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Country profiles of health system responses to the crisis | The Republic of Moldova
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Salaries and motivation of health sector workers
• No response reported.
Payment to providers
• Development of performance assessment and results-based financing aimed at
medical personnel motivation, quality improvement and resource efficiency
(2009).
• The Ministry of Health decided to shift to DRG payment for hospital services
contracted within SHI (previously payment was by tariffs with caps on
overheads and running costs adjusted for the rate of inflation and historic
revenue and spending). Nine pilot hospitals were contracted and paid by
DRGs in 2012, followed by an expansion in 2013.
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• Between 2010 and 2012, the Ministry of Health changed its organizational
chart three times, with the aim of reducing administrative costs. In December
2012, the government approved a Ministry of Health initiative to reorganize
medical institutions at the national level by introducing common management
in order to reduce administrative costs and duplication in logistics and nonclinical
services. This was met with resistance from some groups of politicians,
professionals (institution staff) and part of the population, provoking debate
in the mass media.
Provider infrastructure and capital investment
• Reviewed and put on hold investment plans for costly equipment (2009).
• Parliament adopted a law which introduced a “fund for development and
modernization of public health providers” within the SHI framework
(2010). The fund has maintained and even increased resources for capital
investment, procurement of modern and expensive equipment, sanitary
transport and information technology in the health sector, despite wider
restrictions imposed by the Ministry of Finance. The rate of disbursement
of resources to the fund increased in 2012, resulting in an increase in the
number of medical institutions.
• In March 2012, the Ministry of Health announced its commitment to
launch a reorganization of the public hospitals network based on the
National Hospital Master Plan, which aimed to enhance efficiency,
access and quality of services. However, implementation of the plan is
still pending, and the Ministry of Health is in the process of choosing the
model, based on the piloting results of a “zonal” hospital, carried out with
World Bank technical assistance.