Operational Programme Health Evaluation of Impacts

Transcription

ABCD
Modernization of health infrastructure from EU funds to help the state of health of Slovak population
Ministry of Health of the Slovak
Republic
Operational Programme Health
Evaluation of Impacts
Final Report
KPMG Slovensko spol. s r.o.
27 May 2012
1
© 2013 KPMG Slovensko spol. s r.o., the Slovak member firm of KPMG International
Cooperative ("KPMG International"), a Swiss entity. All rights reserved.
ABCD
Ministry of Health of the Slovak Republic
Final Report, 27th of May 2013
Table of Contents
1
Introduction
1
1.1
1.2
Report Objectives
Report Structure
1
1
2
Executive summary
2
3
Evaluation Objectives and Scope
5
3.1
3.2
3.3
3.4
3.5
3.5.1
3.5.2
3.5.3
3.5.4
5
5
5
6
6
6
6
6
3.5.5
Starting Points for Evaluation
Evaluation Objectives
Evaluation Scope
Beyond the Scope of the Evaluation
Limitations
Criteria for defining the quality, availability and efficiency
Use of the counterfactual method
Use of a panel of experts or of the Delphi method
Quantification of efficiency and availability directly related with
the Programme
Situation related to the Topic 3
4
Evaluation procedure
8
4.1
4.1.1
4.1.2
4.1.3
4.1.4
4.1.5
Summary of Information Inputs
Inputs from the Ministry of Health of the Slovak Republic
Všeobecná zdravotná poisťovňa (health insurance company)
National Health Information Centre (NHIC)
Questionnaires for beneficiaries of finalized projects
Visit and structured interview with an end beneficiary of the
national project
Other resources, documents and legislation
Progress in Time and the Process of Performed Evaluation Activities
Activities performed – Topic 1: Evaluationof achieving the OPH
strategic target
Activities performed – Topic 2: Evaluation of regional contribution
Activities performed – Topic 3: Evaluation of potential overlap of
strategic priorities of the Slovak healthcare system and priorities
and objectives of the EU Cohesion Policy and the Europe 2020
strategy
Evaluation Team
Methods Used
8
8
8
8
9
4.1.6
4.2
4.2.1
4.2.2
4.2.3
4.3
4.4
5
Summary of Findings of teh Evaluation of OPH Outputs and
Impacts
6
6
9
9
10
10
12
14
17
18
20
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© 2013 KPMG Slovensko spol. s r.o.. All rights reserved.
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Ministerstvo zdravotníctva Slovenskej republiky
Hodnotenie dopadov Operačného programu
27. máj 2013
5.1
5.1.1
5.1.2
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20
5.6.3
5.6.4
5.6.5
OPH Projects
Summary of the status of project execution
Summary of the number of projects, financial volumes and drawing
rate
Summary of types of expenditures supported by OPH projects
Summary of projects based on ratio indicators
Outputs of OPH Projects
Explanation of division of outputs into Groups and Subgroups
Financial prospects of project outputs as per Groups and Subgroups
Outputs and outcomes of projects divided into Groups and
Subgroups
Outputs of Projects as per 'Diseases of Group 5'
Impacts of OPH Projects
Logical framework of transition from outputs through effects to
impacts
Justification of the evaluation’s focus of only on finalized projects
Summaries of OPH contributions, as per output Groups, to Quality,
Efficiency and Availability
Summary of OPH contribution to equipment in SR
Regional analysis of OPH allocation and outputs
Summary of regional classification of projects and financial
allocation
Process of determining and ensuring OPH regional allocation
Regions from the point of view of ‘diseases of group 5’
View of regions through selected output Groups
View of regions in cartographic summaries
Measure 2.2 – National project – National Blood Transfusion Service SR
Outputs of the project
Outputs of the project divided into Groups and Subgroups
Impacts of the project
Summary of OPH contribution to equipment in SR (NBTS)
Evaluation of potential overlap of strategic priorities of the Slovak
healthcare system and priorities and objectives of the EU Cohesion
Policy and the Europe 2020 strategy
Basic frameworks for implementation of the Cohesion Policy after
2013
Thematic focus of the Cohesion Policy after 2013 in the Slovak
Republic
Development prognosis
Priorities of the Slovak healthcare system
Potential funding of healthcare from Cohesion Policy funds
6
Evaluation Questions
88
6.1
Topic 1
88
5.1.3
5.1.4
5.2
5.2.1
5.2.2
5.2.3
5.2.4
5.3
5.3.1
5.3.2
5.3.3
5.3.4
5.4
5.4.1
5.4.2
5.4.3
5.4.4
5.4.5
5.5
5.5.1
5.5.2
5.5.3
5.5.4
5.6
5.6.1
5.6.2
ii
21
21
22
30
30
32
35
40
41
42
44
44
48
50
50
54
57
66
69
75
75
75
75
76
77
77
80
82
83
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6.1.1
6.1.2
6.1.3
6.2
6.2.1
6.2.2
6.3
6.3.1
AQ1 – What is the impact of the approved OPH projects on
increasing the quality of the provided healthcare within the
infrastructure of supported healthcare providers?
increasing the efficiency of the provided healthcare within the
increasing the availability of the provided healthcare within the
Topic 2
AQ1 – What is the contribution of the approved OPH projects to
decreasing the regional differences in the context of the existing
healthcare needs of regions as per ‘diseases of group 5’?
(evaluation criterion of availability)
AQ2 – Are the criteria specified in OPH for calculation of the
indicative regional allocation on the level of priority axes and
NUTS II regions relevant and suitable? (evaluation criterion of
relevance)
Topic 3
AQ1 - What is the content potential of overlap of priorities of
strategic development of the healthcare system in Slovakia until
2020 with priorities and objectives of new EU Cohesion Policy for
the 2014-2020 period and the Europe 2020 strategy?
88
91
94
96
96
97
98
98
7
Conclusions and Recommendations
101
7.1
7.2
Conclusions
Recommendations
101
103
A
List of Abbreviations
106
B
List of tables
107
C
List of graphs
108
D
Overview of Calls
109
E
A complete list of Groups and Subgroups with their efects and
possible proofs
110
F
Additional views
112
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1
Introduction
This document represents the Final Report for the Evaluation of impacts of the ‘Operational
Programme Health’ (hereinafter referred to as the ‘OPH’). The Report contains a description of
evaluation steps taken, outcomes of analyses, outputs from the processed data cumulated into
particular outcomes and evaluation recommendations. The evaluation started with preparatory
works on 7 August 2012 and was carried out from 6 September 2012 to 27 May 2013.
This Report is a third and final output resulting from the Contract for Work (Contract
Registration No. 484/2012) of 1 August 2012, effective from 2 August 2012.
This Report contains findings and conclusions to all thematic areas based on available data and
limitations. The reason for limitations is several facts which have been discussed with and
approved by the ordering party.
1.1
Report Objectives
The objective of the Final Report is to present conclusions, answers to defined evaluation
questions, and recommendations resulting from the performed analytical works. The Final
Report contains a summary of the selected procedure, divided into individual tasks, the elements
of the methodology used, to perform the evaluation according to individual evaluation
questions. Further more it contains a description of activities performed throughout the whole
evaluation.
1.2
Report Structure
The interim report is divided into seven chapters, the purpose of which is to detail the following:
1. Chapter 1 - Introduction: introduces the document, its objectives and its structure.
2. Chapter 2 – Summary: summarizes the whole document into a brief and factual summary.
3. Chapter 3 – Objectives and scope of assessment of impacts of OPH: defines the starting
points, objectives and extent of the assessment.
4. Chapter 4 – Assessment process: describes the information sources used, activities
performed, persons involved, with areas of their competencies, as well as methods used in
the assessment.
5. Chapter 5 – Summary of findings of the assessment of outputs and impacts of OPH:
presents individual elaborated outputs from the analyzed data, and classifies partial
conclusions depending on the selected assessment method.
6. Chapter 6 – Assessment questions: answers to individual specified assessment questions for
all three defined topics.
7. Chapter 7 – Conclusions and recommendations: contains overall assessment conclusions
and related recommendations for the future.
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2
Executive summary
Scope and objectives
The objective of the evaluation of impacts of OPH is to inform the public on the current state of
performance of OPH in the following three topics:
•
evaluation of achieving the strategic objective of OPH within the projects approved;
•
evaluation of regional contributions of the projects approved;
•
evaluation of any potential overlaps of strategic priorities of the Slovak healthcare system
and priorities and objectives of the EU Cohesion Policy and the Europe 2020 strategy for
the needs of strategic planning in the new programming period of 2014 - 2020.
The amount of 282,056,912.40 was contracted as of 30 June 2012 within 65 projects, out of the
total OPH financial allocation within the priority axes 1 and 2 representing 284,911,765; i.e.
99.00% of the allocation for the priority axes 1 and 2. Drawing in these projects represents
157,991,387.90; i.e. 56%, and 22 projects were finalized in the value of 80,406,246.10; i.e.
28.5%.
