Orthopaedic devicesOrthopaedic devices& Fair Cost recovery & Fair Cost recovery

systemsystem

Experience of the HCM-City Experience of the HCM-City Hospital for Care & Rehabilitation Hospital for Care & Rehabilitation

of Professional Diseasesof Professional Diseases

BackgroundBackground

Decreasing of Government subsidies for Public Health ServicesDecreasing of Government subsidies for Public Health Services

Wide range of devices needed by wide range of disabilities Wide range of devices needed by wide range of disabilities

Economical improvements induce a demand for high-tech devices Economical improvements induce a demand for high-tech devices

PWDs have to participate more and more in the costs for rehabilitationPWDs have to participate more and more in the costs for rehabilitation

$$ ?

PHCN

ChallengesChallengesCombine financial sustainability and fair access Combine financial sustainability and fair access

Meet the needs of the PWDsMeet the needs of the PWDs

HCM-City Orthopaedic HCM-City Orthopaedic departmentdepartment

Opened in December 2003Opened in December 2003

No financial subsidies form Government No financial subsidies form Government

2 technicians 2 technicians Employs :Employs :

1 bench worker 1 bench worker

1 administrator 1 administrator

1 part-time doctor 1 part-time doctor

1 part-time physiotherapist 1 part-time physiotherapist

Administrated by the HCM-City Health ServicesAdministrated by the HCM-City Health Services ……BUTBUT

HCM-City Orthopaedic HCM-City Orthopaedic departmentdepartmentDelivers :Delivers :

Basic orthopaedic devices (polypropylene technology) Basic orthopaedic devices (polypropylene technology)

Orthopaedic devices with optionsOrthopaedic devices with options

Assistive devices made at the workshopAssistive devices made at the workshop

Commercial devices from local suppliersCommercial devices from local suppliers

Imported devicesImported devices

High tech orthopaedic devices High tech orthopaedic devices

Price policyPrice policyCalculation using ISPO method Calculation using ISPO method

+ 7,5 % for “Reserve fund” + 7,5 % for “Reserve fund”

+ 7,5 % for + 7,5 % for EQUITY FUNDEQUITY FUND

Price policyPrice policyConsequence : Consequence :

Prices 20% - 30 % higher than in the other workshops… Prices 20% - 30 % higher than in the other workshops…

BUTBUTMultidisciplinary service Multidisciplinary service One-year guarantee on products One-year guarantee on products

=> “QUALITY APPROACH”=> “QUALITY APPROACH”

Recall system for follow-up Recall system for follow-up

Written report to prescription doctors Written report to prescription doctors

Equity Fund… how it Equity Fund… how it worksworksClients who want options or high tech products are Clients who want options or high tech products are charged full pricecharged full price

Clients who request the basic are assessed through a Clients who request the basic are assessed through a “Social questionnaire”“Social questionnaire”

According to their social category, they get a discount ofAccording to their social category, they get a discount of

The discount is covered by the EQUITY FUND The discount is covered by the EQUITY FUND

The EQUITY FUND is supplied with the 7,5 % of the The EQUITY FUND is supplied with the 7,5 % of the products pricesproducts prices

50 % (poor) 50 % (poor) 70 % (very poor) 70 % (very poor)

4%2%

2%1%

7%

29%

17%

16%

11%

11%

Shoes

Ortho soles

Canes & crutches

Walking frames

Sport wheelchairs

Paraplegic wheelchairs

Quadraplegic wheelchairs

3 wheels motorbikes

Assistive devices

Repairs (wheelchair)

Results after 1 year Results after 1 year implementationimplementation

Large range of products availableLarge range of products available : :

32%

7%

5%

15%12%

3%

2%

8%

8%

5% 1%

2% Foot orthosis

Ankle-Foot orthosis

Knee-Ankle-Foot orthosis Hip-Knee-Ankle-Foot orthosis

Corrective splints

Trunk corset

Cervical Collar

CP molded seat

AK ProsthesisBK prosthesis

Finger prothesis

Foot prothesis

Ortho shoes

Ortho soleothers

Repairs

Orthopedic devicesOrthopedic devices

Assistive devicesAssistive devices

38%

34%

16%

2%5%

2% 3% Protective cushions

Modular "Jamie" cushions

Technical aids

Hand splint

Wheelchair gloves

Others

Repairs

Commercial productsCommercial products

Results after 1 year Results after 1 year implementationimplementationLarge production enables to reach financial sustainabilityLarge production enables to reach financial sustainability

… … and to maintain the Equity Fundand to maintain the Equity Fund

-2000

-1000

0

1000

2000

3000

4000

Jan Mar May Jul Sep Nov

turn over

Approx profit and loss

Equity Fund

USD

18%

7%

10%

15%

50%

Public hospitals

Private hospitals

Media

Disability organisation

Word of mouth

Results after 1 year Results after 1 year implementationimplementationIn one year, the workshop served 223 persons with In one year, the workshop served 223 persons with Disabilities of various originsDisabilities of various origins

35%12%

30%

23%

Congenital

Cerebral palsy

Disease

Trauma

……coming mainly from southern regioncoming mainly from southern region

Others6%

HCM City64%

Southern region30%

……referred by : referred by :

23 % children 23 % children

Results after 1 year Results after 1 year implementationimplementationNotable positive social impact on 56 % of the beneficiaries of Notable positive social impact on 56 % of the beneficiaries of the poor categoriesthe poor categoriesThe Equity Fund supports 25 % of the beneficiariesThe Equity Fund supports 25 % of the beneficiaries

4%21%

11%

64%

70 % discount

50 % discount

External support

No support

11 % of the beneficiaries are supported by charity organization, 11 % of the beneficiaries are supported by charity organization, employer, insurance or responsible of accidentemployer, insurance or responsible of accident

Difficulties & challengesDifficulties & challengesThe workshop is sustainable and accessible for The workshop is sustainable and accessible for the poorest PWDs….the poorest PWDs….

BUTBUT … … with a limit of 36 %with a limit of 36 %

Additional sources for the Equity Fund Additional sources for the Equity Fund (estimation US$ 3,000 /year) are still (estimation US$ 3,000 /year) are still necessary to completely break discriminationnecessary to completely break discrimination

Difficulties & challengesDifficulties & challengesInternal management of the Equity Fund, Internal management of the Equity Fund, meaning :meaning :

Dependent Equity FundDependent Equity FundRisk of prioritizing financial sustainability and Risk of prioritizing financial sustainability and neglect accessibilityneglect accessibilitySocial assessment made by a non-professional Social assessment made by a non-professional Difficulty to approach private sponsors to complete Difficulty to approach private sponsors to complete the Fundthe Fund

Difficulties & challengesDifficulties & challengesImplement “Private-type management” in a Implement “Private-type management” in a Government structure, meaning :Government structure, meaning :

Workshop closed on weekends, public Workshop closed on weekends, public holiday, and after 16:00 every day holiday, and after 16:00 every day Heavy administrative procedureHeavy administrative procedurePrices higher than in public workshopsPrices higher than in public workshopsNo incentive for the persons who refer No incentive for the persons who refer clientsclientsNecessary “Marketing”Necessary “Marketing”

THANKSTHANKSfor your support !for your support !