1. 15 June 2011 Transplantation in Macedonia – challenges in program financing and budgeting Maja Parnardzieva Zmejkova, M.Sc., CEO

2. 2 Contents Transplantation prices and contracts 2 Action Plan 33 Steps in Developing 44 Health Insurance Fund 1 Conclusion 35

3. 3 Republic of Macedonia Population: 2.06 million citizens HIF insured population: 1.8 million citizens Area: 25 713 km2 in 2010: $9.1 billion USD GDP in 2010: $9.1 billion USD Government healthcare insurance fund (4.6 of GDP) Life expectancy at birth: – Men 73 years –Women 77 years Mandatory health insurance system Insurance premium stipulated by law (7.3 % from the gross salary )

4. Health Contribution Rate Rate for employed persons is 7,3% (+0,5%) from gross salary Source: WHO

5. Cross country comparison % of total public health expenditures to GDP Source: WHO (2010)

6. 6 Health System Institutions  The Ministry of Health creates the health policy at the national level and legal health framework..  Health Insurance Fund of Macedonia is an exclusive provider of the compulsory health insurance. The Fund is defined as a purchaser of health services provided by the health care network.  The health care network consisted from public and private health providers

7. Health care network  The health care network is consisted from the public and private health providers who negotiate the delivery of their health services at the primary, secondary and tertiary levels.  Primary HC - 2646, private health providers  Secondary HC – 207, private and public health providers  Tertiary HC – 33, public health providers 7

8. 8 Health Insurance Fund

9. 9 Transplantations 2 mil EUR Transplantations 2 mil EUR Dialysis 14 mil EUR Dialysis 14 mil EUR

10. Dialysis 1,399 patients 16,178 treatments p.a. 14 mil EUR p.a Centers for dialysis in Macedonia Distribution of patients in 19 dialysis centers

11. 11 DRG Prices 2010 and 2011 Analysis of the transplantation surgery with the clinics and increased prices:  A01Z Transplantation of pancreas 10,380 EUR  A07Z Alogenic Transplantation of Bone Marrow 12,400 EUR  A08B Autologic Transplantation of Bone Marrow 8,700 EUR  A09A Transplantation of kidney with pancreas 15,900 EUR  A09B Transplantation of kidney w/out pancreas 11,200 EUR Currently Prepared new DRG prices for the associated surgery:  A10Z Transplantation of cornea 1,140 EUR  A11Z Donor preparation, multiorgan and tissue explantation 5,170 EUR  A12Z Donor preparation and multiorgan explantation 4,900 EUR  A13Z Donor preparation and organ explantation 5,035 EUR  A14Z Donor preparation and cornea explantation/ eyeball one and/or both 255 EUR  A42Z Serologic analysis of donor organs/tissues 205 EUR

12. Dialysis vs Transplantation Dialysis price 80 EUR One patient on dialysis annually 12,400 EUR Transplantation price 11,200 EUR

13. Transplantation and Health Insurance Fund  Current Waiting list for Living Donor kidney transplantation – 32 persons Non existing Deceased Donor transplant program In 2011 there were 32 transplantations in RM: 10 - kidney transplantation, o/w 2 children 1 - children liver transplantation 22 - bone marrow transplantation  Up coming Establishing national program in transplantation National registry for donation and waiting list for kidney transplantation Developing Donation from Deceased Donors Transparent waiting list for kidney transplantation from living donor Program for permanent education 13

14. 14 Conditional Budget Financing and Contracting 2012 For surgery- RECORD 45 transplantations  Clinic for Urology- min 20 kidney transplantation  Clinic for Children Surgery -3 kidney and 2 liver transplantation  Clinic for Hematology-min 20 bone marrow transplantations  Additional funds for extra transplantations For HLA analyses  Institute for Transfusion – funds for new 200 donors  Institute with the Medical Faculty-funds for 500 new donors

15. 15 Action Plan 2012  Change in the Law for transplantations and enacting 13 bylaws  Appointing the national coordinator  Preparation of clinical pathways  Accreditation of laboratories  Creation of donors registry  Software for the transplantation waiting list  Education  National Campaign for Transplantation

16. 16 Coordination Action plan Ideas and joint work Fund Ministry of Health Public health care institutions and Experts NGO, Religious and political authorities

17. 17 Expected results Enabled legal framework Adequate prices Coordinated clinics Increased number of transplantations Creation of the donors registry Joining the Eurotransplant Cooperation with other countries

18. Conclusion  Acquisition from Transplantations  Quality of life - long-term survival with a high quality of life  Economic benefit - national health care budget expenditure savings. Organ transplantation is the most cost- effective and humane treatment for end stage renal failure. 18

19. Most valuable sentence 19 The most valuable sentence in ``Croatian donation network`` »Sve što može poslužiti životu, grijeh je pokopati.« „ Се што може да послужи на животот, грев е да биде закопано„ „All that can be used for a life, it is sin to be buried” Pope Johan Paul II Website: www.fzo.org.mkwww.fzo.org.mk E-mail: majap@fzo.org.mkmajap@fzo.org.mk

20. THANK YOU FOR YOUR ATTENTION 20 Website: www.fzo.org.mkwww.fzo.org.mk E-mail: majap@fzo.org.mkmajap@fzo.org.mk