The evaluation started with preparatory works on 7 August 2012 and was carried out from 6
September 2012 to 27 May 2013. The evaluation itself was based on defining the quality,
efficiency and availability; then all projects and their outputs were examined in detail, for the
finalized projects an assessment of the outcomes was possible. Formation of the so-called output
Groups and Subgroups for aggregation of parameters of an inhomogeneous set enabled to make
the evaluation. Further examinations analyzed impacts together with their evidentiary nature as
a consequence of individual outputs. The above-stated took into consideration the development
of the need (hospitalisation, mortality) in individual regions in time, the rate of national
allocation, always depending on individual measures, as well as an overall context of the
condition of infrastructure and equipment.
Summary of conclusions
We may generally say that OPH has met the targets of its focus – to support healthcare
infrastructure through reconstructions, construction and purchase of medical equipment. The
proportion of expenditures spent on individual cost areas seems to be appropriate.
Individual outputs of OPH projects and their proportion within the created measures reflect the
needs and priorities of relevant medical facilities as well as their nature:
•
Measure 1.1 – Specialized hospitals – 43.91% used for new diagnostic equipment; 15.89%
for new therapeutic equipment; 18.54 for reconstructions;
•
Measure 1.2 - General hospitals - 7.55% used to improve the condition of operating rooms;
and 4.74% for new operating equipment; 22.12% for reconstructions and 41.35% for
construction;
•
Measure 2.1 – Outpatient healthcare providers – 42.20% used for new diagnostic
equipment; 35.38% for reconstructions and 10.24% for construction;
•
The measure 2.2 is formed by a single national project for NTS (National Blood Transfusion
Service) where 57.94% was used for equipment, 8.92% for special vehicles and 33.13% for
reconstructions.
•
In the five-year period OPH largely contributed to supplementation/renewal of equipment.
On average 22.81% of specific types of equipment purchased between 2007-2011 was
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bought thanks to OPH. As an example of significant equipment, we may mention three
linear accelerators in the self-governing regions of Košice, Žilina and Nitra.
•
From constructional point of view, reconstructions have decreased energy consumption (on
average for m2 4-7% in large construction objects, 20-44% in small construction objects) in
6 finalized projects, similar values may also be expected with unfinished projects. The total
area of new objects for finalized projects is 38,985 m2 and for unfinished projects it is
164,069 m2.
Evaluation of OPH impacts also identified a clear relation and contribution of projects and their
outputs to the quality, efficiency and availability of healthcare. An average structure of the
impact among the quality, efficiency and availability has been assessed as follows: 58% for
quality, 24% for efficiency and 18% for availability.
OPH fulfils the focus on ‘diseases of group 5’ representing a specified priority which is based in
the mortality data (around 92%) as well as on hospitalisation (around 50%).
•
OPH objectives and strategy were set with non existence of the basic strategic framework
for systemic transformation of the Slovak healthcare system, which could be specifically
addressed and align individual investments with. As a result of this fact the extent of OPH is
defined fairly generally.
•
From a regional point of view it is possible to conclude that the OPH’s contribution
positively fulfils the specified objectives to improve the healthcare infrastructure. There are
both similarities and differences among individual regions in the starting condition, and also
the OPH contribution has certain similar and certain different characteristics from the point
of view of financial allocation, groups of outputs, focus on 'diseases of group 5', as well as
from the point of view of individual measures. In view of individual regions, generally the
contribution seems to be in line with the OPH objectives and strategy.
OPH objectives and strategy were set with non existence of the basic strategic framework for
systemic transformation of the Slovak healthcare system, which could be specifically addressed
and align individual investments with. As a result of this fact the extent of OPH is defined fairly
generally.
From a regional point of view it is possible to conclude that the OPH’s contribution positively
fulfils the specified objectives to improve the healthcare infrastructure. There are both
similarities and differences among individual regions in the starting condition, and also the OPH
contribution has certain similar and certain different characteristics from the point of view of
financial allocation, groups of outputs, focus on 'diseases of group 5', as well as from the point
of view of individual measures. In view of individual regions, generally the contribution seems
to be in line with the OPH objectives and strategy.
In spite of the EC’s standpoint in the Position Paper where it expressed the opinion that
interventions in the healthcare system should be primarily funded from national resources, there
are options to support selected parts of the healthcare system. The largest scope for supporting
the healthcare system from funds of the Cohesion Policy may be seen in thematic objective 9
Promoting social inclusion and combating poverty, and within the thematic objective 11
Enhancing institutional capacity and efficient public administration. In our conditions the
above-mentioned thematic objectives should cover the OP Human resources and the OP
Efficient public administration. In line with the EC requirement (relevant ex-ante conditionality)
for the existence of a national strategic framework for healthcare system, funding from
resources of Structural Funds should be justified by the need to systematically address
shortcomings of the Slovak healthcare system (reforms). Efficiency and sustainability of
healthcare provision and enhancement of its quality and availability, while considering the
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demographic trends, should become a priority. Integrated and sustainable solutions will require
a suitable connection of processes and services, human resources and modernization of
infrastructure funded in the programming period of 2014-2020.
Summary of recommendations
•
For a further assessment process it is our recommendation to use the indicators of output
and impact within the whole Programme and for all projects, on the basis of an approach
and logics created when evaluting the impacts.
•
When determining indicative regional allocations in the future, it is our recommendation to
use other parameters and related criteria which are more suitable than those used currently.
•
It is our recommendation to plan a further evaluation of impacts of the Programme at the
time when it is possible to quantify impacts of at least two thirds of OPH projects after their
termination as well as of data prerequisites (amount, quality and system of collection) for a
fully-fledged ex-post evaluation.
•
Successful performance of an evaluation is preconditioned by appropriate data availability
and cooperation with key owners of this data, mainly VŠZP, NHIC or HCSA. Key data
from health insurance company/companies necessary for quantitative aspects of assessment
are currently unavailable due to legislative barriers.
•
For a potential further assessment, it is our recommendation to focus on two specific
thematic areas, namely quantitative specification of added value in increasing energy saving
on the basis of reconstruction and thermal insulation of buildings of healthcare providers,
and assessment of quality improvement of an exactly determined performance of a
particular type of a device for a frequent diagnosis which is of great significance in view of
the hospitalisation rate and mortality.
•
In the area of assessing the potential of overlapping strategic priorities:
-
It is our recommendation to ensure consultancy of the form and content of the Strategic
Framework in the healthcare system for 2013-2030 in relation to a relevant ex-ante
conditionality.
-
To focus on presentation of an integral strategy containing two interrelated
measures/activities with a common target – systemic effort to increase the efficiency of
healthcare, while taking into consideration the development forecast and experience
from OPH implementation, which should be funded from the Cohesion Policy funds.
-
To further elaborate key systemic measures which are a condition/starting point for
performance of other measures and projects.
-
Preparation and execution of systemic changes in the healthcare system is
preconditioned by performing an independent analysis of healthcare provision. The
analysis should also involve assessment of performance, age and use of medical
equipment, also using the data of health insurance companies.
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3
Evaluation Objectives and Scope
This chapter is focused on the definition of a starting point, objective and scope of OPH
assessment.
OPH is a programming document of the Slovak Republic for drawing assistance from funds of
the European Union (hereinafter "EU") for the healthcare sector for the 2007 - 2013 period. It
contains the strategy, targets, and also defines multi-year measures to achieve them, performed
using national resources and resources of the European Regional Development Fund
(hereinafter referred to as the ERDF・. On the basis of Government Resolution of the SR No.
832/2006 of 8 October 2006, the Managing Authority for the OPH is the Ministry of Health of
the Slovak Republic (hereinafter referred to as the MZ SR・.
3.1
Starting Points for Evaluation
The Council Regulation (EC) No 1083/2006 laying down general provisions of the ERDF, ESF
and CF, also specifies assessment principles and rules, based on shared responsibility of the
Member States and of the Commission. MZ SR, as a managing body for OPH, is responsible for
its assessment.
The amount of 282,056,912.40 was contracted as of 30 June 2012 within 65 projects, out of the
total OPH financial allocation within the priority axes 1 and 2 representing 284,911,765; i.e.
99.00% of the allocation for the priority axes 1 and 2. Drawing in these projects represents
157,991,387.90; i.e. 56%, and 22 projects were finalized in the value of 80,406,246.10; i.e.
28.5%.
As a part of the starting point, we find it important to define the terms used in the assessment in
this Report (they are based on definitions of the programming period of 2007-2013):
3.2
•
output – is a direct product/service of a supported intervention (project);
•
outcome – contribution of a product/service for a target group which will be manifested in a
short time;
•
impact – contribution of a product/service not only for a target group which will be
manifested after a longer time.
Evaluation Objectives
The aim of the assessment is to inform the public about the current status of performance of
OPH, mainly from the point of view of assessment, divided into the following three topics:
Topic 1: assessment of achieving the strategic objective of OPH within the projects approved;
Topic 2: assessment of regional contributions of the projects approved;
Topic 3: assessment of potential overlaps of strategic priorities of the Slovak healthcare system
and priorities and objectives of the EU Cohesion Policy and the Europe 2020 strategy
for the needs of strategic planning in the new programming period of 2014 - 2020.
3.3
Evaluation Scope
The scope of assessment of impacts is defined by intentions and objectives of the OPH itself, in
the form of concentrating support for construction, reconstruction and modernization of
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healthcare infrastructure. This focus of the Programme was considered in the assessment as the
main focus perspective.
