Web-economic-crisis-health-systems-and-health-web

364 Economic crisis, health systems and health in Europe: country experience
• Introduction of auctions for purchasing medical equipment for hospitals
(2011).
• VAT on pharmaceuticals and medical devices increased from 9% (2011)
to 14% (2012) and 15% (2013).
Salaries and motivation of health sector workers
• Decrease of 10% in expenditure on public administration employees,
including health sector administrative workers (2009).
• Salaries of physicians working in public hospitals increased (after a national
strike) (2011, 2012) but only implemented in university hospitals.
Payment to providers
• Established DRG payment for acute hospital care (previously global budgets
were used) (2010 and 2012 onwards).
• The government decree that defines the relationship between providers
and health care insurance funds limited the total reimbursement of
outpatient services to 98% of the 2011 level; decreased the maximum
production of acute inpatient care to 95% (relative to the year 2011),
for which it slightly raised the reimbursement rates; decreased the
reimbursement of outpatient care provided in hospitals; equalized prices
for DRGs among various hospitals; and decreased reimbursement of
laboratory tests (2013).
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• The administrative costs of health insurance funds were temporarily
decreased and these savings were used to pay for health care (2011).
• Proposed to create one health insurance office that would integrate all
technical activities of the health insurance funds (e.g. payment for care
in the EU, defining the DRG structure, classifications and registers of
contracted providers and clients) (2013).
• The largest health insurance fund (VZP) centralized its processes, further
concentrated its structure and sold redundant property (2012).
• Health insurance funds used “packages” for purchasing specific services
(e.g. cataract surgery, hip replacement).
Provider infrastructure and capital investment
• Planned to abolish 6000 inpatient acute care beds across all hospitals
in 2012 but this was not fully implemented because of resistance by
hospitals.