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Orthopaedic devices & Fair Cost recovery system. Experience of the HCM-City Hospital for Care & Rehabilitation of Professional Diseases. Background. PWDs have to participate more and more in the costs for rehabilitation. Wide range of devices needed by wide range of disabilities.
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Orthopaedic devices& Fair Cost recovery system Experience of the HCM-City Hospital for Care & Rehabilitation of Professional Diseases
Background PWDs have to participate more and more in the costs for rehabilitation Wide range of devices needed by wide range of disabilities Decreasing of Government subsidies for Public Health Services Economical improvements induce a demand for high-tech devices
$$ ? PHCN Challenges Meet the needs of the PWDs Combine financial sustainability and fair access
HCM-City Orthopaedic department Administrated by the HCM-City Health Services …BUT No financial subsidies form Government Employs : 2 technicians Opened in December 2003 1 bench worker 1 administrator 1 part-time doctor 1 part-time physiotherapist
HCM-City Orthopaedic department Basic orthopaedic devices (polypropylene technology) Orthopaedic devices with options High tech orthopaedic devices Delivers : Assistive devices made at the workshop Commercial devices from local suppliers Imported devices
Price policy Calculation using ISPO method + 7,5 % for “Reserve fund” + 7,5 % for EQUITY FUND
Prices 20% - 30 % higher than in the other workshops… Price policy BUT Multidisciplinary service One-year guarantee on products Consequence : Recall system for follow-up Written report to prescription doctors => “QUALITY APPROACH”
Equity Fund… how it works Clients who request the basic are assessed through a “Social questionnaire” According to their social category, they get a discount of Clients who want options or high tech products are charged full price 50 % (poor) 70 % (very poor) The discount is covered by the EQUITY FUND The EQUITY FUND is supplied with the 7,5 % of the products prices
Orthopedic devices Results after 1 year implementation Assistive devices Commercial products Large range of products available :
USD Results after 1 year implementation … and to maintain the Equity Fund Large production enables to reach financial sustainability
Results after 1 year implementation …coming mainly from southern region …referred by : In one year, the workshop served 223 persons with Disabilities of various origins 23 % children
Results after 1 year implementation The Equity Fund supports 25 % of the beneficiaries 11 % of the beneficiaries are supported by charity organization, employer, insurance or responsible of accident Notable positive social impact on 56 % of the beneficiaries of the poor categories
Difficulties & challenges BUT … with a limit of 36 % Additional sources for the Equity Fund (estimation US$ 3,000 /year) are still necessary to completely break discrimination The workshop is sustainable and accessible for the poorest PWDs….
Difficulties & challenges 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 Internal management of the Equity Fund, meaning :
Difficulties & challenges 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” Implement “Private-type management” in a Government structure, meaning :
