Financing Mental Health in the Czech Republic Future Challenges

Transkript

1 Financing Mental Health in the Czech Republic Future Challenges Pavel Horák, MD, CSc., MBA Director, VZP Czech Republic

2 Burden from the past Stigma for the patient to seek psychiatric care, especially when hospitalized in psychiatric sanatoria's Drug and alcohol abuse considered self inflicted problems, not disease, treatments still considered by many to be not fair to be reimbursed from the medical insurance Out of the city approach (sequestration) for mental health care facilities, inappropriate number of acute beds Psychiatry considered low cost segment with mainly hospitalization costs, no high tech medicine, low atraktivity for the young doctors, low salaries Reimbursement schemes not reflecting specificity of mental health care within the segment of long term care (pharmacotherapy)

3 Network of outpatient clinics adjusted number of physician posts (PPLM) (including outpatient departments in hospitals) Region PPLM calculated per inhabitants y.2007 y.2008 change y y change City of Prague % % Central Bohemia Region % % South Bohemian Region % % Pilsen Region % % Karlovy Vary Region % % Ústí Region % % Liberec Region % % Hradec Králové Region % % Pardubice Region % % Vysočina Region % % South Moravia Region % % Olomouc Region % % Moravian-Silesian Region % % Zlín Region % % Czech Republic % % These figures include the following specialties: psychiatry, child psychiatry geriatric psychiatry treatment of alcoholism and other forms of toxicomania

4 Adjusted number of physician posts (PPLM) per 100 thousand inhabitants according to region in 2008 Psychiatry ambulatory care

5 Network of emergency psychiatric beds (holding beds) sorted by region in the years 2007 and 2008 Region Number of beds Calculated per inhabitants y y change in % y y change in % City of Prague % % Central Bohemia Region 0 0 0% % South Bohemian Region % % Pilsen Region % % Karlovy Vary Region % % Ústí Region % % Liberec Region % % Hradec Králové Region % % Pardubice Region % % Vysočina Region % % South Moravia Region % % Olomouc Region % % Moravian-Silesian Region % % Zlín Region 0 0 0% % Czech Republic % %

6 Number of emergency psychiatric beds (holding beds) per 100 thousand inhabitants in 2008

7 Number of beds for follow-up care in psychiatric sanatoria sorted by region in the years 2007 and 2008 Region Number of beds y y change in % Calculated per inhabitants y y change in % City of Prague % % Central Bohemia Region % % South Bohemian Region % % Pilsen Region % % Karlovy Vary Region 0 0 0% 0 0 0% Ústí Region % % Liberec Region 0 0 0% 0 0 0% Hradec Králové Region % % Pardubice Region % % Vysočina Region % % South Moravia Region % % Olomouc Region % % Moravian-Silesian Region % % Zlín Region % % Czech Republic % %

8 Number of beds for follow-up care in psychiatric sanatoria per 100 thousand inhabitants in 2008

9 Cost of psychiatric care provided in the years 2000 to 2008 a) Care in outpatient clinics NB: - Does not include the cost of prescription drugs and health aids. - The proportion of psychiatry ambulatory care out of total ambulatory care is expressed in percentage.

10 Ambulatory medical care quarterly indicators in 2008 Field and speciality Average number of contacts per quarter Average no. of insured treated per quarter Average no. of points per quarter Average quarterly costs of medication and health aids in CZK 301 Pediatrics Adolescent Medicine Neonatology ,306 Psychiatry Treatment of alcoholism and other forms of toxicomania Sexuology Occupational diseases Clinical oncology Radiotherapy ,405,406 Dermatovenerology Nuclear Medicine ,502 Surgery Traumatology Vascular Surgery Cardiac Surgery Neurosurgery

11 Cost of emergency inpatient psychiatric care in the years 2000 to 2008 NB: The proportion of emergency psychiatric beds out of total emergency beds is expressed in percentage

12 Cost of care provided by psychiatric sanatoria in the years 2000 to 2008 NB: - Does not include the cost of medication and health aids - The proportion of psychiatric sanatoria out of total follow-up care facilities is expressed in percentage

13 Average tariff rates per treatment day (OD) in psychiatric sanatoria in the years Specialized institution- Psychiatry y.2005 y.2006 y.2007 y.2008 Basic average tariff rate per OD In CZK Increase in % compared to previous year 103.1% 104.9% 103.1% Note: This tariff rate per treatment day does not take into consideration patient categories!

