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The contractual methodologies of mandatory health insurance services


Author: Damaşcan Ghenadie
Degree:doctor habilitat of medicine
Speciality: 14.00.33 - Social Medicine and Management
Year:2015
Scientific consultant: Constantin Eţco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 23 September, 2015
Approved by NCAA on the 19 November, 2015

Abstract

Adobe PDF document – 0.39 Mb / in romanian

Thesis

CZU 614.2+368.9.06 (043.2)

Adobe PDF document 5.39 Mb / in romanian
317 pages

Keywords

payment systems, healthcare, contract, effectiveness, P4P, DRG

Summary

Thesis structure: introduction, 6 chapters (including literature review, materials and methods of the research), conclusions and recommendations, bibliography including 312 titles, 10 annexes, 247 basic text pages, 31 tables and 42 figures. The results are published in 43 scientific papers, including four monographs.

Field of study: payment system for medical services in the MHI

The goal: developing new methodologies for purchasing medical services to enhance effectiveness of the contracting process of the medical institutions in the MHI

Objectives: Elaborating the concepts of purchasing and contracting the health services. Developing the methodology for contracting health services for start-up period of MHI. The impact analysis of using the method of payment "per capita" as the basic method for financing of the type of pre-hospital care. The development of prehospital services purchasing strategy for removing shortcomings payment "per capita", encouraging accessibility of these services and improving their quality. Developing the mechanisms of purchasing subsidized drugs in the MHI. Research the funding aspects of the hospital sector through the "per treated case” method. The argumentation of switching to forms of financing based on the complexity of the treated case. The development of the basic components of the DRG system for Moldova and development stages of its implementation. The impact assessment of the implemmentation of DRG payment mechanism (Case-mix). Scientific argumentation of the strategic directions of development of the payment system for medical services in the MHI.

Scientific novelty: For the first time there was made a complex study of the payment system used for the purchase of medical services in the MHI in Moldova, which has contributed to the development of the local market of medical services, developing and implementing mechanisms for contracting of health services highlighting deficiencies manifested in various development payment system for medical services and training mechanisms’ argument, the argument payment mechanisms in terms of widening the health security package, organizational and structural changes that occurred during the MHI.

Fundamentally new science and practice results obtained consist of scientific and methodological substantiation of the processes and tools used in purchasing health services, which considerably increased the effectiveness of the financing system of medical institutions, in order to contract them in the MHI.

Theoretical study. The research led to the development of health services contracting system during the MHI

The value of the work. The research results were used for the development of three decisions of the Government of Moldova and a number of orders of the Healt Minister and CNAM.

Implementation of the scientific results: The results of the study were used as a benchmark for the development and implementation of contracting medical and pharmaceutical institutions in the MHI. They also allowed the development of the purchasing strategy of medical services to encourage accessibility and quality, including payments for primary care and performance-based funding system complexity of the treated case in hospital care.