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

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

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18.06.2015 Views

Country profiles of health system responses to the crisis | The Republic of Moldova 443 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.

444 Economic crisis, health systems and health in Europe: country experience Priority setting or protocols to change access to treatments, coordination of care and patterns of use • Funding of emergency and primary health care prioritized (more than 38% of the SHI funds in total) and the list of compensated medications was extended as part of a plan to combat and mitigate the effects of the crisis on health (2009–2011). • The Ministry of Health approved the 2012–2014 Health Policy Roadmap, which includes the decentralization of primary health care, regionalization of specialized and highly specialized care, introduction of a quality management system in all health institutions, better targeting of state subsidies, and increases in the efficiency of health funds utilization. However, implementation has been slow. Waiting times • No response reported. Health promotion and prevention • Increased population immunization coverage (2011, 2012). • Institution of measures to promote health lifestyle and health education (2011, 2012).

444 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />

Priority setting or protocols to change access to treatments, coordination<br />

of care <strong>and</strong> patterns of use<br />

• Funding of emergency <strong>and</strong> primary <strong>health</strong> care prioritized (more than<br />

38% of the SHI funds in total) <strong>and</strong> the list of compensated medications<br />

was extended as part of a plan to combat <strong>and</strong> mitigate the effects of the<br />

<strong>crisis</strong> on <strong>health</strong> (2009–2011).<br />

• The Ministry of Health approved the 2012–2014 Health Policy<br />

Roadmap, which includes the decentralization of primary <strong>health</strong> care,<br />

regionalization of specialized <strong>and</strong> highly specialized care, introduction of<br />

a quality management system in all <strong>health</strong> institutions, better targeting of<br />

state subsidies, <strong>and</strong> increases in the efficiency of <strong>health</strong> funds utilization.<br />

However, implementation has been slow.<br />

Waiting times<br />

• No response reported.<br />

Health promotion <strong>and</strong> prevention<br />

• Increased population immunization coverage (2011, 2012).<br />

• Institution of measures to promote <strong>health</strong> lifestyle <strong>and</strong> <strong>health</strong> education<br />

(2011, 2012).

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