3.4
Beyond the Scope of the Evaluation
Beyond the scope of assessment there are, inter alia, aspects of impacts on provision of
healthcare resulting from the point of view of development of treatments, pharmaceuticals and
drug policy which are not related to the outputs and focus of OPH projects.
3.5
Limitations
3.5.1
Criteria for defining the quality, availability and efficiency
A major complication for the assessment was the fact that no criteria for defining the quality,
availability and efficiency were defined in the operational programme, i.e. creation of categories
and connections became a part of the assessment; at the same time the analysis of outputs of the
projects was more complex and time-consuming.
3.5.2
Use of the counterfactual method
The counterfactual method was not applicable for the assessment due to a lack of objective and
quantitative data to define control groups. A starting prerequisite for using the counterfactual
method was additionally made complicated as a result of inhomogeneity of the focus of the
projects and their indicators as well as not defined assessment criteria. On the basis of the
above-stated, it was not possible to quantify a direct or indirect connection of investments with
effects and impacts.
3.5.3
Use of a panel of experts or of the Delphi method
The methods of the panel of experts and the Dephi method were not used in the assessment as a
result of sufficiently efficient productivity of the focus group, where a complex consensus was
reached as for the selected methodology of approach as well as partial conclusions and
outcomes.
3.5.4
Quantification of efficiency and availability directly related with the Programme
The quantification of efficiency and availability itself was limited by available information.
A requirement of the insurance company of VšZP to change the catch areas of individual
beneficiaries was critical for availability as one of three assessment parameters. Information
based on this requirement could not be obtained, i.e. the qualification contained in this Report is
based on information provided by the beneficiaries.
3.5.5
Situation related to the Topic 3
Performance of the assessment in relation to the Topic 3 was substantially influenced by the fact
that strategic documents on the level of the Slovak Republic were not available at all at the
beginning of the assessment. It actually means that the assessor got acquainted with a working
(non-official) version of the basic document for the use of the support from the Cohesion Policy
in the healthcare system – Strategic Framework in Healthcare for 2013-2030 - only at the very
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end of the assessment. At the time of assessment, the Partnership Contract between Slovakia
and the European Commission was not elaborated which is the basis for use of the European
Investment and Structural Funds in the programming period of 2014-2020 and it also identifies
the areas of support. A similar situation could also be seen on the level of operational
programmes the first versions of which were submitted in late April 2013.
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4
Evaluation procedure
4.1
Summary of Information Inputs
The following institutions or information channels were some of the main information sources
for the assessment:
4.1.1
•
Ministry of Health of the Slovak Republic;
•
Všeobecna zdravotná poisťovňa health insurance company;
•
National Health Information Centre;
•
Questionnaires for beneficiaries of finalized projects (OP 1.1, OP 1.2, OP 2.1);
•
Visit and structured interview with an end beneficiary of the national project (OP 2.2);
•
Other resources, documents and legislation.
Inputs from the Ministry of Health of the Slovak Republic
The Ministry provided the entire project documentation to all OPH projects as well as summary
documents related to drawing of funds. It represented a partner for expert thematic discussions,
consultations and participation through representatives in the focus group. It also supported the
collection of information from beneficiaries of finalized projects through questionnaires.
4.1.2
Všeobecná zdravotná poisťovňa (health insurance company)
The following requirements were defined for VšZP as input assessment information:
•
A summary of the number of insured persons with VšZP before and after the merger, as
well as the evolution of migration of insured persons in order to make the output values of
other requirements objective.
•
The number of reported performances, number of re-hospitalizations and registered new
performances, including a classification of performances based on the patients' permanent
addresses for specified periods and particular providers.
•
Change of the catch areas of particular providers (OPH beneficiaries).
•
Comparison of general evolution of performances in the Slovak Republic for selected
medical equipment.
In spite of an intensive support by the Ministry of Health of SR, the above-stated information
was not provided to us with the reference to compliance with the Article 76 (1) of the Act No
581/2004 Coll. on Health Insurance Companies and Healthcare Supervision and in view of the
Act No 211/2000 Coll. on Free Access to Information.
Thus the assessment itself did not work with the above-stated data; we tried to make a partial
compensation with information collected directly from beneficiaries through questionnaires.
4.1.3
National Health Information Centre (NHIC)
NHIC provided the below-stated information as the assessment input:
•
Register of medical equipment;
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4.1.4
•
List of medical facilities, according to defined attributes;
•
Number of hospitalizations depending on diagnoses and regions for defined time periods;
•
Number of deceases depending on diagnoses and regions for defined time periods;
•
Summary of the bed fund and its use in the SR for defined time periods;
•
Annual statement of surgeries in bed departments depending on regions for defined time
periods;
•
Statistics on the state of health in the Slovak Republic for defined time periods;
•
Economic reports of selected providers.
Questionnaires for beneficiaries of finalized projects
The data and evidence of final effects of the Programme for providers were obtained through
questionnaires. 23 questionnaires had been sent (all finalized projects as of 30 June 2012 and the
Faculty Hospital Nitra) and 22 questionnaires were received. Generally the questionnaires
contained 350 questions and 265 answers were obtained.
4.1.5
Visit and structured interview with an end beneficiary of the national project
As for the NTS national project, we opted for a visit and a structured interview with the
beneficiary to obtain the necessary data.
4.1.6
Other resources, documents and legislation
•
Europe 2020 strategy.
•
Common strategic framework – staff document, part II.
•
Regulation drafts for the programming period of 2014-2020.
•
Position Paper of the Commission’s services related to elaboration of the Partnership
Agreement and programmes in Slovakia for the time period of 2014-2020.
•
Resolution of the Government Council for the Partnership Agreement for 2014-2020 of 18
December 2013.
•
Resolution of the Government of the SR No 139/2013 to the Draft of the structure of
operational programmes funded from the European Structural and Investment Funds for the
programming period of 2014-2020.
•
Information on healthcare support in the programming period of 2014-2020 from countries
such as Bulgaria, the Czech Republic, Hungary, Greece, Estonia and Latvia obtained in
structured questionnaires through a KPMG network.
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4.2
Progress in Time and the Process of Performed Evaluation Activities
4.2.1
Activities performed – Topic 1: Evaluationof achieving the OPH strategic target
Table 1: Schedule of activities performed within the Topic 1
2012
Topic 1: Assessment of achieving the OPH
strategic target
08 09 10 11
2013
12
01
02
03
04
05
1.1 Updating the needs of the ordering party in relation to the
given topic
1.2 Reconstruction/verification of the intervention logics of
the Programme and its parts
1.3 Analysis of outputs of projects supported within OPH
depending on the kind of the provided healthcare
1.4 Identification of causal relations between outputs and
potential effects
1.5 Assessment of the possibility to measure effects
1.6 Connections of effects with the quality, availability and
efficiency of the healthcare infrastructure
1.7 Identification of information sources for the purposes of
assessment
1.8 Quantification of real and expected effects of supported
projects
1.9 Qualitative analysis of effects of supported projects
1.10 Comprehensive assessment of effects of supported
projects
1.11 Preparation of findings, conclusions and
recommendations
Data source: KPMG
1.1 Updating the needs of the ordering party in relation to the given topic
The needs of the ordering party have been updated in relation to the assessment and the current
status of OPH implementation has been identified.
1.2 Reconstruction/verification of the intervention logics of the Programme and its parts
Summary documents on projects within the Programme, the allocated funds, percentage of
drawing funds, cost groups, the status of performance of projects, etc. have been analyzed.
These represented the starting point for knowing the real connections among problems,
objectives, sources, activities, outputs and effects in order to become familiar with the real
internal logics of the Programme.
Members of the assessment team participated in the ‘Operational Programme Health in projects’
conference to enhance their understanding of the overall context.
1.3 Analysis of outputs of projects supported within OPH as per the kind of the provided
healthcare
Full project documentations for OPH have been obtained and analyzed in order to assess their
outputs as well as an overall influence of the OPH impacts. The purpose of a multi-dimensional
analysis of outputs was to create suitable categories of outputs which could be tracked on the
level of projects, measures, Programme, and at the same time enable to assess the relevance to
the ‘diseases of group 5’.
The output for this activity was a working matrix, classifying projects according to outputs as
well as relevant indicators.
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1.4 Identification of causal relations between outputs and potential effects
Then a detailed analysis was carried out and a summary of achieved and planned outputs
enabling the assessor to assess the staring points for creation of effects. It was assessed how the
given outputs could be manifested in healthcare provision. In this regard the Programme does
not provide a suitable framework for assessment; therefore the assessment at this stage had the
nature of an ‘objective-free’ assessment. At this stage the focus group was used, enabling to
consider the opinions of expert public on the causal relations between outputs and potential
effects as well as overall setting of the selected assessment methodology.
Another input was updating of statistical data regarding hospitalisation and mortality of
population in relation to the ‘diseases of group 5', necessary to verify the topicality of the focus
of the Programme. The output of the process of updating is the chapter 5.4.3.1.
