Infrastructure Development for

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Infrastructure Development for Strengthening and
Restructuring of Healthcare Services Financial
Management in Turkey Prof. Dr. Mustafa Özmen
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Agenda

• Some Figures About Turkey
• Transformation in Health Programme
• The Projects
• Project I Objectives,Outcomes
• Project II Objectives and Expected Results

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Some Figures about Türkiye...
Population 72,974,927 (June 2005
est.) Area 780,580 sq km GNP Per Capita 4,828
USD (2005)
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Total Health Expenditures
Health Expenditures (2005) US GNP 344
Billion Total H.E. 23 Billion Total H.E./GNP
7,18 Per capita 320 US
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Per Capita Health Expenditures
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Distribution of Health Expenditures
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Sources of Financing
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The Health Transformation Programme

• is the national strategy for health reform.
• The reforms envisage
• Streamlining the health financing system
• Increasing managerial autonomy of public-sector
  providers
• Integrating primary care through systematized
  family medicine
• Eliminating fragmentation of policy
  responsibilities

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The Health Transformation Programme
Universal Health Insurance 01/01/2007
Financing Side
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The Health Transformation Programme
Provision Side
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The Health Transformation Programme
New System as of Jan, 2007
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The Projects ...

• Hacettepe University has been assigned the task
  of conducting research projects to assist the
  transition to the envisaged system and provide
  the related trainings and maintenance mechanisms.
  The current projects are
• Infrastructure Development for Strengthening and
  Restructuring of Healthcare Services Financial
  Management in Turkey
• Infrastructure Development for Healthcare
  Services Payments by Universal Health Insurance
  System

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Main Stakeholders of the Projects

• Financer of the Project
• Ministry of Finance
• Owners of the Project
• Ministry of Finance
• Ministry of Health
• Ministry of Labor and Social Security
• Manager of the Project
• Hacettepe University

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Coordination

• A committee consisting of representatives from
  Ministry of Finance, Ministry of Health, Ministry
  of Labor and Social Security, Hacettepe
  University was established.
• The Project activities are coordinated by
  Hacettepe University.
• Hacettepe University established a Project
  Coordination/Monitoring Unit.

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Organization
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The Project...

• Conducting research and development studies in
  order to
• to provide tools for the cost control of health
  care services
• to improve health care financial management
  methodologies for health care institutions
• to enhance governmental expertise in health care
  budgetary control...

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Components of the Project

• Restructuring of the Fee-For-Service Payment
  System (BUT) 15 months
• Development of a Pilot Prospective Payment and
  Budgeting System Based on Diagnosis Related
  Groups (DRGs) 19 months
• Development of Infrastructure for Drugs and
  Medical Material Management 18 months
• Initiated in May 2005...
• To be completed by 31 December 2006

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Component A, the objectives...

• Restructuring of Fee-for-Service Payment
  System
• Improvement of the current fee-for-service
  payment system (BUT) in view of international
  standards, and establishment of required
  information infrastructure for running the
  system.

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Outcomes, Component A...

• The health care services list in within the BUT
  were revised.
• A Coefficient and Conversion Factor System
  based on relative values of services was
  developed based on an analogous FFS schedule.
• Appropriate medical and administrative rules
  were developed so as to prevent excess
  utilization and billing of diagnostic procedures
  in the BUT.
• The rules for payment of health care services
  within the BUT are redefined for processing by
  the information systems.

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Common Terminology, LanguageTerminology Manager
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Revised BUT RVU
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Revised Electronic BUT
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Revised Electronic BUT
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Revised BUT Draft
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Revised Electronic BUT RuleBase
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Outcomes, Component A...

• A Simulation System for analysis and estimation
  of the effects of proposed health care services
  fees and pricing system is developed.
• The other payment categories such as
  pharmaceuticals, orthesis, prosthesis and medical
  supplies are classified in accordance with the
  international standards.
• Development of required infrastructure studies
  for the dissemination of four-digit ICD-10
  diagnostic code utilization in the BUT for
  diagnosis are completed.
• The necessary electronic sources and information
  systems to support the system are established.

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RuleBase Simulation System
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Component B, the objective...

• Development of a Prospective Payment and
  Budgeting System based on Diagnosis Related
  Groups (DRGs)
• Establishment of a prospective payment system
  for inpatient health care services, development
  of a national DRGs system, and setting up of an
  activity based budgeting system for health care
  institutions, and establishment of required
  information infrastructure for running the system
  to be developed.

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Outcomes, Component B...

