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Viorel Soltan, MD, MBA, MPH Center for Health Policies and Studies (PAS Center)
The Players
players in the healthcare system includ care insurers, providers, government agencies, pharmaceutical and biotechnology companies, diagnostic service providers, medical producers, drug distributors, professional associations as well as patient groups and non-governmental organizations
Ministry of Education is responsible for the provision of undergraduate medical education for health services staff The Ministry of Health oversees the content of undergraduate education
It is a single purchaser of health care services in Moldova NHIC is a government subordinated agency consisting of an Administrative Council and Executive Board The Administrative Council is the supreme body of the NHIC, consisting of fifteen members, including representatives of parliament, Presidents Office, government (MOH, Ministry of Finance, and Ministry for the Economy), National Confederation of Employers, trade unions, physicians and patient organizations
Preventive medicine institutions maintain a vertical hierarchical structure and are accountable to the MOH through the National Centre for Preventive Medicine There are 36 branches in each district and municipality which are responsible locally for implementing standards and guidelines for environmental health, communicable diseases and occupational health The NCPM is also in charge of immunization.
Emergency services also maintain a hierarchical structure and are accountable to the MOH through the National Center for Emergency Medicine It has four emergency medicine stations covering their specified zones (Central, North, South and Gagauzia) contract with the National Health Insurance Company for funding In addition to the four zonal emergency stations, there are 43 emergency sub-stations in each of the district, municipality and other autonomous units
The Nurses Association of Moldova was founded in 1994 as a nongovernmental professional organization It is a dynamic organization, affiliated with the European Nursing Forum There are also a number of professional medical associations such as the Association of Surgeons, the League of Physicians and the Family Medicine Association The Sanatatea Trade Union for medical personnel is also active and plays an important role in negotiating salary scales
Central Government Ministry of Health Ministry of Interior, Defense, Justice etc. Regional Emergency Health Stations Municipal hospitals Family medicine centers District health authority District hospitals Family medicine centers National Center for Preventive Medicine Other republican hospitals District preventive medicine offices Mother & child health, oncologic, cardiologic, neurologic, tuberculosis and lung diseases centers, infection diseases, clinical hospital etc.
The payers
in health care, payers generally refer to entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other thirdparty payers, or health plan sponsors (employers or unions).
* Mosby's Dental Dictionary, 2nd edition.
Financial flows
GENERAL POPULATION
General taxation
Out-of-pocket payment
Preventive medicine
Equity in health
It is a key performance measure: payments should be progressive, with richer households paying proportionally more than poorer households In 2004, average direct household expenditure on health for the poorest 20 percent of the population fell 21% in real terms compared with 2003 The share of out-of-pocket payment for health has fallen from 51.5% in 2003 to 42.3% in 2005, for both official and unofficial payments
The transformation of the system of health care financing was smooth, and the provision of medical services was uninterrupted Public funding of health care increased by 19 percent in 2004 in real terms, and by 16 percent in 2005 Reforms have increased the stability of public funding for health care The achievement of a real balance between state guarantees of free health care and their public funding
* Shishkin, Kacevicius et al. 2006
Salary increases The possibility of earning salaries based on the real volume and quality of their work
Improved accessibility of emergency prehospital and inpatient care for the insured (data on out-patient care not reliable enough to draw conclusions) Decrease in the magnitude of informal payments
Future developments
Over the past five years, the Republic of Moldova has made significant progress in reforming the health sector The first phase of reforms was driven by financial crisis in the sector which forced local governments to close small district hospitals and reduce the number of health care personnel The second phase has been largely driven by the introduction of mandatory social health insurance and the commensurate increases in health financing With health spending at nearly 10% of GDP, it is critical to introduce a new phase of reforms in order to make gains in efficiency and quality