- Количество слайдов: 42
PHAZ CONFERENCE 18 JUNE 2015
Theme • Surviving with Adversity
Topic SURVIVING WITH ADVERSITY IN THE HEALTHCARE SECTOR
By SHYLET SANYANGA
Presentation Outline • • • Introduction The environment Survival techniques Cutting Costs Recommendations Conclusion
Introduction • Adversity is a state or instance of serious or continued difficulty or misfortune. (Wikipedia)
Introduction…Contd • Even in good times, there's enough difficulty to go around for everyone. But the last few years' economic problems have made for more adversity than many have seen in a lifetime. • The dilemma is that healthcare is an essential service. This makes surviving with adversity more challenging.
The environment • The economy and liquidity crunch affecting the country has had dire consequences on both Funders and providers. • Delayed payments by funders mainly as a result of delayed subscriptions payment. • Non- payments by debtors for both funders and providers resulting in bad debts. • Strained cash flows for both funders and providers.
The environment. . . Contd • In 2014 AHFo. Z lost 4 members due to viability challenges. • Low utilisation patterns. • Some people opting to consult faith and traditional healers or simply stay home. • Some facilities in need of upgrading to suit modern standards and need equipment replacement.
The environment. . . Contd • Increasing claims costs despite shrinking membership (10% of population). • Claims paid trend: • $155 m in 2011 • $174 m in 2012 • $342 m in 2013 • Hospitals taking the “Lion’s share” though this is said to be insufficient for their needs.
Environment. . . Contd
Environment. . . Contd • Statistics show that hospitals are currently taking at least 25% of total claims paid. • Hospitals report that they are surviving on very tight budgets despite the “Lion’s share” • Funders looking at the 25% already going to hospitals and are concerned about sustainability given any increases. • Hospital bills are usually paid in full including drugs.
Environment. . . Contd • In 2013 AHFo. Z members collectively paid $341 657 735. 04 • 92, 193, 449. 47 (27%) went to Private hospitals.
20, 742, 727. 99, 6. 1% Claims 2013 36, 610, 368. 26, 10. 7% 21, 414, 260. 55, 6. 3% 42, 515, 953. 67, 12. 4% Out -Patients services/ including Industrial Clinics 23, 397, 536. 13, 6. 8% 33, 886, 145. 11, 9. 9% Radiology Pathology Surgical/ Anaesthetic Services Government & Mission Hospitals Private Hospitals & Nursing Homes Ancillary services & Ambulances Foreign treatment Dentists Drugs 47, 124, 771. 59, 13. 8% Optical 3, 414, 656. 92, 1. 0% 13, 343, 641. 28, 3. 9% 92, 193, 449. 47, 27. 0% 7, 014, 224. 07, 2. 1%
Environment. . . Contd • Fee increases require subscription increases. • Members are struggling with subscriptions at current levels. • Changes that have the effect of increasing costs need to be tested for affordability at prevailing subscription levels. • Movement of non-chargeable items to chargeable list increases costs hence need for careful assessment.
Environment. . . Contd • This applies to some amendments that have the same effect. • Some funders have recently adjusted subscriptions for some packages to catch up with costs under those packages. • Some Funders have gone into service provision to provide an option for their members.
Environment. . . Contd • AHFo. Z does not condone directing of patients to funders’ facilities as this is illegal. • Medical aid fraud is on the increase and is contributing in pushing up costs. • Applications for AHFo. Z payee numbers continue to increase. • This means more players coming to share from a shrinking cake.
Environment. . . Contd • Total AHFo. Z payee numbers from database is 6000 though 2000 are thought to be in the diaspora while 4000 are active in Zimbabwe. • 150 private hospitals have AHFo. Z payee numbers and are active. • In 2014 hospitals’ registrations increased by 9% while GP registrations increased by 18%.
Environment. . . Contd 250 Total No. of Registrations 200 150 Total No. of Registrations 100 50 13 20 12 20 11 20 10 20 20 09 0
Environment. . . Contd 90 80 70 60 50 40 30 20 10 0 Harare Mashonland East Bulawayo Manicaland Midlands Masvingo Mashonaland Central Matebeleland North Matabeleland South
Survival techniques “The capacity to respond quickly and constructively in a crisis—can be hard to master when a manager is paralyzed by fear, anger, confusion, or a tendency to assign blame”.
Survival techniques. . . Contd • Given the harsh economic environment the starting point is to explore areas where costs can be cut. • Elimination of waste can bring amazing results. • Review the supply chain procurement tendencies for goods and services e. g. consumables and staffing?
Survival techniques. . . Contd • In the healthcare sector, costs cannot be passed on to the consumer as health is an essential commodity. • Review operations in line with emerging trends e. g new competitors, new technologies and changing consumer habits which may disrupt established practices.
Survival techniques. . . Contd • Make the appropriate corrections. “The alternative to grime-encrusted lenses isn’t rose -tinted glasses: It’s a healthy dose of reality”.
Cutting Costs • Under the circumstances, cutting costs is one of the most beneficial strategies. • Identify areas of wastage. • Look at staffing and procurement Policies. • Review and monitor usage of drugs and consumables. • The exercise to identify potential areas of cutting costs may require consultants.
Recommendations • Review procurement practices. • Look at the value chain and identify opportunities for mergers, integration, e. g vertical, forward or backward? • Identify waste and eliminate waste in order to reduce operating costs. • Be innovative e. g explore concept of Group practice, in-house service providers and Partnerships.
Recommendations. . . Contd • Review reimbursement models to global billing for example. • All parties should think long term and jealously guard the dollar being lost through medical tourism. • Need to get the fundamentals right.
Recommendations. . . Contd • Collectively address underlying issues driving costs. • Let us create our own spider web by promoting a “buy Zimbabwe healthcare” Agenda. • We are Zimbabweans first then AHFo. Z and PHAZ later.
Conclusion • With 80% of service providers’ income coming from funders, it is apparent that the 10% insured population cannot sustain the healthcare sector.
Conclusion. . . contd • Uncontrolled costs will result in adverse selection which will inevitably affect providers resulting in a total collapse of the private sector. • The macro economical fundamentals need to be right in order for the sector to thrive. • Under the circumstances, survival lies in the ability to adapt and avoid being extinct like the mammoth.
Conclusion. . . contd • The woolly mammoth was well adapted to the cold environment during the last ice age. It failed to adapt to climatic changes and it became extinct. • Need to embrace the “New Normal” (Dr. Mangundya RBZ) and be innovative.
END • Lastly - let us Learn From Adversity - “Never give in, never, never!” (Sir Winston Churchill).
I THANK YOU