Conference R NIHDI MMMaelbeek CHU - Liège Conference R. Lunch 14H00 Visit of the KCE Access to Performance of The capitation - or MMM Belgium Health the health system in the 17H00 care system and medical houses improving the in Belgium quality of health care Determination of the health budget and cost containment Place KCE or MMM Conference R Sunday 13/04 Departure to Hanoi 5

6 Provisional schedule of the study tour Subject - Learning objectives - Presenters Day: Monday 12/05 Subject Main topics Learning objectives Presenter Location - Belgian health system: To understand the Belgian Dr Isaline Greindl (Senior Conference room Different levels of health system. public health adviser) health care. Igreindl@aedes.be - Distribution of roles: Mr Mathieu Antony (Health governance, policies, economist) regulation, financing, Mantony@aedes.be provision of health care Introduction to the Belgian Health care system Visit of the KCE (Or MMN) - Discussion around the study on hospital payments in 5 European countries. - Payment mechanisms to encourage - the provision of integrated care Understanding the Hospital care payments systems. To be defined Centre Fédéral d Expertise des Soins de Santé (KCE) Brussels 6

7 Day: Tuesday 13/05 Subject Main topics Learning objectives - Main turning points in the history of the Belgian To understand the health implementation - Basic principles of the Belgian health system of the HI - Administrative organization : regulation execution control - Where is the money coming from? - Where is the money going to? - Negotiation in the Belgian health care - Policy challenges for the Belgian health care Introduction to the Belgian health care. Policy of health relating to primary care Access to Belgium health care. - Expanding the preventing role of GP (Global Medical File) - Support of practice of GP s - Promoting grouping of GP s (Impulseo II) - Patient pathways - Local primary care - Basic Principles - General Access to Belgian Health Care - Contributions - Accessibility Measures for lower socioeconomic groups (preferential reimbursement, maximum billing and third-party payment system) - Accessibility Measures for patients with high Health Expenses - Third-party payment system mandatory for vulnerable patients To understand the policy of Belgium health to promote primary care To understand the Belgian strategies in achieving access to health care for people who are unable to pay Presenter Thomas Rousseau Thomas.Rousseau@riziv. fgov.be Project collaborator Coopami Luc Maroy Adviser Karlien Van Hellemont Attaché Location 7

8 Day: Wednesday 14/05 Subject Main topics Learning objectives Presenter Location - controlling the misuse of diagnostic and Understand the role and Dr Charles Vranckx therapeutic freedom the importance of General Medical Inspector - evaluating the reimbursement of medical medical evaluation and care consumption in light of the measures inspection in health Dr Didier Renauld taken to prevent and detect misuse Director Medical Inspector - providing information to health care providers, such as recommendations on good medical practice and indicators of over-consumption The medical evaluation and inspection department Database on health Performance of the health system and improving the quality of health care Determination of the health budget and cost containment - The Belgian health databases - How do we use databases? o Diagnosis o Treatment o Monitoring - Concept of performance and quality of health care - Methodology: o Choice of themes and indicators o Sources of information - Financing of the health budget - Growth rate - Financial responsibility (of sickness funds and of health care providers) - Monitoring of expenses - Actions when overspending Understand the need and the utilisation of databases for Health Understand how and why to measure the performance of the health system and how to improve quality of health care Understand how the fix a health budget and how to monitor en control health expenses. Dr Pascal Meeus Adviser medical inspector Dr Pascal Meeus Adviser medical inspector Michel Vigneul Project manager 8

9 Day: Thursday 15/05 Subject Main topics Learning objectives - Visit of the Health centre - Presentation on the capitation system in Belgium First line health services in Belgium: Visit of a medical house (Maison médicale) The capitation system in the medical houses in Belgium - History of the medical houses in Belgium - The role of medical houses - Quality of care and family medicine - The capitation system To discover an integrated approach for the practice of family medicine. To understand the capitation payment system for family medicine in Belgium Presenter To be defined. Dr Isaline Greindl Location Medical House Conference room Day: Friday 16/05 Subject Main topics Learning objectives Presenter Location Visit of the university - Visit of the hospital Understanding The Prof Bouffioux University Hospital. Sart Tilman - CHU de Liège. - Discussion on the benefit package at hospital level. current benefit package at hospital level. hospital-sart Tilman - - Hospital care payment mechanisms. Liège - 9

10 Day: Saturday 12/04 Subject Main topics Learning objectives Presenter Location Debriefing of the study tour Analysing main lessons learnt regarding governance, policies, implementation, and procedures. Isaline Greindl Mathieu Antony Conference room 10