Result Based Financing: Screening for Cervical Cancer in Thailand

Transcription

1 Result Based Financing: Screening for Cervical Cancer in Thailand Grit Leetongin, MD. National Health Security Office, Thailand 21 November 2011 Why Cervical Cancer Screening? Cervical cancer is an important public health problem, comprises approximately 12% of all cancers in women; In Thailand, prevalence 20-25/100,000 female population, first top women cancer and third cause of death from cancer in women; Cervical screening is the most effective approach for cervical cancer control. Nordic countries have shown that well-organized cytology screening programmes have reduced mortality from cervical cancer by approximately 60%. Cervical cancer screening in developing countries : report of a WHO consultation

2 Why we can? Ministry of Public Health take leadership and centralized decision making; Health care infrastructures mostly are government and expand around Thailand; Funding from Universal coverage funds managed by National Health Security Office; Technical support and monitoring by National Cancer Institute, Department of Medicine 3 Cervical cancer prevention program goals Intermediate goals Increase coverage of screening (80% of female between 30 and 60 were screened) Increase cervical cancer detection rate, all +ve screening receive proper management and follow up. Ultimate goals Decrease mortality of cervical cancer 4 2

3 Target group and screening Target group: women aged years Screening method: Pap smear for women aged years, VIA for women aged years Screening frequency: every 5 years Organized population screening in addition to opportunistic screening VIA: Visual inspective and acetic acid applications 5 Design for CA cervix screening design until currently capitation Target group Screening frequency 250 /case of CA Cx screening 230 /case of VIA c treatment Women age, 5 year intervals 35,40,45,50,55,60 Every 5 years 250 /case of CA Cx screening 230 /case of VIA c treatment Any women yr. assume everyone never screening same No. of Target 4 M/5 years, (800,000/year) 13 M/5 years, (2.6 M/year) Technical support National Cancer Institute Mgt unit NHSO NHSO Payment to Payment method Information From: NHSO 2010 Directly to CUP and to PCU via NHSO provincial branch Postpaid-every three months Summary report, Pap registry (Individual record) National Cancer Institute Directly to CUP and to PCU via NHSO provincial branch Postpaid-every three months and now prepaid Pap registry (Individual record) 6 3

4 Relationship between NHSO, front line service providers and NCI 2010 Result verification NHSO Individual records on the result of screening NC I Result verification Lump sum Pap = 250 VIA = 70 Send data Send data Staffs Incentives depends on CUP CUP & Network Send data Cytology unit Finding cases Specimen and payment for screening, for Pap [VIA is not paid as its self containing service Smear reader, randomized recheck for negative smear 7 Existing active in-service Cytologists: 338 Supply side service planning between NHSO and NIC for scaling up in 2010, when money is not a problem, supply side capacities are critical success factors Expected number of services [slides] Workloads Total slides screened In office hours 40 slides per day 13,520 Overtime works Total annual services rendered days 2,700,000 Per year, assume half of daytime workload 1,350,000 Annual 4,050,

5 Screening Results Target : women aged 35,40,45,50,55,60 years total No. of screening 405, , , , ,341 2,904,339 Normal 402, , , , ,994 2,877,520 Abnormal 3,169 5,227 6,474 5,602 6,347 26,819 Low Grade 1,814 2,908 3,830 3,259 2,979 14,790 High Grade 1,141 2,013 2,309 2,002 1,699 9,164 Cancer , : coverage of women population aged years % 9 Screening Results Target : women aged years (at May) No. of screening 2,195, ,792 Normal 2,170, ,403 Abnormal 24,957 10,389 Low Grade 15,177 6,841 High Grade 8,565 3,190 Cancer 1, : coverage of women population aged years % 10 5

6 Coverage of CA Cx Screening in women population aged years (%) year NSO : REPRODUCTIVE HEALTH SERVEY 2006,2009 Challenges Needs audit to prevent frauds and false reporting, Individual records useful to recheck, NHSO pays upon receipt of pap reading results from NCI Need to ensure a seamless link between the positive screened cases and cancer admissions/ treatment Limit number of cytologists for Pap reading constrains further massive scaling up, More cost effective VIA are being promoted, 12 6

7 Lessons learned Payment method: postpaid and prepaid effect - screening delivery, - data (no record or over key record) Thank you for your attention 7