1. Orthopaedic devices & Fair Cost recovery system Experience of the HCM-City Hospital for Care & Rehabilitation of Professional Diseases

2. Background Decreasing of Government subsidies for Public Health Services Wide range of devices needed by wide range of disabilities Economical improvements induce a demand for high-tech devices PWDs have to participate more and more in the costs for rehabilitation

3. $$ ? PHCN Challenges Combine financial sustainability and fair access Meet the needs of the PWDs

4. HCM-City Orthopaedic department Opened in December 2003 No financial subsidies form Government 2 technicians Employs : 1 bench worker 1 administrator 1 part-time doctor 1 part-time physiotherapist Administrated by the HCM-City Health Services …BUT

5. HCM-City Orthopaedic department Delivers : Basic orthopaedic devices (polypropylene technology) Orthopaedic devices with options Assistive devices made at the workshop Commercial devices from local suppliers Imported devices High tech orthopaedic devices

6. Price policy Calculation using ISPO method + 7,5 % for “Reserve fund” + 7,5 % for EQUITY FUND

7. Price policy Consequence : Prices 20% - 30 % higher than in the other workshops… BUT Multidisciplinary service One-year guarantee on products => “QUALITY APPROACH” Recall system for follow-up Written report to prescription doctors

8. Equity 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 questionnaire” According to their social category, they get a discount of The discount is covered by the EQUITY FUND The EQUITY FUND is supplied with the 7,5 % of the products prices 50 % (poor) 70 % (very poor)

9. Results after 1 year implementation Large range of products available : Orthopedic devices Assistive devices Commercial products

10. Results after 1 year implementation Large production enables to reach financial sustainability … and to maintain the Equity Fund USD

11. Results after 1 year implementation In one year, the workshop served 223 persons with Disabilities of various origins …coming mainly from southern region …referred by : 23 % children

12. Results after 1 year implementation Notable positive social impact on 56 % of the beneficiaries of the poor categories The Equity Fund supports 25 % of the beneficiaries 11 % of the beneficiaries are supported by charity organization, employer, insurance or responsible of accident

13. Difficulties & challenges The workshop is sustainable and accessible for the poorest PWDs…. BUT … with a limit of 36 % Additional sources for the Equity Fund (estimation US$ 3,000 /year) are still necessary to completely break discrimination

14. Difficulties & challenges Internal management of the Equity Fund, meaning : Dependent Equity Fund Risk of prioritizing financial sustainability and neglect accessibility Social assessment made by a non-professional Difficulty to approach private sponsors to complete the Fund

15. Difficulties & challenges Implement “Private-type management” in a Government structure, meaning : Workshop closed on weekends, public holiday, and after 16:00 every day Heavy administrative procedure Prices higher than in public workshops No incentive for the persons who refer clients Necessary “Marketing”

16. THANKS for your support ! THANKS for your support !