Seminars & Workshops

Budapest
Hospital Based Management Information Systems - The Canadian Experience

Trinidad
Information Seminar on Health Care Financing & National Health Insurance

Stakeholder Workshop on Health Care Financing and National Health Insurance

Budapest

Hospital Based Management Information Systems - The Canadian Experience
Budapest, Hungary
Three Day Conference, October 6, 7, 8, 1997

Objectives of the Conference

To share with our colleagues, officials of Ministries of Health and Welfare from the Baltic states, countries of Central and Eastern Europe, and former Soviet republics, Canada's efforts in delivering a cost-effective service in the acute care sector over the past 20 years.

The objective of the conference was not to promote Canada's system as the best, as none of the developed countries can honestly make this claim, but rather to enable the participants to learn from Canada's experience in establishing, initially, a uniform accounting (i.e., cost accounting) system in hospitals across Canada; evolving into a computer based management information system (MIS); and currently, to take advantage of smart technology and other cost saving IT applications.

To report and, in turn, manage hospital costs Canada first had to learn to walk not only as individual hospitals but uniformly as groups (provinces) and, in turn, nationally (Canada). Once we mastered the so-to-speak, manual system, computer technology enabled us to process and manage the system more quickly and efficiently. This learning process proved invaluable building on previous knowledge and moving in step with emerging technologies. As such, first we had to learn to walk before we could run.

The second, equally important objective of the conference, was to listen and to learn from each of the participant's situation, experiences and aspirations - and to learn from each other.

Finally to ascertain, whether, in the opinion of those attending the Conference, there is a role for Canada in their efforts to restructure the health care delivery system, specifically in the areas of hospital based management information systems.

The Conference, sponsored by the World Bank and Government of Canada, was attended by about 40 delegates. If you require additional information we would be pleased to respond.

Trinidad

Information Seminar on Health Care Financing & National Health Insurance
Trinidad & Tobago Health Sector Reform Programme
October 25, 2001

Purpose

The main purpose of the Seminar was to inform and sensitise senior Ministry of Health (MOH) and Ministry of Finance (MOF) officers regarding the critical aspects of a national health financing system and the role of National Health Insurance (NHI) in such a system. Additionally, the Seminar included a discussion of the NHI design and implementation issues from an international perspective.

Seminar Highlights

1. Health Policy and Tools to Meet Policy Goals

Financing health care is not for eliminating poverty, resolving problems of inequality and deprivation, nor is it for collecting money for the health sector; it is for:

• managing risks
• mobilizing funds
• subsidising the poor.

The Seminar identified some of the following dilemmas in health care financing:

• How to manage uncertainty and risk?
• How to manage transfers over time and between generations?
• How to mobilise funds?
• How to pay for poorer people to get access to effective care?
• How to control costs and avoid conflict with other national objectives?
• How to give choice (and do patients really want choice or just a good service)?
• How to avoid a service for the poor becoming a poor service?
• How to avoid 'provider capture'?

The Seminar highlighted what worked and what did not in a number of countries:

• A mainly market solution is a partial solution - USA
• A rich country can have a popular, universal and affordable system - Canada
• Worry all the time about cost - Thailand
• It is always better for poorer people to get free access to some services than some subsidy for all - Korea
• Voluntary NHI is unlikely to be NHI and a system based on the well subsidising the ill, needs well people - Iran
• The package of services must constrained - Czech Republic

The Seminar emphasized the following:

• Successful change needs sponsors and the ground has to be prepared
• Opposition to change is usually more articulate than support
• Many health problems have origins outside the formal health sector
• Many problems of access to care are related to social and economic conditions.

The key message was the need for clear policy direction and that success depends on a clear understanding of what is to be achieved with regards to a health care financing system, i.e., "keep your eye on policy goals".

2. National Health Insurance - Helping to Meet Policy Goals

• Higher level of funding for health sector
• More stable funding of health sector
• Less spending by government
• Better use of government spending on specific services
• Better access for poorer, older and younger
• More choice for patients
• Better incentives to providers.

Private sector health insurance seldom pays directly for those with more serious health care needs and the services paid for by private sector health insurance yield relatively small health gains. There is little evidence to suggest that private sector financing relieves the financial burden on government.

3. Feasible, Practical and Sensible Next Steps in Health Care Finance

Progress in designing a health care financing system will require a wide understanding and buy-into the agreed goals. The following are some of the important choices that need to be made in designing a national health care financing system:

• For all or for some?
• Single package of benefits, or more than one package?
• Compulsory or voluntary?
• Payroll or a broad base for contributions?
• How much cross-subsidy within the system?
• How much subsidy of the system?
• Funded or pay-as-you-go?
  

Stakeholder Workshop on Health Care Financing and National Health Insurance
Trinidad & Tobago Health Sector Reform Programme
November 15, 2001

Purpose

The main purpose of the Workshop was to inform and sensitise the major stakeholders regarding the many aspects of health care financing, the role of NHI and its probable impact on the delivery of health care services. Both the previous Seminar and the Workshop had the following objectives:

• guide MOH and MOF officers through the various health care costs that comprise the total cost of a health care system
• explain the elements of a national health financing system and present financing options for a health care system based on these fundamental principles of health care financing
• explain the role of NHI in the financing of a health care system and provide an understanding that social health insurance is not a health care financing panacea
• provide expert advice on the major policy, design and implementation issues that must be addressed as part of the design and implementation of a NHIS.

The Workshop, however, was a much broader stakeholder sensitization session and included international and country experts in the areas of health financing, provider payment mechanisms, social insurance assessment tools, Jamaican experiences with NHI and the Trinidad & Tobago situation.

Stakeholder groups included the Regional Health Authorities (RHAs), the private insurance companies, the banking industry, IDB, PAHO, professional associations (e.g., medical association, nurses association, dental council, actuarial association), academic institutions, business, Non-Governmental Organisation (NGO), and members from other Ministries within government.

Workshop Highlights

1. Health Care Funding Options

Three objectives of health care financing:

• improve the health of the population serviced
• respond to people's expectations
• provide financial protection against the costs of ill health.

Three functions related to these objectives:

• collection of funding,
• allocation of resources
• remuneration of providers.

With regard to funding health care, two major methods were described:

• direct funding through user fees and pre-payment/savings accounts
• indirect funding or pooled insurance finance through selective insurance (private insurance, social insurance, payroll taxes and community insurance) and universal insurance (general taxation).

2. NHI Provider Payment Mechanisms

Evidence shows provider payment mechanisms significantly influence provider behaviour. The Workshop underscored the importance of providing the right set of incentives to providers in order to achieve goals set for the health care system.

Key recommendations from a study recently conducted on provider payment mechanisms in the Caribbean included the following:

• adopting a mixed system of payment mechanisms
• introducing changes incrementally
• conducting a country analysis prior to implementation of any new provider payment mechanism.

The Workshop look at the different payment mechanisms to physicians and health care facilities and the need to change the current provider payment mechanisms that are prevalent across the Caribbean, particularly the general practice of line-item budgeting.