14 Total costs in the field of psychiatry in the years 2000 to 2008 (both outpatient and inpatient care) NB: Does not include the cost of medication and health aids

15 Development of costs incurred by VZP (in billions of CZK) in the field of psychiatry in the years NB: Does not include the cost of medication and health aids

16 The growth of costs in the field of psychiatry in the years NB: Does not include the cost of medication and health aids

17 The cost of care provided in the field of psychiatry in the years

18 The cost of drugs and medication prescribed to the insured of VZP ČR in 2008 by contractual health facilities Alimentary tract and metabolism Blood and haematopoietic organs Cardiovascular system Dermatological agents Urogenital system and sex hormones Systemic hormonal preparations except sex hormones Systemic anti-infectious agents Antineoplastic agents and immunomodulators Musculoskeletal system Central nervous system Psycholeptics Psychoanaleptics Antiparasitic agents Respiratory system Sensory organs Others y.2001 y.2002 y.2003 y.2004 y.2005 y.2006 y.2007 y.2008 mil.czk % 12.8% 12.4% 12.3% 12.0% 12.3% 12.9% 13.6% 13.9% mil.czk % 2.0% 1.9% 1.9% 2.0% 2.3% 2.5% 2.8% 2.9% mil.czk % 29.6% 29.1% 29.2% 29.4% 26.9% 26.8% 29.1% 27.6% mil.czk % 2.2% 2.0% 1.9% 1.7% 1.6% 1.4% 1.5% 1.3% mil.czk % 4.5% 4.6% 4.3% 4.2% 4.0% 4.0% 4.0% 3.8% mil.czk % 1.7% 1.8% 1.7% 1.5% 1.5% 2.3% 2.2% 2.1% mil.czk % 6.2% 5.5% 5.3% 4.8% 5.2% 4.5% 4.7% 4.7% mil.czk % 9.7% 11.6% 12.5% 13.6% 14.9% 15.0% 9.0% 10.5% mil.czk % 6.7% 6.8% 6.7% 6.5% 6.1% 5.0% 4.8% 4.3% mil.czk % 5.3% 5.4% 5.5% 5.6% 6.2% 6.3% 7.0% 7.3% mil.czk % 2.7% 2.9% 2.9% 2.8% 2.7% 3.1% 3.5% 3.7% mil.czk % 3.8% 3.8% 3.9% 4.1% 4.4% 4.5% 4.9% 5.0% mil.czk % 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% mil.czk % 9.0% 8.6% 8.4% 8.3% 8.7% 8.2% 9.1% 8.8% mil.czk % 1.5% 1.5% 1.5% 1.5% 1.5% 1.6% 1.8% 1.9% mil.czk % 2.2% 2.1% 2.0% 1.8% 1.6% 1.8% 1.9% 1.9% Total

19 The cost of drugs and medication prescribed to the insured of VZP ČR in 2008 by contractual health facilities

20 Psychoanaleptics the costliest ATCs of all prescription drugs Cost in thous. CZK Index ATC ATC Name year 2006 year 2007 year 2008 y.2008 / y.2007 y.2008 / y.2006 N06AB04 Citalopram N06AB06 Sertraline N06AB10 Escitalopram N06AX16 Venlafaxine N06AX11 Mirtazapin N06DA02 Donepezil N06AB05 Paroxetine N06AB03 Fluoxetine N06BX03 Piracetam N06DA03 Rivastigmin N06DX01 Memantine N06AX05 Trazodone N06DX02 Ginkgo biloba N06DA04 Galantamine

21 Psychoanaleptics costliest prescription drugs Name Note ATC Cost in thous. CZK year 2007 year 2008 CITALEC film coated tablets N06AB CIPRALEX 10 MG film coated tablets 28x10mg N06AB ZOLOFT film coated tablets N06AB ASENTRA film coated tablets N06AB CITALOPRAM film coated tablets N06AB EXELON hard capsules N06DA EBIXA 10 MG hard capsules 56x10mg N06DX ARGOFAN modified release tablet N06AX ARICEPT tablets N06DA TRITTICO AC extended release tablets N06AX YASNAL film coated tablets N06DA SEROPRAM 20 MG film coated tablets 28x20mg N06AB SERLIFT film coated tablets N06AB REMOOD 20 MG film coated tablets 30x20mg N06AB APO-CITALOPRAM film coated tablets N06AB MIRZATEN film coated tablets N06AX CITALON film coated tablets N06AB APO-PAROX film coated tablets N06AB REMINYL Capsules, tablets N06DA ESPRITAL film coated tablets N06AX GERATAM film coated tablets N06BX APO-CITAL film coated tablets N06AB APO-SERTRAL hard capsules N06AB VELAXIN hard capsules N06AX Index

