Medical HBC Services
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HOME-BASED MEDICAL AND SOCIAL CARE SERVICES ASSESSMENT IN THE REPUBLIC OF MOLDOVA Prepared by: Centre of Investigations and Consultation “SocioPolis” May 2018 CONTENT ACRONYMS. ........................................................................4 3.18. Suggestions and recommendations to Chapter II I.103 LIST OF FIGURES...............................................................5 LIST OF TABLES..................................................................6 IV. INTERNATIONAL HBC MODEL.S...............................105 LIST OF BOXES....................................................................8 4.1. Model of HBC services in Romania and the role ACKNOWLEDGEMENTS.. ....................................................9 of the local government.......................................106 EXECUTIVE SUMMAR.Y.. ...................................................10 4.2. Model of HBC services in Slovak Republic and INTRODUCTION.. ..............................................................26 the role of the local government in social HCB services.................................................................108 I. THE ASSESSMENT FRAMEWORK... ..............................30 4.3. Care provisions distributed directly to services’ 1.1. Overall and specic objectives................................31 beneciaries: Czech Republic................................111 1.2. Methodology of the assessment ............................31 4.4. Matrix on dependency rate systems in 1.3. Limitation of the assessment..................................35 Romania, Slovakia and Czech Republic ................115 4.5. Lessons learned ....................................................117 II. DESK REVIEW OF THE EXISTING 4.6. Suggestions and recommendations LEGAL FRAMEWORK ON HBC SERVICE.S.. .....................37 to Chapter IV. ........................................................126 2.1. Evolution of HBC services. .......................................38 2.2. Short review of the legal framework V. ASSESSMENT OF THE USE OF THE AVAILABLE for HBC services. .....................................................40 FUNDS AND POTENTIAL RESOURCES FOR HBC 2.3. Social HBC service...................................................43 SERVICES.. .......................................................................130 2.4. Medical HBC services. .............................................49 5.1. Available HBC service funds. .................................131 2.5. Integrated HBC services. .........................................55 5.2. Potential resources for HBC services. .....................132 2.6. Suggestions and recommendations 5.3. LPA budget potential and forecast........................132 to Chapter II. ..........................................................55 5.4. Share of the NHIC funds in the health system for HBC, potential and needs. ...............................135 III. MAPPING OF THE EXISTING HOME CARE 5.5. Social Insurance Fund, potential use for social SOCIAL AND MEDICAL SERVICE PROVIDERS HBC services.........................................................138 AND THE REAL NEEDS OF HBC SERVICE.S.....................57 5.6. Contribution from the clients................................139 3.1. Characteristics of HBC service providers ..................58 5.7. Contribution from the donors ...............................140 3.2. HBC service models ................................................62 5.8. Suggestions and recommendations to Chapter V. .141 3.3. Geographical coverage of HBC services. ..................68 3.4. Admittance of beneciaries to HBC service. ............70 VI. THE COSTS OF DELIVERY OF HBC SERVICE..S.. .......146 3.5. Characteristics of HBC beneciaries.........................71 6.1. Methodological approach.....................................147 3.6. Evolution of HBC beneciaries for 2014-2016.........77 6.2. Resources used to deliver HBC services. ................149 3.7. Types of HBC and their subservices. ........................78 6.3. The cost of delivery of HBC services. .....................153 3.8. Drafting the Individual Home Care Plan (IHCP). ......81 6.4. Cost of HBC versus cost of services provided 3.9. Human resources and continuous training .............82 in public facilities..................................................160 3.10. HBC services and specialists’ assessment.................83 6.5. Suggestions and recommendations to Chapter 6 .161 3.11. Development of partially paid and paid HBC services ...........................................................88 ANNEXES. ........................................................................164 3.12. Collaboration between institutions in providing Annex 1. The sample ......................................................164 HBC services ...........................................................92 Annex 2. Data about social and medical HBC service 3.13. HBC volunteering. ...................................................95 providers that participated in the assessmen.t...165 3.14. Switching from medical HBC to palliative care........96 Annex 3. Subjects tackled during HBC training, 3.15. Access to HBC.........................................................96 according to categories of providers.................169 3.16. The estimated number of people requiring HBC.....99 Annex 4. Summary of resources used for 3.17. Providers’ opinion regarding the improvement HBS service delivery. ........................................170 of HBC quality.......................................................101 03 ACRONYMS ABC method – Activity Based Costing Method ATU – Administrative Territorial Unit ATU Gagauzia – Autonomous Territorial Unit Gagauz Yeri CHIF – Compulsory Health Insurance Fund CPA – Central Public Authorities CSO – Civil Society Organizations EU – European Union GDP – Gross Domestic Product HBC – Home-based care HC – Health Centers IHCP – Individual Home Care Plan LLC – Limited Liability Company LPA – Local Public Authorities MDT – Multidisciplinary Teams MH – Ministry of Health MHLSP – Ministry of Health, Labour and Social Protection MLSPF – Ministry of Labour, Social Protection and Family NBS – National Bureau of Statistics NHIC – National Health Insurance Company RM – Republic of Moldova TMA – Territorial Medical Associations TUSA – Territorial Units of Social Assistance UC – Unit Cost URONPIC – The Network of Non-Commercial Organizations Providing Community Care 04 LIST OF FIGURES Figure 1. Research methods Figure 2. HBC types and sources of funding Figure 3. HBC social service providers Figure 4. Trends in number of beneciaries of the public social HBC service providers, number Figure 5. Medical HBC service Figure 6. Socio-demographic prole of beneciaries of TUSA Figure 7. Socio-demographic prole of beneciaries of medical institutions Figure 8. Socio-demographic prole of beneciaries of CSOs Figure 9. Socio-demographic prole of beneciaries who receive for free HBC Figure 10. Socio-demographic prole of beneciaries who receive for partially paid HBC services Figure 11. Socio-demographic prole of beneciaries who pay for HBC services Figure 12. Beneciaries' ability to pay for HBC services, % Figure 13. HBC services funds, million MDL Figure 14. HBC medical services, home visits Figure 15. Expenditures on different type of resources by incidence of each type of resources, medical institutions (share of total providers) Figure 16. Expenditures on different type of resources by incidence of each type of resources, TUSA (share of total providers) Figure 17. Expenditures on different type of resources by incidence of each type of resources, non-prot providers (share of total providers) 05 LIST OF TABLES Table 1. Changes in cost of medical HBC service per visit within the Unique Program of Compulsory Health Insurance, for 2008-2018 Table 2. HBC providers according to the geographical coverage, number Table 3. Types of HBC providers, number Table 4. HBC service providers ensuring services for free or for a fee, number Table 5. The number of beneciaries per HBC providers, number Table 6. Advantages and disadvantages of a xed period for service provision Table 7. Models of social HBC services delivery Table 8. Models of medical HBC services delivery Table 9. Models of integrated HBC service delivery Table 10. Number of visits contracted by service providers from NHIC in 2017 Table 11. Categories of beneciary dependency Table 12. Number of beneciaries of medical HBC services registered with public medical institution according to their category, number Table 13. Number of beneciaries of social HBC registered with TUSA according to the their category, number Table 14. Number of HBC beneciaries of CSOs according to their category, number Table 15. The average number of HBC beneciaries per institutions participating in the research during 2014-2016 Table 16. The average number of beneciaries according to the type 06 of HBC services (medical, social, integrated), during 2014-2016 Table 17. Types of provided social HBC, % of the total number of service providers Table 18. Types of medical HBC services provided, % Table 19. HBC service providers from the perspective of the continuous training of employees during 2016, number Table 20. The existence of an evaluation system for HBC, number Table 21. The existence of HBC supervision system, number Table 22. Beneciaries' views regarding the extent their needs are covered by provided HBC services, % Table 23. Share of nancing social HBC services provided by CSO “CASMED” or CASMED umbrella CSOs Table 24.