1.5 Assessment of the possibility to measure effects
Creation of causal connections among the achieved/planned outputs and potential effects was
initiated. Not all effects could be quantified, or rather not all effects can be quantified through
the data collected by NHIC and health insurance companies. At this stage it was necessary to
identify the effects (contributions) which could be quantified and assessed from a qualitative
point of view or with a combination of both methods. At this stage the most suitable assessment
methods were evaluated and proposed, taking into consideration the inaccessibility of data from
VšZP.
1.6 Connections of effects to quality, availability and efficiency of the healthcare
infrastructure
In spite of the fact that the aim of the programme is to contribute to the quality, availability and
efficiency of healthcare, the OPH does not contain any closer definition of these attributes. For
the purposes of assessment it was necessary to additionally quantify the criteria for quality,
availability and efficiency, on the basis of which it is possible to evaluate the contributions.
Therefore a wider definition (context) of the given categories was proposed, to which effects
could be matched. Then it was necessary to exactly determine the data (indicators) which are
directly connected to these categories.
The output for this activity is the chapter 5.3.1.
1.7 Identification of information sources for the purposes of assessment
This task is crucial for quantification of effects (contributions) of the Programme. The system of
monitoring OPH provides a set of indicators with a different relevance for assessment of effects.
Therefore we obtained a summary of availability of data also from other sources; for this
purpose the meeting with NHIC and VšZP was used. Communication with both institutions and
exchange of information started immediately after a kick-off meeting of the project; however,
no relevant data has been obtained from VšZP. As a substitute, and as a different source of
information, questionnaires for beneficiaries of finalized projects have been selected.
A detailed list of information sources can be found in the chapter 4.
1.8 Quantification of real and expected effects of supported projects
In relation to identified outputs and effects, we have performed a collection of relevant data on
effects of the support. The first step was focused, using the data from NHIC, on quantification
of gross effects in which effects of other factors than OPH were also manifested. Then the
option to use contrafactual methods was assessed. The most perspective for this type of
assessment, from the point of view of the sample size and the possibility to create a control
group, seemed to be the Measure 2.1. The risk factor was a lack of time after finalizing the
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27. máj 2013
projects and availability of the data to the monitored characteristics which, together with
unavailability of data, lead to the fact that contrafactual methods could not be used.
1.9 Qualitative analysis of effects of supported projects
When quantifying the effects (gross or net ones) it is possible to find out to what extent the
selected characteristics of the target group have been changed. Under characteristics we
understand selected indicators of healthcare provision which can be monitored before and after
the use of the support from OPH, while beneficiaries represent the target group. However, the
quantitative analysis itself will not provide the information why such change has occurred and
what the main reasons were. For this reason also qualitative aspects of implementation were
assessed.
1.10 Comprehensive assessment of effects of supported projects
It represents the summary of knowledge and findings from both the quantitative and qualitative
assessments. The overall assessment should not only identify contributions of the programme to
the strategic objective of OPH, but also explain why the identified effects have or have not
occurred.
1.11 Preparation of findings, conclusions and recommendations
Based on the findings (quantitative and qualitative ones), main conclusions and
recommendations for the ordering party have been prepared.
4.2.2
Activities performed – Topic 2: Evaluation of regional contribution
2012
Topic 2: Assessment of regional
contribution
08 09 10 11
2013
12
01
02
03
04
05
given topic
2.2 Identification of main information sources to perform the
assessment
2.3 Analysis of healthcare needs of regions as per ‘diseases of
group 5’
2.4 Assessment of the contribution of approved projects from
the regional point of view
2.5 Assessment of indicative regional financial allocations
2,6 Preparation of findings, conclusions and recommendations
Data source: KPMG
The needs of the ordering party have been updated in relation to the assessment and the current
status of OPH implementation has been identified.
2.2 Identification of main information sources to perform the assessment
Full project documentations for OPH were obtained and analyzed in order to assess their outputs
as well as an overall influence from the point of view balancing of the focus of the Programme
on a regional level. The purpose of a multi-dimensional analysis of outputs was to create
suitable categories of outputs which could be tracked on the level of projects, measures,
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Programme, and at the same time enable to assess the relevance to the ‘diseases of group 5’ in
the context of regional comparison.
As other data sources, data from NHIC, Statistical Office and health insurance companies were
identified. Members of the assessment team participated in the ‘Operational Programme Health
in projects’ conference to enhance their understanding of the overall context.
A detailed list of information sources can be found in the chapter 4.
2.3 Analysis of healthcare needs of regions as per ‘diseases of group 5’
In order to analyze the healthcare needs of regions as per ‘diseases of group 5,’ statistical data
on hospitalisation and mortality of population in relation to the ‘diseases of group 5’ was
updated. The aim of this step was to update the status of demand, used as a benchmark for
assessing an actual and expected contribution of the approved OPH projects. The output of the
process of updating is the chapter 5.4.3.1.
2.4 Assessment of the contribution of approved projects from the regional point of view
The outcomes of the analysis of needs on the level of individual regions are confronted and
assessed against the outcomes of the analysis of obtained outcomes and effects of individual
projects. From a regional point of view, a shift in decreasing regional differences and covering
the identified demand was compared and displayed.
2.5 Assessment of indicative regional financial allocations
In order to assess the relevance and suitability of indicative regional allocations, summary
documents on projects within the Programme, allocated funds, the percentage of drawing, cost
groups and the status of performance of projects, etc. were analyzed, mainly in the context of
regional distribution. The proportion of achieving the effects on a regional level against original
objectives and criteria, and assessment of the impact of deviations or of a failure to meet the
originally determined indicative regional allocations were assessed. The output of this activity is
the chapter 5.4.1.1.
On the basis of analyses performed within the above-stated steps, the assessment team has
elaborated conclusions for individual assessment questions in the form of findings and answers
to the defined assessment questions, and specified supporting documents and starting points
related to these conclusions as well as relevant recommendations.
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4.2.3
Activities performed – Topic 3: Evaluation of potential overlap of strategic
priorities of the Slovak healthcare system and priorities and objectives of the EU
Cohesion Policy and the Europe 2020 strategy
Topic 3: Assessment of overlap of
2012
priorities of the healthcare system and the
08 09 10 11
Cohesion Policy
2013
12
01
02
03
04
05
given topic
3.2 Identification of main information sources to perform the
assessment
3.3 Collection of information and data on priorities of the
healthcare sector
3.4 Collection of information and data about the Cohesion
Policy after 2013 on the EU level
3.5 Collection of information on the status of preparation of
the programming period 2014-2020 in the Slovak
Republic
3.6 Assessment of relevance of medium-term priorities to the
support possibilities within the Cohesion Policy
3.7 Assessment of relevance of medium-term priorities in
relation to priorities of the SR for 2014-2020
3.8 Analysis of support of the healthcare system from
Structural Funds in other EU Member States
3.9 Assessment of suitability of selected forms of support for
the sector
3.10 Summary of possibilities and obstacles in healthcare
support from the SF after 2013
3.11 Preparation of findings, conclusions and
recommendations
Data source: KPMG
Based on an agreement with the ordering party, the analytical works related to performance of
the Task 3 started in early 2013. The main reason was the fact that only then important materials
for assessment of the possibilities to fund priorities of the healthcare sector from the Cohesion
Policy after 2013 were supposed to be available, i.e. a long-term concept of the Slovak
healthcare system and preliminary thematic focus of assistance from the SF and CF in the 20142020 programming period. Therefore, until 2012 the attention of the assessor was focused on
collection of relevant information and data mainly on the EU level or from other Member
States.
In the initial stage of the assessment, the needs of the ordering party in relation to the
assessment, particularly to performance of the Topic 3, were updated through personal meetings
and consultations.
3.2 Identification of main information sources to perform the assessment
Due to absence of basic documents to perform the analysis of potential overlap of priorities of
the Slovak healthcare system and the objectives of the Cohesion Policy, the attention was
focused on identification of main information sources. It was also necessary to monitor the
development of preparation of the Slovak Republic for the new programming period in view of
authorities in charge, particularly the Ministry of Transport, Construction and Regional
Development of the SR and the Government Council for Partnership Agreement for 2014-2020.
Since healthcare represents a significant topic also in the context of the Cohesion Policy for
several EU Member States (particularly new Member States), the assessor, following an
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agreement with the ordering party, initiated preparation of collection of information from other
countries. The information was related to the attitude to using funds of the Cohesion Policy to
support the healthcare system in the current programming period, and also the augmenting base
to support interventions in the healthcare system in the 2014-2020 programming period.
3.3 Collection of information and data on priorities of the healthcare sector
As the assessor was informed at the start of the assessment by the MA, the healthcare system, in
relation to strategic tasks of the new management of MOH SR, started to prepare a conceptual
document addressing the development of the healthcare system until 2030. The initial deadline
for processing a working draft of the concept which could be provided to the assessor was late
2012 and early 2013. Before the working version of the document was made available, the
assessor, in cooperation with the MA, initiated a meeting with a representative of the unit
responsible for elaboration of the concept. The purpose of the meeting was to obtain preliminary
information on intentions and content of the strategic document which was supposed to define
priorities of the healthcare system. A part of them should be funded from SF funds (ERDF or
ESF) in the future. The document itself- National Strategic Framework for Healthcare until
2030 - was not available to the assessor at the time of performing the assessment.
