Assist ProfDragan KorolijaMarinić Consultant surgeon University Hospital for Tumours Zagreb Croatia University Hospital Center Sestre milosrdnice Assistant Minister of Health 2014 june2016 feb ID: 556938
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Management of waiting lists at national level in Croatia. Reinventing the wheel...
Assist. Prof.Dragan Korolija-Marinić
Consultant surgeon
University Hospital for Tumours, Zagreb, Croatia
University Hospital Center
Sestre milosrdnice
Assistant Minister of Health (2014 june-2016 feb)Slide2
Presentation content
1. Hospital sector status in Croatia
2. Business process improvement
a) Main activities
b) HTA
c) Waiting lists management – Programme Plus
3. ConclusionSlide3
1. Hospital sector statusSlide4
Reducing waiting list for elective care
Policy strategies:
Increase supply –
increasing activity
, increasing capacity,
using capacity more efficiently.
Reduce demands –
ilness prevention, prioritising patients, eliminate inappropriate tests and
treatments.
Local organizations strategies –
incentives and sanctions for hospitals which meet
targets.
Kreindler SA Br Med Bull, 2010.Slide5
Devil’s triangle
Negative financial results
Not enough doctors Not enough money
Hospital underperformance Big waiting lists
Not enough patients
Slide6
Angels Triangle - Thesis:
Will more efficient process improve results ?
Positive financial result
Human resources Rational resources
managment usage
Optimal performance Short waiting lists
Gudilenes and pathways
implementation
sdgbsbSlide7
Number of services in hospital sector (2011 – 2014)
sdgbsb
Outpatient service
Inpatient treatmentSlide8
Major change in 2015....D-Day
National insurance fund leaving the Treasury
Operating indipendently
Mid-term planning
Pay-for-performance contracting for hospitalsSlide9
Programme
P
lus – patients in the center of care
Start-up:
11 Feb 2015 –
World Day of the sick
Target: increase access and efficiency of services, additional working hours: Wednesday afternoon and Saturday morning.
Programme evaluation – decrease in average waiting time (days) and number of patients on waiting lists...Slide10
Program
me
plus
– first ten weeks
First four weeks: 21.451 patients
Ten weeks:
47.139 patients !!
Great public support...media, NGO....Slide11
Number of services (patients) –
Jan / March
2015 vs. 2014Slide12
Results – first ten weeks – national level
Significant decrease in average waiting time
Apr
2014 - 155
days vs. Apr
2015 - 132
days
(15 %)
Seasonal increase compensation (February - April) 2014 –
increase for 58.678
referals (01.02 - 08.04.2014.) 2015 –
increase for 16.547 referals
(01.02 - 14.04.2015.)
42.131 referals less (patients waiting) compared to 2014 !! Slide13
First ten weeks results - national level
Significant decrease in number of patients waiting (green)
Significant decrease in average waiting time in days (green)
Trends by specific procedures
Programme bensfits
Gastroscopy
Colonoscopy
MRI
Cardiac
ultrasound
11.02.
20.04.
Ratio
11.02.
20.04.
Ratio
11.02.
20.04.
Ratio
11.02.
20.04.
Ratio
No
of patients
4.450
3.919
-12%
3.968
3.963
0%
19.499
18.402
-6%
16.110
15.090
-6%
Av.
waiting time (days)
81
74
-9%
115
109
-6%
212
206
-3%
214
204
-4%Slide14
Positive examples from Croatian hospitals
20.04. vs 11.02.
MSCT
UHC Rijeka
Number of patients decreased from 605 na 453
(25%)
Average waiting time (days) decreased from 66 to 58
(13%)
Cataract surgery
UHC RijekaNumber of patients decreased from 876 to 530
(39%)Average waiting time (days) decreased from 154 to 118
(23%)Slide15
Positive examples from Croatian hospitals
Cardiac ultrasound
GH Bjelovar
Number of patients decreased from 836 to 333
(60%)
Average waiting time (days) decreased from 320 to 241
(25%)
UHC Rijeka
Number of patients decreased from 1.388 to 970
(30%)Average waiting time (days) decreased from 150 to 122 or zero! (19%)Slide16
Waiting lists comparison 2014 vs. 2015
1.1.2014.
15.6.2014.
31.12.2014.
13.4.2015.Slide17
Waiting lists comparison 2014 vs 2015Slide18
Results
Feb 2015. – Ratio of hospitals with service within 60 days
Nov 2015. – Ratio of gospitals with service within 60 days
First consultation
64%
74%
Clinical examination
80%
81%
Gastroenterology
35%
71%
Cardiology
50%
71%
Neurology
93%
93%
Ophtalmology
39%
43%
Therapeutic procedures
29%
43%
Cataract surgery
29%
43%
Diagnostics
60%
67%
Gastroscopy
64%
82%
Colonosscopy
70%
76%
Mamography
76%
96%
Abdominal ultrasound
56%
57%
Carotid color doppler
81%
80%
Breast ultrasound
38%
37%
Cardiac ultrasound
37%
52%
Total – 13 services
60%
69%Slide19
Final results
Activities started in Feb 2015:
Programme plus, 72 HOURS, Open days week, Top ten doctors.
1,2 milion services more (total of 13,2 mil.).
21 % reduction in average waiting time (days)
from February do December 2015.
Minimal additional cost.
42 percent of hospitals had positive balance sheet at the end of 2015.Slide20
Conclusion
More efficient and productive processes can decrease waiting lists and result in better hospitals
performance –
Increase supply !!
Key points are more services and proactive
localhospital
management
.
Administration must be present in hospitals !
After 20 years this was the first year to achieve financial stability in healthcare sector as oppose to some European countries....Slide21
Thank you for your attention...
‘The only way is up’