Panama 1

Slide1: 

Undertaking Health Sector Reform: The Case of Panama Xavier Coll Director Social and Human Development Department Latin America and the Caribbean Regional Office World Bank The Third Summit on International Managed Care Trends December 11, 1998

Context of Health Sector Reforms in Latin America: 

Context of Health Sector Reforms in Latin America Disparities in health status Changing epidemiological and demographic profile Drop in fertility rate Better treatment and prevention of infectious diseases Aging population High levels of health spending Unsatisfactory outcomes

Panama in Latin America: 

Panama in Latin America Population: 2,631,013 inhabitants. Main cities: Panama and Colon. Concentrate 75% of all economic activity Almost 4 of every 10 Panamanians are poor. Urban areas: 2 of every 10. Rural areas: 6 of every 10.

Panama: Overall Indicators: 

Panama: Overall Indicators Source: World Development Report 1998/99

Disparity: Health Expenditure and Infant Mortality: 

Disparity: Health Expenditure and Infant Mortality

Panama: Intra-Country Disparities: 

Panama: Intra-Country Disparities IMR is 2.5 times higher in the poorest region than in the richest region. 98% of women in urban areas give birth in health institutions as compared to 32% in indigenous areas. 85% of those in the top income quintile seek care from the health system as compared to 60% of those in the bottom quintile.

Changing Epidemiological Profile: 

Changing Epidemiological Profile BOD in LAC. Females BOD in LAC. Males Comm., matern., perin., & nutric. Cond. Non Comm. Injuries.

Slide8: 

Comparative per Capita Health Expenditure (1994)

High Level of Health Expenditure: 

High Level of Health Expenditure

Health Care Expenditure - 1995 (percentage of GNP): 

Health Care Expenditure - 1995 (percentage of GNP)

Public and Private Share of Spending in Selected LAC Countries (1995): 

Public and Private Share of Spending in Selected LAC Countries (1995)

Public and Private Share of Spending (1995): 

Public and Private Share of Spending (1995)

Allocation of Public Health Spending - 1995: 

Allocation of Public Health Spending - 1995 Public-Private share

System Fragmentation: 

System Fragmentation MOH Social Security Private Sector (ability to pay) Poor Middle Income Rich Poor

System FragmentationExpenditure per Capita in Panama: 

System Fragmentation Expenditure per Capita in Panama MOH Social Security Poor (US$146) Mid. Income (US$207)

Ministry vs. Social Security Institute: 

Ministry vs. Social Security Institute MINSA Financed through General Taxation Unsalaried poor Covers 40% of population Primarily rural & indigenous population CSS Employer/employee contributions Salaried middle class Covers 60% of population Primarily urban population

Key Problems: 

Key Problems INEQUITY: Access, financing and utilization of services INEFFICIENCY: Fragmented Health System Duplication in service delivery Centralized decision making

The Objective of Reform: 

The Objective of Reform Integrated MOH and social security financing delivery financing/provider split corporatization of public sector and service delivery - Performance Agreements (PA) integration of hospital and out-reach services increased community participation in decision making Pooling of resources Purchasing Agency

Implementing the Reform Process: 

Implementing the Reform Process using the pilot approach creating a joint purchasing agency coorporatizing the public hospital

Law 27: Creation and Organization of CONSALUD: 

Law 27: Creation and Organization of CONSALUD Joint purchasing agency for MINSA and CSS Coordinates the financing, contracting and provision of services nationwide through the establishment of PAs with providers Financed by both MINSA and CSS

Law 28: Creation of the Management Board for the Hospital in San Miguelito: 

Law 28: Creation of the Management Board for the Hospital in San Miguelito THE HOSPITAL OF SAN MIGUELITO becomes a legal entity. MANAGEMENT BOARD composed of representatives from civil society and institutions (MINSA and CCS). Board responsible for: defining PA with CONSALUD. hiring and firing staff. PRIVATE PROCUREMENT REGULATIONS

The Pilot Approach: 

The Pilot Approach Why San Miguelito? Considerable share of the population (15%). Construction of new hospital. Technical and managerial capacity of regional managers and personnel. Government commitment.

San Miguelito Indicators: 

San Miguelito Indicators Population 396,018 2,631,013 Life Expectancy 75.5 73.4 Mortality Rate 3.6 4.2 Infant Mortality 13.6 23 Maternal Mortality 0.1 0.8 San Miguelito Panama

Health Reform Model: 

Health Reform Model MINSA CSS MINSA Providers CSS Providers Private Providers Finance Provision Purchase

Contracting Mechanisms: 

Contracting Mechanisms Contracts/PA will take into account: Definition and quantity of services to be provided. Price of the services contracted. Payment System related to activity, through UBA’s, and with budget ceilings

Challenges for the Future: 

Challenges for the Future Strengthening the institutional capacity of the MOH. Improving coordination between MOH-CSS. Expanding nationwide. Decentralization. Public providers autonomy. Adequate monitoring and supervision.