Orthopaedic devices& Fair Cost recovery system
Experience of the Hô ChiMinh-City Hospital for Care & Rehabilitation of Professional Diseases
Patrick Le Folcalvez
Séminaire Handicap InternationalTananarive, Madagascar26 -29 Octobre 2015
Background
Decreasing of Viêtnam Government subsidies for Public Health ServicesDecreasing of Viêtnam Government subsidies for Public Health Services
Wide range of devices needed by wide range of disabilities Wide range of devices needed by wide range of disabilities
Economical improvements induce a demand for high-tech or comfort devices Economical improvements induce a demand for high-tech or comfort devices
PWDs have to participate more and more in the costs for rehabilitationPWDs have to participate more and more in the costs for rehabilitation
$$ ?
Challenges
Combine financial sustainability and fair access
Meet the needs of the PWDsMeet the needs of the PWDs
Rehabilitatio
n
HCM-City Orthopaedic department
No financial subsidies form Government No financial subsidies form Government
2 technicians 2 technicians
Employs :Employs :
1 bench worker 1 bench worker
1 administrator 1 administrator
1 part-time doctor 1 part-time doctor
1 part-time physiotherapist 1 part-time physiotherapist
Administrated by the HCM-City Health ServicesAdministrated by the HCM-City Health Services ……BUTBUT
HCM-City Orthopaedic department
Delivers :
Basic orthopaedic devices (polypropylene technology) Basic orthopaedic devices (polypropylene technology)
Orthopaedic devices with optionsOrthopaedic devices with options
Assistive devices made at the workshopAssistive devices made at the workshop
Commercial devices from local suppliersCommercial devices from local suppliers
Imported devicesImported devices
High tech orthopaedic devices High tech orthopaedic devices USER-CLIENT has the choice
Price policy
Calculation using ISPO method
+ 7,5 % for “Reserve fund” + 7,5 % for “Reserve fund”
+ 7,5 % for + 7,5 % for SOCIAL FUNDSOCIAL FUND
Price policy
Consequence :
Prices 20% - 30 % higher than in the other centers… Prices 20% - 30 % higher than in the other centers…
BUTBUT
Multidisciplinary service Multidisciplinary service
One-year guarantee on products One-year guarantee on products
=> “QUALITY APPROACH”=> “QUALITY APPROACH”
Recall system for follow-up Recall system for follow-up
Written report to prescription doctors Written report to prescription doctors
Social Fund… how it works
Clients who want options or high tech products are charged full price
Clients who request the basic are assessed through a “Social Clients who request the basic are assessed through a “Social questionnaire”questionnaire”
According to their social category, they get a discount ofAccording to their social category, they get a discount of
The discount is covered by the SOCIAL FUND The discount is covered by the SOCIAL FUND
The SOCIAL FUND is supplied with the 7,5 % of the products pricesThe SOCIAL FUND is supplied with the 7,5 % of the products prices
50 % (poor) 50 % (poor) 70 % (very poor) 70 % (very poor)
4%
2%
2%1%
7%
29%
17%
16%
11%
11%
Shoes
Ortho soles
Canes & crutches
Walking frames
Sport wheelchairs
Paraplegic wheelchairs
Quadraplegic wheelchairs
3 wheels motorbikes
Assistive devices
Repairs (wheelchair)
Results
Large range of products available :
32%
7%
5%
15%12%
3%
2%
8%
8%
5% 1%
2% Foot orthosis
Ankle-Foot orthosis
Knee-Ankle-Foot orthosis
Hip-Knee-Ankle-Foot orthosis
Corrective splints
Trunk corset
Cervical Collar
CP molded seat
AK Prosthesis
BK prosthesis
Finger prothesis
Foot prothesis
Ortho shoes
Ortho sole
others
Repairs
Orthopedic devicesOrthopedic devices
Assistive devicesAssistive devices
38%
34%
16%
2%
5%2% 3% Protective cushions
Modular "Jamie" cushions
Technical aids
Hand splint
Wheelchair gloves
Others
Repairs
Commercial productsCommercial products
Results
Large production enables to reach financial sustainability
… … and to maintain the SOCIAL FUNDand to maintain the SOCIAL FUND
-2000
-1000
0
1000
2000
3000
4000
Jan Mar May Jul Sep Nov
turn over
Approx profit and loss
Equity Fund
USD
18%
7%
10%
15%
50%
Public hospitals
Private hospitals
Media
Disability organisation
Word of mouth
Results
In one year, the department serves an average of 230 persons with Disabilities of various origins
35%12%
30%
23%
Congenital
Cerebral palsy
Disease
Trauma
……coming mainly from the metropoliscoming mainly from the metropolis
Others6%
HCM C ity64%
Southern region30%
……referred by : referred by :
23 % children 23 % children
Results
Notable positive social impact on 56 % of the beneficiaries of Notable positive social impact on 56 % of the beneficiaries of the poor categories the poor categories (assessed after 1 year)(assessed after 1 year)
The Social Fund supports 25 % of the beneficiariesThe Social Fund supports 25 % of the beneficiaries
4%
21%
11%
64%
70 % discount
50 % discount
External support
No support
11 % of the beneficiaries are supported by charity organization, 11 % of the beneficiaries are supported by charity organization, employer, insurance or responsible of accidentemployer, insurance or responsible of accident
Difficulties & challenges
The department is financially sustainable and accessible for the poorest PWDs….
BUTBUT … … with a limit of 36 % of its userswith a limit of 36 % of its users
Additional sources for the Social Fund (estimation US$ 3,000 /year) Additional sources for the Social Fund (estimation US$ 3,000 /year) are still necessary to completely are still necessary to completely break discriminationbreak discrimination
Difficulties & challenges
Internal management of the Social Fund, meaning :
Dependent Social FundDependent Social Fund
Risk of prioritizing financial income and neglect accessibilityRisk of prioritizing financial income and neglect accessibility
Social assessment made by a non-professional Social assessment made by a non-professional
Difficulty to approach private sponsors to complete the FundDifficulty to approach private sponsors to complete the Fund
Difficulties & challenges
Implement “Private-type management” in a Government structure, meaning :
Department closed on weekends, public holiday, Department closed on weekends, public holiday, and after 16:00 every day and after 16:00 every day
Heavy administrative procedureHeavy administrative procedure
Prices higher than in public workshopsPrices higher than in public workshops
No incentive for the persons who refer clientsNo incentive for the persons who refer clients
Necessary “Marketing”Necessary “Marketing”
THANKSTHANKSfor your attention !for your attention !