3.4 Collection of information and data about the Cohesion Policy after 2013 on the EU
level
The preparation process of a new cycle of the Cohesion Policy on the EU level continued, and
in the course of the assessment basic principles and requirements for the future 2014-2020
programming period were known. The Europe 2020 strategy and its strategic objectives on the
level of EU and of the Member States, as a starting point for preparation of the Cohesion Policy
after 2013, were approved. The Common Strategic Framework was adopted, detailing the
thematic focus of the Cohesion Policy and negotiations of regulations with the EC. In late
October 2012 the so-called Position Paper was published, containing the ideas of the EC on the
thematic focus of assistance from the SF and CF for the Slovak Republic in the 2014-2020
programming period. The MA made other materials available to the assessor, dealing with
healthcare support options from the SF (EC documents, outputs of international projects).
3.5 Collection of information on the status of preparation of the 2014-2020 programming
period in the Slovak Republic
Collection of information relevant for assessing the option to fund the healthcare sector from
funds of the Cohesion Policy was affected by a delay in the preparation process of the Slovak
Republic for the 2014-2020 programming period. It was only in December 2012 when the
Government Council for the Partnership Agreement for the 2014-2020 programming period
made a decision on determining governing bodies together with a basic thematic orientation of
the programmes. In relation to this decision, in January 2013 the process of real preparation on
the level of the Partnership Agreement and operational programmes was initiated. The CCB and
governing bodies were obliged, until the end of April 2013, to submit first drafts of the
Partnership Agreement and new operational programmes. For the purposes of assessment, the
assessor only had a non-official version of the analytical part of the Partnership Agreement
available.
3.6 Assessment of funding options of interventions in the healthcare system
On the basis of the collected documents, the assessor initiated the analysis of funding options of
the healthcare system from funds of the Cohesion Policy in the 2014-2020 programming period.
The analysis was based on available official texts and knowledge of the negotiation process of
the EC. In the analysis the assessor proceeded from the Europe 2020 level through the Common
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27. máj 2013
Strategic Framework, drafts of regulations and other specific supporting documents. It means
from the EU strategic objectives until 2020 up to the level of thematic focus and eligibility of
the support of particular funds (ERDF and ESF). The analysis forms basic frameworks for
funding options of the healthcare system in the 2014-2020 programming period.
3.7 Assessment of relevance of medium-term priorities in relation to thematic objectives
and investment priorities of the Slovak Republic for 2014-2020
In the course of the assessment the assessor did not have a strategic document related to
development of the Slovak healthcare system available – National Strategic Framework for
Healthcare until 2030. At the same time, the strategic part of the Partnership Agreement was not
elaborated at this time which would clearly identify and describe thematic objectives and
investment priorities (strategy) for the future programming period. For this reason the analysis
was based on the supporting documents provided by the MA on the status of discussions with
MA about the option to include particular needs of the healthcare system in relevant
programmes.
3.8 Analysis of support of healthcare from Structural Funds in other EU Member States
The healthcare system is not, and will not be, a prominent area of support from the Cohesion
Policy. At the same time, the current setting of the strategic documents of the EU and regulation
drafts creates a scope for investment support in the healthcare system. In particular new
Member States (EU12) will wish to co-fund a part of their needs in the healthcare system from
the ERDF and ESF funds, as the healthcare system represents a strategic priority for them. In
order to find out the approach of selected EU Member States (Bulgaria, Czech Republic,
Hungary, Greece, Estonia, Latvia) to supporting their healthcare systems in the 2014-2020
programming period, a special questionnaire was prepared. It focused on a brief analysis of
funding of the healthcare system from the SF in the 2007-2013 programming period, and on
information on the process towards integration of the needs of healthcare system in the
Partnership Agreement/operational programmes so that they could be funded from the SF.
3.9 Assessment of suitability of selected forms of support for the healthcare sector
The aim of this activity was to process an analysis of alternative attitudes to funding of selected
interventions in the healthcare system. In the 2014-2020 programming period the EC will foster
an increase in the volume and total share of funds from the Cohesion Policy used through a
returnable form of assistance. Funding through innovative financial tools is related particularly
to SMEs. The assessor elaborated a summary of basic tools, possibilities and limitations of their
application on the basis of the current status of the preparation process of the 2014-2020
programming period.
3.10 Summary of possibilities and obstacles in healthcare support from the SF after 2013
On the basis of information and performed analyses, the assessor identified the possibilities and
limitations in the support of healthcare system in the 2014-2020 programming period. This part
contains main findings, conclusions and recommendations related to justification of funding of
the healthcare system, taking into account the starting point of the EC - that this area should be
funded mainly from funds of the national budget.
Based on the findings (quantitative and qualitative ones), main conclusions and
recommendations for the ordering party have been prepared.
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4.3
Evaluation Team
We are including a list of persons who participated in the evaluation activities, together with
specification of their tasks and performed activities and areas of their responsibility.
Table 4: Evaluation team
Expert’s name
Martin Obuch
Michal Blaško
Position:
Activities performed
•
•
•
•
•
•
specialist
•
•
•
•
•
specialist
•
•
Adam Hochel
expert in
healthcare
Danka Kovaľová
expert in
Cohesion Policy
András Kaszap
expert in
Cohesion Policy
János Matolcsy
expert in
Cohesion Policy
Zdeno Veselík
expert in
healthcare
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
communication with MOH SR
methodological leadership of the team
identification of information sources
participation in focus groups
assessment of effects of the Programme
assessment of overlap of priorities of strategic
development of the healthcare system in Slovakia
until 2020 with priorities and objectives of new EU
Cohesion Policy for the 2014-2020 period and the
Europe 2020 strategy
application of selected methods
data collection and processing
communication with MOH SR
identification of information sources
analysis of priorities and strategic objectives in the
healthcare system
assessment of effects of the Programme on the
regional level
analysis of priorities and strategic objectives in the
healthcare system
analysis of EU Cohesion Policy
analysis of preparation of SR for 2014-2020
analysis of forms of use of Structural Funds
analysis of preparation of SR for 2014-2020
analysis of forms of use of Structural Funds
assessor of impacts of public policies
analysis of priorities of the healthcare system
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27. máj 2013
Miroslav
Štvrtecký
specialist
Jozef Géci
project manager
•
•
•
•
•
•
•
allocation policy assessment
project management
communication and prioritisation of tasks in the
team
checking and reporting the status
coordination and cooperation with the ordering
party
Data source: KPMG
4.4
Methods Used
The below-stated summary contains a description of applied methods of assessment, as per
individual assessment questions, and their justification
Table 5: Summary of applied evaluation methods
Assessment
Topic
Method
question
Justification
1, 2, 3
Analysis of
project
documentation
Based on a multi-dimensional analysis of outputs we
created suitable categories of outputs which could be
tracked on the level of projects, measures and
Programme, and at the same time enabled to assess the
relevance to ‘diseases of group 5’.
1, 2, 3
Synthesis of
project outputs
A synthesis of similar characteristics of outputs
enabled creation of output groups and subgroups and
their further analysis beyond the project level itself.
1, 2, 3
Analysis of causal
relations
Based on an analysis of causal relations it was possible
to identify the relation among outputs, effects and
impacts on individual levels (projects, measures,
Programme).
1, 2, 3
Direct interviews and questionnaires enabled to
Direct interviews
identify specific effects for the projects as well as their
with beneficiaries
quantification in granularity of assessment on the level
and questionnaires
of the beneficiaries.
1, 2, 3
Focus group
The Programme does not provide a suitable framework
for assessment on the basis of defined criteria;
therefore the assessment has an ‘objective-free’ nature.
Focus group which enabled to consider opinions of
expert public on causal relations between outputs and
potential effects.
1, 2, 3
Commenting
Commenting enabled to consider opinions of expert
public as well as of the ordering party on the given
area.
1
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2
1, 2, 3
Brainstroming
Brainstorming enabled to efficiently involve the whole
assessment team in identification of individual
relations, effects as well as potential sources of
information.
1, 2, 3
Comparative
analysis
Comparative analysis enabled to consider individual
areas and assess their similarities or differences.
1,2
Analysis of causal
relations
On the basis of analysis of causal relations it was
possible to identify the relation among impacts on
individual levels (projects, measures, Programme) in
view of decreasing regional differences.
1,2
Comparative
analysis
1,2
Commenting
Commenting enabled to consider opinions of expert
public as well as of the ordering party on the given
area.
1
Analysis of
strategic
documents
On the basis of analysis of strategic documents, we
created integral strategic trends for individual areas.
1
Synthesis of
strategic trends
Synthesis of similar characteristics of strategic
documents enabled to create overall trends and their
further analysis.
1
Comparative
analysis
1
Survey in other
countries
In order to find out the attitude of selected EU Member
States to the support of healthcare system in the 20142020 programming period, a specific questionnaire
was created.
3
Data source: KPMG
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5
Summary of Findings of teh Evaluation of OPH Outputs and
Impacts
5.1
OPH Projects
5.1.1
Summary of the status of project execution
The table below contains a summary of OPH projects classified according to the stage of
execution of physical activities in the project as of 30 June 2012.