22 Psychoanaleptics most frequently prescribed drugs Name Note ATC Cost in thous. CZK year 2007 year 2008 CITALEC film coated tablets N06AB CIPRALEX 10 MG film coated tablets 28x10mg N06AB PROTHIADEN 25 coated tablets 30x25mg N06AA PIRACETAM film coated tablets N06BX ZOLOFT film coated tablets N06AB GERATAM film coated tablets N06BX ASENTRA film coated tablets N06AB CITALOPRAM film coated tablets N06AB GINGIO film coated tablets N06DX TRITTICO AC extended release tablets N06AX TANAKAN film coated tablets N06DX SERTRALIN film coated tablets N06AB SEROPRAM 20 MG film coated tablets 28x20mg N06AB REMOOD 20 MG film coated tablets 30x20mg N06AB CITALON film coated tablets N06AB AMITRIPTYLIN film coated tablets 50x28.3mg N06AA MIABENE film coated tablets N06AX MIRZATEN film coated tablets N06AX ARGOFAN modified release tablets N06AX CAVINTON tablets 50x5mg N06BX SERLIFT film coated tablets N06AB ANAFRANIL tablets N06AA TEBOKAN 40 MG film coated tablets N06DX ESPRITAL film coated tablets N06AX Index

23 Psycholeptics the costliest ATCs of all prescription drugs Cost in thous. CZK Index ATC ATC Name year 2006 year 2007 year 2008 y.2008 / y.2007 y.2008 / y.2006 N05AH03 Olanzapine N05AH04 Qvetiapine N05AX08 Risperidone N05AL05 Amisulpride N05AL03 Tiaprid N05AE04 Ziprasidone N05AX12 Aripiprazol N05BA12 Alprazolam N05AX11 Zotepine N05AH02 Clozapine N05BX01 Mefenoxalone N05AL01 Sulpiride N05AA02 Levomepromazine N05AD03 Melperon

24 Psycholeptics - costliest prescription drugs Name Note ATC Cost in thous. CZK year 2007 year 2008 ZYPREXA film coated tablets N05AH SEROQUEL film coated tablets N05AH ZYPREXA VELOTAB orodispersible tablets N05AH ZELDOX por cps dur 30x40mg N05AE ABILIFY tablets N05AX SOLIAN tablets N05AL TIAPRIDAL tablets N05AL ZOLEPTIL tablets N05AX KETILEPT film coated tablets N05AH NEUROL Tablets N05BA RISPERDAL film coated tablets N05AX QUETIAPIN MERCK film coated tablets N05AH LEPONEX tablets N05AH RISPEN film coated tablets N05AX DENIBAN tablets 60x50mg N05AL KVENTIAX film coated tablets N05AH TISERCIN film coated tablets 50x25mg N05AA BURONIL 25 MG tablets 50x25mg N05AD DORSIFLEX 200MG tablets 30x200mg N05BX DIMEXOL por tbl nob 30x200mg N05BX TIAPRA film coated tablets N05AL CHLORPROTHIXEN film coated tablets N05AF HALOPERIDOL-RICHTER 1.5 MG tablets 50x1.5mg N05AD Index

25 Psycholeptics most frequently prescribed drugs Name Note ATC Cost in thous. CZK year 2007 year 2008 Index NEUROL tablets N05BA LEXAURIN tablets N05BA DIAZEPAM tablets N05BA CHLORPROTHIXEN film coated tablets N05AF TIAPRIDAL tablets N05AL TISERCIN film coated tablets 50x25mg N05AA OXAZEPAM LÉČIVA tablets 20x10mg N05BA DORSIFLEX 200MG tablets 30x200mg N05BX HALOPERIDOL-RICHTER 1.5 MG tablets 50x1.5mg N05AD BURONIL 25 MG tablets 50x25mg N05AD ZYPREXA film coated tablets N05AH DIMEXOL tablets 30x200mg N05BX PROSULPIN tablets N05AL DOGMATIL 50 MG hard capsules 30x50mg N05AL PLEGOMAZIN tablets N05AA RISPERDAL film coated tablets N05AX FRONTIN tablets N05BA SEROQUEL film coated tablets N05AH TIAPRA film coated tablets 50x100mg N05AL ZOLEPTIL tablets N05AX ATARAX tablets 25x25mg N05BB ELENIUM coated tablets 20x10mg N05BA TIAPRID-RATIOPHARM 100 MG tablets 50x100mg N05AL XANAX tablets N05BA RORENDO ORO TAB orodispersible tablets N05AX

26 Average reimbursement per 1 package N05 - Psycholeptics No. of packages in mil. Cost in mil. CZK Average reimbursement per 1 package y y y y y y y y y

27 Average reimbursement per 1 package N06 - Psychoanaleptics No. of packages in mil. Cost in mil. CZK Average reimbursement per 1 package y y y y y y y y y

28 Current Approach by VZP Selective financing of psychiatry within the LTC Costs of pharmacotherapy will be reimbursed fairly Cost of hospitalization mainly for social reasons to be reimbursed by the Ministry of the social affairs nor medical insurance Promotion of continuity of the care between ambulatory and hospitalization care Program of quality of the care AKORD will be cloned for psychiatric patients to address their special needs Promotion of structural changes (number of acute and chronic beds) by the Insurance company