Transplantation in Macedonia

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Transplantation in Macedonia challenges in
program financing and budgeting

• Maja Parnardzieva Zmejkova, MA - HIFM CEO

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Contents
Health Insurance Fund
1
Transplantation prices and contracts
2
Action Plan
3
3
Steps in Developing
4
4
Conclusion
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5
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Republic of Macedonia

• Population 2.06 million citizens
• HIF insured population 1.8 million citizens
• Area 25 713 km2
• GDP in 2010 9.1 billion USD
• Government healthcare insurance fund (4.6 of GDP)
  
• Life expectancy at birth
• Men 73 years
• Women 77 years
• Mandatory health insurance system
• Insurance premium stipulated by law (7.3 from
  the gross salary)

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Health Contribution Rate

• Rate for employed persons is 7,3 (0,5) from
  gross salary

Source WHO
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Cross country comparison of total public health
expenditures to GDP
Source WHO (2010)
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Health System Institutions

• The Ministry of Health creates the health policy
  at the national level and legal health framework.
  
• Health Insurance Fund of Macedonia is an
  exclusive provider of the compulsory health
  insurance. The Fund is defined as a purchaser of
  health services provided by the health care
  network.
• The health care network consisted from public and
  private health providers

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Health care network

• The health care network is consisted from the
  public and private health providers who negotiate
  the delivery of their health services at the
  primary, secondary and tertiary levels.
• Primary HC - 2646, private health providers
• Secondary HC 207, private and public health
  providers
• Tertiary HC 33, public health providers

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Health Insurance Fund
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Health Insurance Fund
Transplantations 2 mil EUR
Dialysis 14 mil EUR
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Dialysis

• 1,399 patients
• 16,178 treatments p.a.
• 14 mil EUR p.a

Centers for dialysis in Macedonia
Distribution of patients in 19 dialysis centers
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DRG Prices

• 2010 and 2011
• Analysis of the transplantation surgery with the
  clinics and increased prices
• A01Z Transplantation of pancreas 10,380 EUR
• A07Z Alogenic Transplantation of Bone Marrow
  12,400 EUR
• A08B Autologic Transplantation of Bone Marrow
  8,700 EUR
• A09A Transplantation of kidney with pancreas
  15,900 EUR
• A09B Transplantation of kidney w/out pancreas
  11,200 EUR
• Currently
• Prepared new DRG prices for the associated
  surgery
• A10Z Transplantation of cornea 1,140 EUR
• A11Z Donor preparation, multiorgan and tissue
  explantation 5,170 EUR
• A12Z Donor preparation and multiorgan
  explantation 4,900 EUR
• A13Z Donor preparation and organ explantation
  5,035 EUR
• A14Z Donor preparation and cornea explantation/
  eyeball one and/or both 255 EUR
• A42Z Serologic analysis of donor organs/tissues
  205 EUR

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Dialysis vs Transplantation

• Dialysis price 80 EUR
• One patient on dialysis annually
• 12,400 EUR
• Transplantation price
• 11,200 EUR

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Transplantation and Health Insurance Fund

• Current
• Waiting list for Living Donor kidney
  transplantation 32 persons
• Non existing Deceased Donor transplant program
• In 2011 there were 32 transplantations in RM
• 10 - kidney transplantation, o/w 2 children
• 1 - children liver transplantation
• 22 - bone marrow transplantation

• Up coming
• Establishing national program in transplantation
• National registry for donation and waiting list
  for kidney transplantation
• Developing Donation from Deceased Donors
• Transparent waiting list for kidney
  transplantation from living donor
• Program for permanent education

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Conditional Contracting

• For surgery
• Clinic for Urology
• Clinic for Children Surgery
• Clinic for Hematology
• For HLA analyses
• Institute for Transfusion
• Institute with the Medical Faculty

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Action Plan 2012

• Change in the Law for transplantations and
  enacting 13 bylaws
• Appointing the national coordinator
• Preparation of clinical pathways
• Accreditation of laboratories
• Creation of donors registry
• Software for the transplantation waiting list
• Education
• National Campaign for Transplantation

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Coordination
Action plan
Ideas and joint work
NGO, Religious and political authorities
Public health care institutions and Experts
Ministry of Health
Fund
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Expected results

• Enabled legal framework
• Adequate prices
• Coordinated clinics
• Increased number of transplantations
• Creation of the donors registry
• Joining the Eurotransplant
• Cooperation with other countries

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Conclusion

• Acquisition from Transplantations
• Quality of life - long-term survival with a high
  quality of life
• Economic benefit - national health care budget
  expenditure savings.
• Organ transplantation is the most cost-effective
  and humane treatment for end stage renal failure.

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Most valuable sentence

• The most valuable sentence in Croatian donation
  network
• Sve što može poslužiti životu, grijeh je
  pokopati.
• Pope Johan Paul II

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THANK YOU FOR YOUR ATTENTION
Website www.fzo.org.mk E-mail majap_at_fzo.org.mk