Financovanie zdravotníctva v SR. m.prof. MUDr. Milan Dragula, PhD. Slovenská lekárska komora
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1 Financovanie zdravotníctva v SR m.prof. MUDr. Milan Dragula, PhD. Slovenská lekárska komora
2 Aká je realita? Slovensko vo svetle reálnych dát Dáta sú z roku 2008 Priemer nákladov vynaložených na zdravotníctvo ako % HDP predstavuje v OECD 8,9 % Na Slovensku je to v súčasnosti cca 5,76 % Náklady na ambulantnú starostlivosť a lôžkovú starostlivosť sú na Slovensku nižšie ako v iných štátoch OECD Náklady na lieky na obyvateľa sú približne 254,10 Eur Výdavky na zdravotníctvo na obyvateľa, 2008 Nemocničná starostlivosť Ambulantná starostlivosť
3 Farmaceutický trh 2010 a Q Slovensko je na 21. mieste v EÚ a náklady nerastú, resp. klesajú Poradie Štát Predaj 2010 (v tis. ) Rast (2009) (%) Predané balenia 2010 (v tis.) Rast (2009) (%) 21 Slovensko ,0 2, ,9 1,3 Zdroj: IMS, IMS Executive Market Report, marec 2011 Poradie Štát Predaj Q (v tis. ) Rast Q4 (2009) (%) Predané balenia Q (v tis.) Rast Q4 (2009) (%) 21 Slovensko ,0 0, ,1-3,7 Zdroj: IMS, IMS Executive Market Report, marec 2011
4 Iceland Switzerland Liechtenstein Cyprus Sweden Norway Spain Netherlands Ireland France Germany Italy Greece United Kingdom Austria Malta Luxemburg Belgium Denmark Finland Portugal Slovenia Czech Republic Croatia Macedonia Poland Slovakia Bulgaria Hungary Romania Estonia Latvia Lithuania vek (roky) Očakávaná dĺžka života pri narodení Slovensko na chvoste Európy Očakávaná dĺžka života pri narodení - muži
5 Ireland Slovenia Czech Republic Austria Luxemburg Germany Portugal Finland Switzerland Belgium Norway Sweden Netherlands Denmark Hungary Spain Iceland Slovakia Greece Romania Bulgaria Lithuania Predĺženie očakávanej dĺžky života Trend nevyvoláva veľký optimizmus 10,0% Očakávaná dĺžka života pri narodení - predĺženie % (2006 vs. 1986) - muži 8,0% 6,0% 4,0% 2,0% 0,0% -2,0% -4,0% -6,0%
6 Celkové doplatky pacientov za lieky na lekársky predpis vo verejných lekárňach (milióny ) Milióny
7 Štruktúra doplatkov pacientov v SR 350 Doplatky pacienta /rok celá populácia Celá veková skupina Top 10% pacientov vo vekovej skupine Pozn.: Top 10% pacientov vo vekovej skupine = 10% pacientov z danej vekovej skupiny, ktorý majú najvyššie doplatky
8 Doplatky pacientov V roku 2010 rástli doplatky pacientov (+7%) rýchlejšie ako náklady zdravotných poisťovní na lieky (1,5%) klesajú úhrady zdravotných poisťovní na deň terapie Priemerný doplatok obyvateľa SR v roku 2010 za lieky bol 32 ALE! Najviac postihnutá skupina pacientov vo veku od 60r má priemerný doplatok na lieky vo výške 250 až 320 za rok 2010!
9 Spotreba liekov v počte balení, úhrade zdravotných poisťovní a doplatkoch pacientov po štvrťrokoch, receptové lieky, v mil. balení a v mil. EUR
10 K OECD výdavkom za lieky na obyvateľa je potrebné poznamenať, že OECD sleduje koncové ceny, vrátane marží a DPH a teda porovnanie nie je úplne korektné, nakoľko v rámci V-3 máme aj po znížení stále najvyššiu Referencovanie cien liekov na Slovensku prebieha od roku 2009 a teda v tejto štatistike ešte nie je viditeľný pokles spotreby v jeho dôsledku. Pokiaľ sa na to pozrieme v cenách výrobcov, tak ten pohľad je dosť iný. Posledné dáta celkovej spotreby sú k 11/2010 (tzv. databaza IMS) - priložená PPT. Medziročný nárast spotreby liekov v cenách výrobcov (IMS dáta) bol na Slovensku: 2008/2009 len 1,1% 2009/2010 len 1,6%
11 ZDROJ: TK MZ SR, Lekárnik 3/2011
12 Zdroj: Lieky a ich možnosti (prof. RNDr. V. Foltán, CSc., Farmaceutická fakulta UK)
13 ZDROJ: Lekárenské listy 7-8/2011
14 ZDROJ: Lekárenské listy 7-8/2011
15 ZDROJ: Česko patří v rámci OECD k zemím s nejnižší spoluúčastí pacientů ( ; Právo; s. 4; PERGL Václav) Pacienti v Česku v roce 2009 ze svých peněženek přímo vydali 47,9 miliardy korun. O rok později, tedy v roce 2010, to již bylo 48,6 miliardy a podle vládní koalice by spoluúčast pacienta měla během tří let stoupnout ze současných 16,7 % na 22 %. Ustav zdravotnických informací a statistiky uvádí, že nízkou spoluúčast v rámci OECD mají také Island se 17,4 % a Švédsko 18,6 %. Naopak Švýcarsko má spoluúčast 40,3 %, Slovensko 30,8, Maďarsko 30,4 a Portugalsko 38,5 %.
16 ?...Poisťovne tak prideľovaním peňazí jednotlivým poskytovateľom fakticky od riadia zdravotníctvo......existencia zdravotných poisťovní v oblasti povinného zdravotného poistenia v takýchto podmienkach nie je vôbec opodstatnená a ani možná. Ich úlohu by vedela nahradiť jedna inštitúcia vo forme zdravotnej pokladnice, ktorá by peniaze len vyberala, ale nerozdeľovala. Výrazne by sa znížili zbytočné administratívne náklady na prevádzku poisťovní...
17 ?...Prvým, povinným pilierom nového systému financovania by mali tzv. verejné zdroje občanov sústredené v zdravotnej pokladnici. Kryla by náklady na poskytovanie zákonného nároku prevencie a liečby všetkých občanov, ktorý je garantovaný Ústavou v systéme povinného zdravotného poistenia... Pre občana a nakoniec aj pre celú spoločnosť je vcelku jedno, aký systém zdravotníctva funguje, je jedno, či bude zdravotníctvo riadene centrálne8, alebo bude úplne decentralizované9. Občan pre seba požaduje "zdravotnú bezpečnosť" na úrovni konca druhého a začiatku tretieho milénia.
18 Medzinárodné porovnanie spotreby liekov v cenách výrobcov (IMS) celý trh r.2008
19 Ďakujem za pozornosť
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