Table 6: Summary of OPH projects from the point of view of the status of their execution
Priority
axis
1.1
Number of
contracted
projects
11
1.2
15
Measure
Priority
axis 1
Priority axis 1 Total
2.1
Priority
axis 2
2.2
1
10
Number of
exceptionally
finished projects
0
11
4
0
26
12
14
0
40
30
8
2
Number of projects being
performed
Number of finalized projects
2
1
0
1
42
31
8
3
Total
68
43
22
3
Data source: MOH SR, Data current on 30.6.2012
•
It may be observed from the summary that the number of finalized projects for the whole
OPH is 22. In view of the defined term, the outcome the assessment may be focused on
actual outcomes exactly with these 22 projects.
In the table below we are presenting a cumulative summary of finalized projects as per years.
Table 7: Summary of OPH projects from the point of view of finalization as per years
2009
2010
2011
30.6.2012
1.1
Number
of
projects
*
11
3
7
10
10
1.2
15
0
0
4
4
26
3
7
14
14
2.1
38
1
2
7
8
2.2
1
0
0
0
0
39
1
2
7
8
Total
65
4
9
21
22
Priority
axis
Priority
axis 1
Measure
Priority
axis 2
Cumulated number of finalized projects depending on individual years
* Number of projects reduced by 3 exceptionally finished projects Applicable also to all below-stated tables
•
It may be concluded from the cumulated summary that the assessment may be focused in
outcomes only for 22 projects, but it needs to be emphasized that out of these, it is possible
to assess the impacts on the basis of objective statistical indicators only with 9 projects. This
is collected on an annual basis and as of the date of the elaboration of the assessment, the
most updated available processed data is for 2011.
•
In spite of the above-mentioned point, also two other projects, the National Blood
Transfusion Service (NTS) and the Faculty Hospital in Nitra were taken into consideration
in assessment of outcomes through a questionnaire and a visit. Both of them were included
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due to their importance; NTS forms a separate measure and the Faculty Hospital in Nitra has
been using its linear accelerator (part of outputs of OPH) since 2010.
•
5.1.2
In spite of the limitation which the above-stated summaries represent, the assessment
focuses on all outputs and impacts for all projects, i.e. with 65 projects the view of
assessment of expected outcomes and impacts will be used.
Summary of the number of projects, financial volumes and drawing rate
The table below contains a summary for OPH from the point of view of priority axes and
measures as well as the rate of drawing of funds.
Table 8: Summary of OPH projects from the point of view of drawing funds
Measure
Number of
projects*
Priority
axis 1
1.1
11
22 549 342 €
22 416 912 €
1.2
15
204 314 219 €
102 583 356 €
50,21%
26
226 863 562 €
125 000 268 €
55,10%
2.1
38
47 935 936 €
26 109 688 €
54,47%
2.2
1
7 257 415 €
6 881 432 €
94,82%
39
55 193 351 €
32 991 120 €
59,77%
Total
65
282 056 912 €
157 991 388 €
56,01%
Priority
axis 2
Contracted amount of NFC
Drawn amount of NFC as of 30
June 2012
Percentage of
drawing as of 30
June 2012
99,41%
Priority axis
Data source: MOH SR Current data on 30 June 2012, EUR – contracted NFC
5.1.3
•
It may be concluded from the summary that the Measure 1.1 focused on specialized
hospitals has been almost fully drawn.
•
Measure 2.1 contains the highest number of projects and currently one half of its funds have
been drawn.
•
The total drawing rate for all OPH projects is also about one half.
Summary of types of expenditures supported by OPH projects
The table below contains a detailed breakdown of expenditures supported by OPH. On the basis
of this summary, in particular the percentage breakdown of expenditures for modification of
constructions and purchase of equipment, it is possible to confirm the focus of the operational
programme on modernization of healthcare infrastructure. 44.25% was expended on the
purchase of medical equipment, modification of constructions represented 55.35% from the
OPH contracted amount and 0.33% were spent on ICT. However, this proportion is different on
the level of individual measures. In particular:
•
Measure 1.1 – equipment 80.31%, constructions 18.86%, ICT 0.78%
•
•
•
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27. máj 2013
Table 9: Summary of OPH projects form the point of view of types of expenditures
Type of costs
Measure
1.1
Priority axis 1
Measure
%
1.2
%
Priority axis 2
Measure
Measu
%
%
2.1
re 2.2
Total for OPH
EUR
637003 Promotion and advertising
8 676
0,04%
34 442
0,02%
91 358
0,18%
5 950 0,08%
140 425
637004 General services
1 441
0,01%
11 124
0,01%
155
0,00%
5 010 0,07%
17 729
176 426
0,78%
288 402
0,14%
492 136
0,99%
0
0,00%
956 964
711003 Purchase of software
0
0,00%
5 054
0,00%
8 599
0,02%
0
0,00%
13 653
711004 Purchase of licenses
0
0,00%
1 368
0,00%
18 001
0,04%
0
0,00%
19 369
176 426
0,78%
281 980
0,14%
464 224
0,94%
0
0,00%
922 630
0
0,00%
0
0,00%
1 312
0,00%
0
0,00%
ICT purchase
713002 Purchase of computer
equipment
713003 Purchase of telecommunication
technology
Purchase of medical equipment - total
18 108 875
713004 Purchase of operational
machinery, devices and equipment
713005 Purchase of special machinery,
devices and equipment
8 228 429
78 301 794
64 332 824
38,32
5 807
23 324 699 47,05%
%
773
5 037
31,49
20 107 066 40,56%
374
%
0,05
%
0,01
%
0,34
%
0,00
%
0,01
%
0,33
%
0,00
%
80,03
44,25
125 543 141
%
%
69,41
34,44
97 705 693
%
%
1 312
43,82
%
13 968 970
6,84% 3 217 633
6,49%
0
0,00% 27 067 049
0
0,00%
56 575 532
27,69
%
0,00%
0
0,00% 56 575 532
4 253 924
18,86
%
42 163 608
1 438
20,64
22 573 446 45,53%
683
%
19,82
24,83
70 429 661
%
%
0
0,00%
26 939 317
13,19
3 096 316
%
0,00% 30 035 633
9 880 446
714005 Purchase of special vehicles
0
Constructions and their modifications total
717001 Performance of new
constructions
717002 Reconstruction and
modernization of constructions
717003 Annex buildings, extensions,
construction modifications
80,31
%
36,49
%
%
4 253 924
9,54
%
10,62
0,27
0,00%
0
0,00%
0
0,00% 770 399
770 399
%
%
1 438 19,82
55,35
18,86
61,51
125 678 457
25 669 762 51,78%
157 040 826
683
%
%
%
%
0
6,25%
0
19,94
%
10,59
%
Data source: MOH SR, Data current on 30 June 2012, EUR – contracted NFC
5.1.4
Summary of projects based on ratio indicators
5.1.4.1
Target and approach of using the method of ratio and comparative analysis
The primary target of applying a de-compositional, i.e. ratio and comparative analysis, is to
identify and assess the absorption ability of individual operational programmes.
The basic logics of the ratio analysis is based on the DuPont analysis, as it divides the total
absorbing capacity rate of the operational programme on the basis of the following
implementation sub-procedures: submitting applications for NFC, approval of applications for
NFC, contracting projects and financial execution of projects.
5.1.4.2
Calculation of ratio indicators
Objective: calculation of ratio indicators
Task: to identify the rate of absorption and split it on the level of individual implementation subprocesses.
Output: defining individual ratio indicators for Measures 1.1., 1.2., 2.1. and 2.2.
•
Absorption rate (reimbursed grants / budget);
•
Demand rate (requested grants / budget);
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ABCD
•
Success rate after administrative check (grants approved by the administrative check /
requested grants);
•
Success rate after preliminary financial check (grants approved by the preliminary financial
check / grants approved by the administrative check);
•
Success rate after expert assessment (grants approved after assessment/ grants approved by
the preliminary financial check);
•
Approval rate (approved grants / grants approved after assessment);
•
Rate of contracting (contracted grants / approved grants);
•
Reimbursement rate (reimbursed grants / contracted grants).
Absorption
ratio
Popularity
ratio
Reimbursed
grants
*
Budget
Prel. fin.
pass ratio
Requested
grants
Evaluation
pass ratio
*
Admin check
passed req.
grants
Approval
ratio
Evaluation
passed req.
grants
Prel. fin.
passed req.
grants
Admin check
passed req.
grants
Requested
grants
=
Budget
Admin pass
ratio
*
Prel. fin.
passed req.
grants
Approved
grants
*
Evaluation
passed req.
grants
*
Contracted
ratio
Payment
ratio
Contracted
grants
Reimbursed
grants
Approved
grants
*
Contracted
grants
By assessing the outcomes of the ratio analysis, the it should be possible to identify the factors
influencing the performance of the particular operational programme on individual levels of
Programme implementation.
5.1.4.3
Financial indicators of the Programme
Financial indicators of OPH are specified in the summary table below.
