Влияние нового законодательства об обязательном медицинском страховании на деятельность страховых медицинских организаций
In the context of global efforts to move towards universal coverage in health systems, this report reviews health financing reforms in the Republic of Moldova and looks in particular at how the population´s access to health services has been affected. In 2004, as has been widely documented elsewhere, wholesale reforms were made to the way in which government funds were used to fund health services, shifting the system overnight from a highly fragmented and inflexible one, to one in which funds for the health sector were pooled nationally, allowing improved risk-sharing as a result of greater flexibility to allocate funds in line with health needs. A new source of funding in the form of a payroll tax for health was also introduced directly leading to a growth in total levels of government health spending. A second phase of reforms starting in 2009 addressed the issue of gaps in population coverage under mandatory health insurance, with legislative measures taken to ensure that all citizens of Moldova had access to primary health care, and to ensure that the poor receive subsidized health insurance. Fiscal constraints have limited the full implementation of these reforms however. Moldova has shown that it is prepared to tackle difficult policy issues head on and has articulated clear goals for the sector. In particular, the Roadmap “Accelerating Reforms: addressing the needs of the health area through investment policies” approved on 1 March 2012, lays a clear agenda for the next phase or priority reforms focusing on principally on service delivery reorganization but also on health financing. This is the correct focus given that progress on a number of priority indicators such as equity in access to services and financial protection has been limited in recent years. This report summarizes the main impact of health financing reforms to date and agrees with the Roadmap about the major challenges for the coming decade, in particular the need to address inefficiencies in service delivery, but also to ensure that the close link between guaranteed benefits and available funding is maintained in future policy decisions.
To compete on value providers must embrace a series of strategic and organizational imperatives. How can health care providers create more effective strategies and improve their performance? The starting point for strategy is to define the right goal. For every health care provider, the primary goal must be excellence in patient value. Value is the health outcomes achieved per unit of value compared to peers. A provider's size, range of services, reputation, and whether it earns a comfortable operating surplus are secondary. Unless a provider is delivering value to the patients it serves, it is failing at its fundamental mission even if it is financially successful. A provider that delivers superior patient results will be in a position to prosper even in the current system.Patient value can only be measured at the level of medical conditions, and assessed relative to peers. Competence alone is not enough. A provider must be able to achieve results that compare favorably to others that provide similar services.Excellent value in some services does not offset mediocrity in others. Patients, not to mention the entire health care system, are not well served if providers maintain even one service line in which they do not achieve results equal to or better than peers. In value-based competition, excellence, not breadth or convenience, should shape the choice of services by providers and the overall configuration of the health care system. While the goal of patient value may seem self-evident, goal definition in health care delivery has been clouded by a variety of factors. Financial viability often appears as an important goal. But financial results are an outcome, not the goal in and of itself. A comfortable operating surplus cannot offset mediocrity in serving patients. In a value-based system, as we will discuss, excellent results will lead to more patients, greater efficiency, and higher margins.The starting point for developing strategy in any field is to define the relevant business or businesses in which an organization competes. Health care delivery is no different. Health care providers do not think of themselves as businesses, but they are in the business of providing services to patients.