1. Tuzla, september 2007. godine HEALTH CARE SYSTEM PLANNING Salihbašić Šehzada, dipl.ecc. Technical Training for Rehabilitation Center Managers Economy and Funding of Health Care Systems Health System Economies and Financing

2. The plan principally provides an outlook of the current organization and reflects the overall business strategy throughout the period of about five years; the detailed operative plan and budget are proposed for a period of one year. Strategy and plan refer to all aspects of business making. The approach applied in planning depends on activities and services provided (institutions, institutes and companies).

3. Health care planning system is under the influence of the following members: PARLIAMENT MINISTRY GOVERNEMNT PUBLIC HEALTH CARE SERVICE PROVIDERS HEALTH INSURANCE USER – CITIZEN

4. Planning in health care system is in integral connection between the buyer (insurant), provider (health care institutions), the user (insurees) and governments. Health care institutions Health Insurance Employers –insurees

5. 1.Planning health care Refers to assessment of the vital events and health of the population in future Refers to assessment of the vital events and health of the population in future Is professional controlling of the events Is professional controlling of the events Coordinating and directing the development towards the desired aim which is defined by health indicator, allocating investments in order of priority to the existing resources, training staff as needed, reducing communicable diseases through adequate sanitation Coordinating and directing the development towards the desired aim which is defined by health indicator, allocating investments in order of priority to the existing resources, training staff as needed, reducing communicable diseases through adequate sanitation

6. Aspects of planning in health care  planning individual activities  planning of the work for the individual working units  planning measures for solving of a specific health problem  planning health care for a specific location  planning health care for a specific area  planning human resources*  planning facility investment  planning scientific-research  planning health care measures as a part of the social-economic development  planning of the development of other health care-related sectors

7. Health care plan includes  the reached level of the health care  sustainable funds plan  funding sources  health care standards and norms Plans are made for the following periods  long-term strategic plans  mid-term plans  short-term plans and programs  operative quarterly plans

8. STAGE ONE - preparation stage (making decisions about plan preparation, developing expert and analytic file material and developing guidelines and policies). FB&H and Tuzla Canton experiences STAGE TWO – adjustment stage (health care needs and demand analysis, analysis of the available resources, identifying priorities) STAGE THREE- adopting plan (developing the plan draft, proposal, adopting plan and obtaining consent by the governing authorities, governments and parliament) STAGE FOUR – health care implementation (implementation of the planned activities) STAGE FIVE – evaluation (evaluation using adequate methodology) Stage planning

9. List of indicators for health care planning 1.information about the area 2.demographic profile of the area 3.economic potential of the area 4.ecologic factors 5.health of the population 6.health service capacities 7.health care means and plan funding 8.data sources Limiting planning factors: 1.unlimited needs for health care 2.limited funds allocated to the health care 3.long-term facility building 4.long-term education

10. Units of long-term planning in health care 1.the number of MD places in planning health care 2.the number of MD places in specialized institutions 3. the number of other health workers 4.the number of hospital beds 5.the number of dentists and pharmacists 6.specified-purpose allocations  operating expenditures  facility and equipment investments

11. HEALTH CARE PROGRAMMING Represents detailed quantification and qualification of plans for the health care service development. Health care service development program – the network  development program  investment program  project document program  individual stage development program  equipment acquisition program  staff training program

12. Health standard is agreed or planned capacity and structure of health care services per user. Health standard represents a basis for planning and programming for health care, as well as for evaluation of the quality and the conducted measures of the health care. It is used to improve work programs and available funds allocation; it is an important tool in management of the health policy and direction of the health care development. Health standards can be divided into several groups: With respect to the levels at which they are being established: 1.state standard 2.canton standards 3.municipal standard 4.local community standards and 5.health care organization standards

13. With respect to the components they are composed of: 1.health care program 2.secondary health care 3.healthcare with precise differentiation 4.Medicines 5.social and health care activities 6.health promotion With respect to the means of expressing health standard: 1.natural indicators (physical capacity) 2.monetary value With respect to the methods by which the health standard is established: 1.method of comparison 2.empirical method 3.normative method 4.method of description

14. The health care quality standard is defined by nomenclature and description of health care services, and ways and circumstances under which these services are provided. Denominator of the health standard is the population or a particular group: With regards to the physical capacity health standard in health care programming represents: 1. general health care = 5,10 services per user 2. health care for children aged between 0 and 6 = 11,30 services per user 3. health care for school children and the young = 8,79 services per user 4. health care for workers = 14,60 services per user 5. dental health care = 3,30 services per user

15. Norms are measures which set maximum allowed consumption of time, space, equipment and material needed for the work of experts. Norms in terms of health care services represent objectively conditioned amount of work, material, equipment and staff needed to ensure health care service execution and health care program implementation. (Ćatović) Norm sets the amount of time, space, equipment, expendable supplies, as well as work by experts of different profiles, needed for completion of a standard procedure. Norm is scientifically established and represents a desired aim which is to be achieved in a certain period of time (eg. Hygienic norms = the allowed amount of additives in food, epidemic norms = immunization capacity, hospital treatment norms) Norms are indicators of quality and quantity of the health care.

16. There are several types of norms: 1. medical staff 2. Equipment 3. space capacity 4. Expenditures 5. medical and non-medical work 6. nomenclature and norms related to the duration of medical services Norms vary with respect to the activity they refer to: 1. norms in health care programming 2. norms in secondary health care 3. norms in highly differentiated health care

17. Health care service activity organization includes:  basic activities set by the health care program  work operations  the number of examinations, services, procedures (specified by types)

18. HEALTH CARE PLAN EVALUATION Evaluation is the process of the assessment of realization of the aims defined in the plan, activities of the plan and adequacy and efficiency of the plan. The aim of the evaluation is to determine the contribution of the health care in protection and improvement of the people’s health. Evaluation includes: Evaluation includes: 1. Efficacy: assessment of the results achieved and the desired aim 2. Effectiveness: assessment of the funds allocated to the activities carried out in realization of the achieved aims 3. Quality of service: assessment of the extent to which the planned services are in accordance with the adopted technical standards 4. Adequacy: assessment of the extent to which the health care services meet the priority health care needs of the population 5. Expeditiousness: assessment of the speed of decision making and time economizing 6. Flexibility: assessment of the adaptability of the health care to the conditions of the changes in health care needs

19. Evaluation includes cost-benefit analysis and cost- effectiveness analysis COST – BENEFIT ANALYSIS – CBA Economic analysis of cost and benefit including alternative solutions with the following aims:  Determining which solution or combination of solutions, contributes the most to achieving aims, with invariable investments  Determining the profit which could be expected, from investments, and with minimum investments CBA is used as a tool in the selection of the stated aims and the assessment of the importance of individual aims in health care.

20. COST – EFFECTIVENESS ANALYSIS – CEA It is a comparison between alternative interventions, for which the costs are measured in monetary terms, and the effects (results) which are measured in non-monetary terms:  decrease in morbidity and mortality rates  the number of lives saved  the number of symptom-free days experienced by a patient  the mm Hg reduction in diastolic blood pressure blood pressure