Health Care Waste Management (HCWM) Financing of the Future HCWM System

1
Health Care Waste Management (HCWM)Financing of
the Future HCWM System

• Ohrid,
• Ana Petrovska

2
Present Tariffs

• Tariff paid for collection of HCW in the Skopje
  area is MKD 56 (0,9 Euro) per kg excl. VAT
  (18).
• Tariff paid for delivery of HCW at the gate at
  Drisla Landfill is MKD 45 (0,75 Euro) per kg
  excl. VAT (18).
• Tariff paid for collection of yellow HCW boxes
  (25 litres) from private General Practitioners
  and ambulatories, etc. in the Skopje area, is
  MKD 385 (6,4 Euro) per box (3 kg), or 128 MKD per
  kg. (2,0 Euro) excl. VAT (18).
• Tariff paid for collection of yellow HCW boxes
  (25 litres) from private General Practitioners
  and ambulatories in Kumanovo MKD 130 (2,1 Euro)
  per kg excl. VAT (18), to be paid to the
  Kumanovo Health Centre, which is organizing
  collection and transport to the "Drisla" landfill
• Transparency of setting the tariffs is not
  sufficient

3
Sources of Financing

• Major investments in a new HCWM system can not be
  made based on funds from the Health Insurance
  Fund, due to its accumulated debts.
• Financing directly from the state budget via MoH
  is considered, in combination with
• Contributions from MEPP on specific environmental
  programmes,
• Soft loans based on Government guarantees,
• International grants, etc

4
Future Tariffs

• Future tariff for HCWM should incorporate the
  following costs
• The costs of establishing and maintaining proper
  storage facilities at general hospitals and
  health centres,
• Costs for purchase, maintenance and operation of
  a sufficient number of small vans or trucks to be
  used in the primary collection service,
• Other internal costs such as investments in small
  plastic containers on wheels, receptacles, etc.
  and use of consumables in the form of plastic
  bags, sharps boxes, etc.
• Costs for the investments in the establishment of
  the final treatment facilities (e.g. three
  regionally based autoclaves) and associated
  operation maintenance costs

5
Responsibilities for Setting of Tariffs

• According to the Law on Waste the Operator of the
  disposal facility is in charge of setting the
  tariff
• The MEPP shall approve the tariff, taking care
  for the inclusion of all costs
• Tariff paid by the generator shall cover the full
  costs for the operation of the (regional) HCWM
  Systems
• Small generators shall pay to the regional
  centers also a margin for the internal
  collection

6
Financing of the Regional HCWM Systems

• Preparation of annual budgets on all costs
  related to the operation and maintenance of the
  regional system
• Determination of corresponding tariffs to be paid
  by medical waste generators being serviced by the
  system, and assuring approval of such tariffs
• Daily accounting/bookkeeping, and based hereon
  issuing of invoices at regular intervals to the
  medical waste generators being serviced by the
  system and assure that invoices are being paid
• Financing of regional offices and staff
  management
• Reporting of all relevant financial, technical
  and environmental aspects to the owners of the
  medical waste management system and to the
  responsible authorities (MoH and MoEPP).