• Pilot implementation of the selected DRG system
  at the Hacettepe University Hospitals has began.
• 8 different hospitals from different
  institutions and with different cost structures
  were selected to initiate studies for a national
  DRG system.
• Infrastructure building activities were
  conducted for the nationwide dissemination of
  four-digit ICD-10-AM diseases coding.
• Software and information systems are developed
  for data collection and analysis

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ICD-10-AM Browser
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DRG Data Collection with ICD Code Finder
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Component C, the objective...

• Development of infrastructure to facilitate the
  implementation of an improved electronically
  enabled national health supply chain management
  system including drugs, medical supplies and
  devices.

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Outcomes, Component C...

• The necessary standards for electronic handling
  of medical material management processes were
  determined and implemented.
• A National Drug Database which enables
  registration and tracing of necessary information
  of all registered drugs as well as regarding
  information on the companies those produce, trade
  or import/export these in Turkey is developed
  and necessary information systems to maintain
  the database are established.
• A National Medical Supplies and Devices
  Database which enables registration and tracing
  of necessary information on prices and technical
  specifications of all medical supplies and
  devices as well as regarding information on the
  companies those produce, trade or import/export
  these medical supplies and devices was developed.

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Proposed System
Stakeholders
Hospitals (Procurement, Stock, internal
consumption
Purchasers
Stakeholders
Reimbursement Agencies
National Data Bank
Stakeholders
Regulator Body (MoH)
Purchasers
Stakeholders
Physicians, patients
Purchasers
Stakeholders
Vendors
Stakeholders
Transporters
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National Medicine DataBank
6800 MedicineInternational Standard Rulebase
Database
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HUAP Web Portal
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National Medical Device DataBank
4.000 Company 200.000 Medical Devices
International Standard Rulebase Database
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Standards Being Used

• DIAGNOSIS AND PROCEDURES
• ICD-10
• ICD-10-AM
• ACHI
• ICHI
• DRUG MANAGEMENT
• EAN/UCC
• ATC (Anatomical, Therapeutic, Chemical)
• NFC (New Form Code)
• INN (International Nonproprietary Names)
• CAS (Chemical Abstract Registery Services)
• UoM (Unit of Measurement)

• MEDICAL MATERIAL MANAGEMENT
• EAN/UCC
• HIBCC (Health Industry Business
• Communications Council)
• UNSPSC (United Nations Standard
• Products and Services Code)
• GMDN (Global Medical Device
• Nomenclature)
• UMDNS (Universal Medical
• DeviceNomenclature System)

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Infrastructure Development for Strengthening and
Restructuring of Healthcare Services Financial
Management in Turkey - II Prof. Dr. Mustafa
Özmen MD
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The Project...

• to develop the necessary infrastructure enabling
  the Universal Health Insurance Agency (GSS) to
  provide accessible and good quality health
  services in an efficient and effective manner,
  preventing inadequate use of the respective
  health services...

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Components of the Project

• Development of necessary policies and instruments
  for GSS healthcare services payments 12 Months
• Analysis of cost differences in inpatient
  healthcare services by hospital types and regions
  based on DRGs 36 Months
• Building of a National Healthcare Providers and
  Physicians Database 18 Months
• Development of an organizational model for GSS of
  Social Security Institution and the
  infrastructure for institutional transformation
  of processes 12 Months (on going)

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Component D, the objective and expected outputs...

• Development of necessary policies and
  instruments for GSS healthcare services payments
• Appropriate purchasing models to preserve the
  actuarial balances of the institution will be
  identified
• Contract models to be concluded with provider
  agencies will be determined and prepared
• Methods and mechanisms will be developed to
  monitor / audit payments and to investigate
  irregular implementations, fraud detection
  (neural networks)
• Transition plans for different payment mechanisms
  (2008-2015) will be prepared
• Incentive mechanisms will be developed based on
  healthcare services payments in order to support
  healthcare policies.

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Component E, the objective and expected outputs...

• Analysis of cost differences in inpatient
  healthcare services by hospital types and regions
• DRG-based clinical coding and costing studies
  will be conducted in 40 hospitals that are able
  to represent geographical distribution, distinct
  hospital types and various cost structures.
• A management information system will be
  established to ensure central compiling and
  analysis of DRG clinical coding and costing data
  so that necessary information will be obtained
  for management of healthcare services

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Component F, the objective and expected outputs...

• Development of a National Healthcare Providers
  and Physicians Database
• An information system for accumulating and
  updating the health care provider data will be
  developed
• The data base containing all the national
  healthcare providers will be established

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Component G, the objective and expected outputs...

• Development of the organizational structure and
  workflows for the new Universal Health Insurance
  Institution (GSS)
• Process design of GSS.
• Development of GSS Organization Model.
• Preparing functional requirements of GSS business
  processes and performing the functional design.
• Development of GSS institutional transition
  plans.
• Training of GSS teams.

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