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 !