Table 10: Summary of OPH funds
Budget
Grants
Grants
Grants
Approved /
Requested approved approved approved
Contracted Reimburse
assigned
grants
by admin. by prelim.
after
grants
d grants
grants
check
fin. check assessment
Priority axis
227 147 059 471 040 749 437 010 976 427 805 244 367 185 591 227 114 388 226 863 561 125 000 267
1
Measure 1.1
22 714 705
56 712 415
55 744 738
54 786 623
54 786 623
22 640 792
22 549 342
22 416 911
Measure 1.2 204 432 353 414 328 333 381 266 237 373 018 621 312 398 968 204 473 595 204 314 219 102 583 356
Priority axis
2
57 764 706
245 946 722 178 979 031 174 338 493 160 073 935
61 993 999
61 142 755
32 991 120
Measure 2.1
50 507 291
234 337 203 167 369 512 162 728 974 148 464 416
50 384 480
49 578 065
26 109 687
Measure 2.2
7 257 415
11 609 519
11 609 519
11 564 690
6 881 432
11 609 519
11 609 519
11 609 519
Data source: MOH SR, Data current on 30 June 2012, data in EUR
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27. máj 2013
Data on the number of applications for NFC in individual sub-processes of OPH implementation are
stated in the table below.
Table 11: Summary of the number of projects within OPH
Requested
grants
Grants
approved by
admin. check
Grants
approved by
prelim. fin.
check
Grants
approved
after
assessment
Approved /
assigned
grants
Contracted
grants
Priority axis 1
67
60
60
52
26
26
Measure 1.1
23
21
21
21
11
11
Measure 1.2
44
39
39
31
15
15
Priority axis 2
202
128
128
116
42
42
Measure 2.1
200
126
126
114
40
40
Measure 2.2
2
2
2
2
2
2
5.1.4.4
Ratio indicators
Based on the attitude explained in 5.1.4.1, the table below presents calculated ratio indicators of
Programme implementation, while the table below shows rates calculated by using financial
sums within individual sub-processes of OPH implementation and the following table based on
applications for NFC submitted within these sub-processes.
Table 12: Ratio indicators of OPH (based on finances)
Absorption
rate
Demand
rate
Success
rate after
admin.
check
Success
Success
rate after
Approval
Rate of Reimburse
rate after
admin.
rate
contracting ment rate
assessment
check
Priority axis
1
55%
207%
93%
98%
86%
62%
100%
55%
Measure 1.1
99%
250%
98%
98%
100%
41%
100%
99%
Measure 1.2
50%
203%
92%
98%
84%
65%
100%
50%
Priority axis
2
57%
426%
73%
97%
92%
39%
99%
54%
Measure 2.1
52%
464%
71%
97%
91%
34%
97%
53%
Measure 2.2
95%
160%
100%
100%
100%
100%
99%
60%
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ABCD
Table 13: Ratio indicators of OPH (based on applications for NFC)
Success rate after Success rate after Success rate after
admin. check
admin. check
assessment
Approval rate
Rate of
contracting
Priority axis 1
90%
100%
87%
50%
100%
Measure 1.1
91%
100%
100%
52%
100%
Measure 1.2
89%
100%
79%
48%
100%
Priority axis 2
63%
100%
91%
36%
100%
Measure 2.1
63%
100%
90%
35%
100%
Measure 2.2
100%
100%
100%
100%
100%
5.1.4.5
Assessment of the Priority axis 1
The absorption rate on the level of the Priority axis 1 amounts to 55%. On the basis of
assessment and comparison of ratio indicators on the level of sub-processes we may identify
that the quality of elaboration of applications for NFC was considerably high (see the 93%, 98%
and 86% success rate of applications for NFC after their check and assessment). At the same
time we may state based on the data provided that only 62% of funds of the total volume of
funds of successful applications for NFC could be approved and then contracted. The current
absorbing capacity of the PA (55%) is mainly given by the reimbursement rate (55%). The
reimbursement rate corresponds to the current state of drawing in Slovakia, taking into
consideration the length of Programme implementation and its stage at the moment of
assessment.
The absorption rate of the Measure 1.1 amounts almost to its maximum (99%). Within this
measure a high interest in submission of applications for NFC by eligible applicants was
identified. As a result of that and in relation to limited funds in the financial plan of this
Measure, the approval rate amounts only to 41%. On the other hand we may state that drawing
of funds amounts almost to 100% (99%).
As for the Measure 1.2., amounting almost to 90% of the total budget for the Priority axis 1, the
absorption rate amounted to 50%. Similarly to the Measure 1.1., the demand rate by eligible
applicants was high, almost a double in comparison with the financial plan, and also the
qualitative aspect of applications for NFC was high – as many as 84% (from the point of view
of the requested NFC amount) of all submitted requests for NFC met the conditions of formal
correctness, completeness, eligibility and minimum required criteria of expert assessment.
5.1.4.6
Assessment of the Priority axis 2
The absorption rate of the Priority axis 2 amounts to 57%; that is a similar level as in the case of
the Priority axis 1. The demand rate in this Priority axis was achieving extreme values, as the
total number of applications for NFC exceeded the available allocation by more than fourfold.
On the other hand, only 73% of applications for NFC met the conditions of completeness,
formal correctness and eligibility. Similarly to the Priority axis 1, a low approval rate of
applications for NFC can be justified by the volume of funds allocated for the particular priority
axis. In view of the 59% reimbursement rate, we may conclude that main reasons for the
average level of absorption result from still continuing payments on the level of individual
projects.
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ABCD
27. máj 2013
The volume of funds for the Measure 2.1 forms a major part of the total allocation for the
Priority axis 2. The total demand rate in the stated measure amounted to astonishing 464%, i.e.
the total volume of requested funds exceeded the allocation by more than fourfold. However,
only 63% of all applications for NFC met the conditions of completeness, formal correctness
and eligibility. At the same time, due to low allocation only 34% of the total volume of
requested funds could be approved. We must also point out that as projects implemented within
the Measure 2.1. are still under process, until now the reimbursement rate has amounted only to
53% from totally contracted funds.
Within the Measure 2.2. only one national project has been carried out until now which,
however, has drawn the whole allocated amount of funds from the point of view of contracting.
Drawing of funds achieved a relatively high level, 95%, as of the date of submission of financial
statements.
5.1.4.7
Financial data on implementation of the Programme from the regional point of view
Currently we may use a comparative analysis to evaluate also implementation of OPH from the
regional point of view. The group of assessors used similar data for assessment from the
regional point of view as with overall assessment, yet it was necessary to divide regional
allocation down to the level of individual measures. In this case we used ratio calculation, based
on indicative regional allocation. We have classified basic financial indicators related to
implementation of the Programme into four basic categories:
•
Financial plan as per regions;
•
Amount of requested funds within applications for NFC as per regions;
•
Amount of funds within applications for NFC which met the conditions of formal
correctness and criteria of expert assessment as per regions;
•
Amount of funds within applications for NFC as per regions which were approved in the
selection procedure;
•
Amount of funds within applications for NFC as per regions which were contracted.
It is also necessary to mention that the above-stated assessment as per regions only applies to
Measures 1.1., 1.2. and 2.1. Within the Measure 2.2. there is 1 national project performed where
the eligible area is all regions in the SR.
The table below shows basic financial data classified as per regions.
26
ABCD
Table 14: Financial data on OPH implementation as per regions
STU
Financial plan
(budget)
Grants meeting
conditions of
fin.check and
criteria of expert
assessment
Requested
grants
Approved
grants
Contracted
grants
Priority axis 1
227 147 059
471 040 749
367 185 592
227 114 388
226 863 562
Measure 1.1
22 714 706
56 712 416
54 786 623
22 640 793
22 549 342
TT
874 516
491 070
491 070
491 070
491 070
NR
3 895 572
10 779 268
10 368 831
1 662 276
1 662 276
TN
3 180 059
6 773 619
6 010 454
0
0
BB
4 088 647
17 891 442
17 783 376
7 479 419
7 467 123
ZA
2 725 765
0
0
0
0
KE
3 498 065
7 096 278
7 096 277
7 096 277
7 017 234
PO
4 452 082
13 680 739
13 036 615
5 911 751
5 911 639
204 432 353
414 328 333
312 398 969
204 473 595
204 314 219
TT
7 870 645
27 627 901
27 050 798
13 579 358
13 579 358
NR
35 060 149
30 870 343
30 842 814
30 842 814
30 800 526
TN
28 620 529
46 065 115
24 572 098
3 640 000
3 640 000
BB
36 797 824
68 177 947
52 194 770
43 328 310
43 316 252
ZA
24 531 882
97 701 891
64 134 072
28 214 690
28 198 533
KE
31 482 582
81 153 213
51 187 064
40 885 349
40 832 774
PO
40 068 741
62 731 924
62 417 353
43 983 074
43 946 777
Priority axis 2
57 764 706
245 946 722
160 073 936
61 994 000
56 835 480
Measure 2.1
50 507 291
234 337 204
148 464 417
50 384 481
49 578 065
TT
5 894 610
36 458 149
19 493 984
6 305 170
6 208 255
NR
7 466 505
30 875 881
17 938 441
7 465 554
7 381 061
TN
6 287 584
24 936 404
17 281 375
1 167 675
1 167 675
BB
6 985 232
30 017 548
19 935 266
8 538 891
8 490 949
ZA
7 270 345
36 995 037
25 971 695
8 332 042
8 287 068
KE
8 135 477
30 750 070
16 182 675
4 101 260
4 089 408
PO
8 467 538
44 304 115
31 660 981
14 473 889
13 953 650
7 257 415
11 609 519
11 609 519
11 609 519
7 257 415
Measure 1.2
Measure 2.2
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ABCD
27. máj 2013
5.1.4.8
Assessment of measures from regional point of view
In assessment of individual Measures the assessment group also used comparative analysis,
assessing 4 basic ratio indicators which are crucial from the regional point of view:
•
Demand rate (requested grants / budget);
•
Success rate after administrative check, preliminary financial check and expert assessment
(grants approved after assessment / requested grants);
•
Approval rate (approved grants / grants approved after assessment);
•
Rate of contracting (contracted grants / approved grants).
