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 “Every
Serbian citizen should have a personally chosen doctor
and they should know that doctor’s name. That’s the way
of building more trust in the health system. Capitation
represents a formula to change the way of financing
because it’s understood that there are possibilities to
motivate doctors and nurses in Dom
Zdravlja
(DZ) to work more with preventive healthcare as planned
for by the DZ.
Capitation
is not on its own a goal. It is when you pay the DZ not
on the basis of how big it is – how many square meters
it has or how many employees there are - but on the
basis of how many citizens/patients opt for treatment in
that DZ....
Prof Dr Tomica Milosavljević
Serbian Minister of Health
What is Capitation?
Capitation
is the payment mechanism whereby the doctor or relevant
health institution gets a financial advance for a
limited period of time (monthly, every third month, or
once a year) for each patient that is registered for
treatment with a chosen doctor or with the health
institution in order to enable the provision of all
health services at all three levels: primary, secondary
and tertiary.
The amount of money that will be used by the system is
known in advance and does not depend on the number or
type of services provided. This new mechanism brings
more risk to the doctors and health institution by
making them into a sort of smaller-sized health
insurance fund. The amount of capitation depends on the
expected expenses of the provided health services.
The amount of capitation can be fixed or “adjusted to a
risk”. A higher allocation of capitation payment relates
to gender, age, chronic disease and social status. In
the Serbian primary healthcare system (PHC)
it’s been decided to implement a gradual transition from
financing based on the number of employees and their
collective contracts, to payment based on registered
patients according to each employee. Capitation will
reduce the risk of those employed getting the same funds
as those that are unemployed or those that work less.
“The capitation system should bring more satisfaction to
both doctor and patient - to the doctor through adequate
financial compensation for invested work and to the
patient through complex care for his health”. If we
speak about formula of payment in capitation, it will be
simple at the beginning while it will be improved at the
later stages. This means that, firstly, the doctor will
be stimulated based on the number of registered
patients. In the later stages there will be new criteria
introduced in the capitation formula such as the number
of preventive services performed.
 Basically,
capitation is a model where the Health Insurance Fund
can achieve some goals i.e. primary healthcare will be
directed in a specific direction because there is a
financial mechanism to support the relevant activities
like preventive health services. It is important to
discover a problem at the primary level, not to
implement a more expensive system at the level of
secondary healthcare which is less efficient because the
secondary level is supposed to sort the problem out and
the primary level to discover and stop it. If a problem
enters the phase where surgery cannot help or if it is
needed to be solved by using oncology with expensive
medicines – we get very expensive activity with a low
level of success. Therefore, the capitation formula
should be created step by step. There are no quick
solutions – they may jeopardise the whole system”.
(Svetlana
Vukajlović,
Director of the Serbian Health Insurance Fund)
"Support to the Implementation of Capitation Payment in
Primary Healthcare in Serbia" is a joint project of the
Ministry of Health of the Republic of Serbia and
European Union. The project is funded by the European
Union.
Activities on the project started in September 2007.
and will continue until the end of 2010.
The value of the project is 5 million euros of which 2.5
million intended for technical assistance and 2.5
million for the procurement of IT equipment for dom
zdravlja's involved in the project
National
partners of the project:
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News |
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The
Conference
“Strengthening Management in Primary
Health Care: From Capacity Building Towards better
performance“ was held in Belgrade on 22nd April, 2010 in Sava
Centar, Belgrade. |
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Training for management in Primary Health Care
Change Management was
held in Belgrade on 8, 9, 10, 11, 12 and 16th of February.
Management teams from Dom zdravlja’s included in the project
were attended
at the seminars. |
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January 29th, 2010 Belgrade
Association
of Primary Health Care Managers in Serbia
was founded in Belgrade with the aim of contributing to the
development and improvement of management practices in primary
health care (PHC). |
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November 6th, 2009 Belgrade, Seminars on capitation
Within the
project activities, the last in a series of seminars dedicated
to introduction of health care financing and payment to health
care providers to management teams for Primary Health Care (PHC)
was held in Belgrade in 6th November 2009... |
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October 14th and 15th, 2009 Belgrade,
Financing of Primary Health Care and better use of capitation,
The Seminars introduce management teams from Primary
Health Care to the basic health-care financing and payment
systems for providers of health services...
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October 14th, 2009 Belgrade, Ambassador of
Finland visits the Project
H.E. Kari
Veijalainen, Ambassador of Finland in Belgrade, visited the
project "Support to the Capitation Implementation in Primary
Health Care in Serbia"... |
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May 9th, 2009 Europe Day
Representatives of dom
zdravlja included in pilot project „Support to the
Implementation of Capitation in Primary Healthcare in Serbia“ –
DZ Voždovac, DZ Savski Venac and DZ Vračar, participated in
celebrating Europe day... |
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