We are presenting evaluation of individual OPH Measures below.
Table 15: Ratio indicators of OPH Measure 1.1 from regional point of view
Demand rate
Success rate after
admin.check,
prel.fin.check and
evaluation
Approval rate
Rate of contracting
Measure 1.1
250%
97%
41%
100%
TT
56%
100%
100%
100%
NR
277%
96%
16%
100%
TN
213%
89%
0%
0%
BB
438%
99%
42%
100%
ZA
0%
0%
0%
0%
KE
203%
100%
100%
99%
PO
307%
95%
45%
100%
It is generally true for the Measure 1.1 that the total demand rate significantly exceeded the
amount of allocated funds. From the point of view of individual regions we may state that
applicants from the regions of BB and PO were interested most. Applicants from the regions of
NR and KE were also very interested. In view of the fact that up to 97% of all submitted
applications for NFC met the conditions of administrative check, preliminary financial check
and expert evaluation, we may observe a high quality of their preparation. It also results from
the regional point of view that while the success rate in the selection procedure of applications
for NFC was high in the regions of BB, KE and PO, in NR only 16% were contracted from the
total volume of requested funds, and in TN it was as little as 0%. Eligible applicants from the
region of ZA did not submit any single application for NFC within 2 performed calls for the
Measure 1.1 (Note: there are only two eligible applicants in the region).
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ABCD
Demand rate
Success rate after
admin.check,
prel.fin.check and
evaluation
Approval rate
Rate of contracting
Measure 1.2
203%
75%
65%
100%
TT
351%
98%
50%
100%
NR
88%
100%
100%
100%
TN
161%
53%
15%
100%
BB
185%
77%
83%
100%
ZA
398%
66%
44%
100%
KE
258%
63%
80%
100%
PO
157%
99%
70%
100%
Within the Measure 1.2 applicants from all 7 STUs demonstrated their interest by submitting
applications for NFC. The highest demand was seen with applicants from the regions of ZA, TT
and KE. The demand rate again exceeded the total volume of allocated funds. In comparison
with the Measure 1.1, a lower qualitative level of applications for NFC was also seen, mainly
with applicants from the regions of TN and KE. On the contrary, a very high quality of
elaboration of requests for NFC was seen with applicants from the region of TT and then NR
and PO. The least successful were applications for NFC submitted by applicants from the region
of TN. However, the unequal success rate of applications for NFC in individual regions shows
smaller variations than with the Measure 1.1.
Demand rate
Success rate after
admin.check,
prel.fin.check and
evaluation
Approval rate
Rate of contracting
Measure 2.1
464%
63%
34%
98%
TT
618%
53%
32%
98%
NR
414%
58%
42%
99%
TN
397%
69%
7%
100%
BB
430%
66%
43%
99%
ZA
509%
70%
32%
99%
KE
378%
53%
25%
100%
PO
523%
71%
46%
96%
In the Measure 2.1 we may observe the highest demand rate whatsoever. Within all regions, it
greatly exceeded the capacity defined by financial allocation for the particular measure. The
above-stated implies a clear financial undersizing of this Measure. A high popularity and a
wider scale of eligible applicants may have lead to the fact that the quality of elaboration of
applications for NFC was significantly lower (63%) than with Measures 1.1. and 1.2. On the
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ABCD
27. máj 2013
contrary, with the exception of the region of TN we may state that the success rate of
applications for NFC in the selection procedure was most balanced from the regional point of
view with this Measure.
The rate of contracting is almost maximal with all Measures.
5.2
Outputs of OPH Projects
5.2.1
Explanation of division of outputs into Groups and Subgroups
Provision of healthcare may be defined as processes carried out through healthcare providers in
their premises/buildings in the form of diagnostics and treatment of diseases. The
premises/buildings of the providers have an impact on these processes; they mainly influence
the hygienic standard of patients as well as performance and work efficiency of medical experts.
From the economic point of view the premises/buildings are operating costs which have a
significant impact on the providers’ economy. From the point of view of healthcare quick and
correct diagnostics is crucial for the patients so that they can be provided with correct treatment
– in view of this the contribution of modern diagnostic technology plays a clearly important role
in these processes. The following treatment, if it takes place with the healthcare provider itself,
is modified by the quality/functionality of environment and therapeutic equipment. Each stay in
a medical facility is risky for the patient to a certain extent, while these risks may be decreased
by a fast and high-quality surgery or conservative treatment based on current scientific
knowledge with the tendency to shorten the hospitalisation period as much as possible.
In view of the above-stated processes, in order to assess the projects, we have created a system
of identification of the structure and quality of investments (in premises/buildings,
diagnostic/therapeutic equipment and other equipment) and their subsequent evaluation. The
basis was to define output groups and subgroups through which we subsequently identified and
evaluated effects of projects on the defined expectations in the area of impacts on the quality,
efficiency and availability of medical services. We have defined these Groups and Subgroups on
the basis of intervention areas in close connection with basic OPH expectations – to support
investments in infrastructure focused on diagnostics and treatment of ‘diseases of group 5’ in
view of increasing the quality, efficiency and availability of its provision.
Areas of intervention reflecting the basic areas of OPH investment are:
•
investments in equipment in the logics of preventivention and healthcare provided in the
system of public healthcare in SR (new diagnostic equipment, new surgical equipment, new
therapeutic equipment);
•
investments in other equipment of premises and operations directly related with providing
curative-preventive care (improvement of the status of operating rooms, improvement of the
status of emergency receptions, improvement of the status of departments of intensive care);
•
investments in other operations which improve the potential of high-quality healthcare
provision (construction of other healthcare-providing facility);
•
investments in buildings which, with their hygienic standard, have a potential to have a
positive influence on safety of patients during their stays in medical establishments, at the
same time they have an influence on operational cost-saving (reconstructions, constructional
extension of buildings) as well as investments in improving barrier-free facilities
(availability for disabled patients);
30
ABCD
•
investments in ICT logically improve the access to information on patients (results of
auxiliary examinations), rationalize documentation keeping and archiving.
We have further detailed the areas into specific Groups and these are further subdivided into
Subgroups in order to better understand individual effects and the possibility of their detailed
examination within the defined evidentiary approaches, and also the potential of comparing
investments performed through OPH and total investments performed in SR for the same period
(more details in the chapter 5.3.4).
The resulting Groups and Subgroups defined on the basis of the above-stated are:
New diagnostic equipment
Bronchoscopes
Density meter
ECHO – ultrasound diagnostic equipment
Gastroscopes and duodenoscopes
Other new diagnostic equipment
Colonoscopes, sigmoidoscopes and
rectoscopes
Laboratory technology
Mammographs
Equipment for magnetic resonance
Equipment for scanning, reproducing and
recording bioelectric values
Equipment for examining airways
X-ray diagnostic equipment
Computer tomography (CT)
USG – ultrasound diagnostic equipment
Equipment for assessing X-ray images
Equipment for special examination
(angiography)
New surgical equipment
Surgical endoscopes (laparoscopes,
arthroscopes)
Other new surgical devices
Colonoscopes, sigmoidoscopes and
rectoscopes
Medical lasers
New therapeutic equipment
Hyperbaric chamber
Other new therapeutic equipment
Linear accelerators
Lithotripters
X-ray therapeutic equipment
Devices for treatment with light, heat and
water
Simulation walking training for patients
with spinal chord damage using weighrelieving
Improvement of the condition of
Emergency department
New Emergency department equipment
Improvement of the condition of departments
of intensive care (department of
anaesthesiology and intensive medicine
(DEIM) and intensive care unit (ICU))
New equipment of departments of intensive
care (DEIM, ICU)
Resuscitation and intensive-care beds
Improvement of the condition of operating
rooms
Other equipment of operating rooms
Reconstruction of operating rooms
Other equipment
Functional equipment for operation
Furniture
Reconstruction
Reconstruction of buildings - utilities
Reconstruction of buildings - functionality
Reconstruction of buildings – facilities for
disabled
Constructional extension of premises
Creation of new premises for healthcare
provision
ICT
PACS
Software
PC and accessories
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27. máj 2013
This methodology was the subject of opposition by participants in the focus group of
4 December 2012, while it has been approved as the definitive assessment methodology.
Technical comments of participants in the focus group have been implemented in the
methodology.
We have also connected the defined effects with the expected influence on impacts (on quality,
efficiency and availability) which were defined in the OPH objectives and which are also one of
assessment objectives. More details on effects and evidence are to be found in the chapter 5.3.
In order to understand the methodology better, we are adding an example:
New diagnostic device (output group) – bronchoscope (output subgroup) has been bought 6
times through OPH (3 times out of that in finalized projects). These devices are expected to
have the potential to bring new quality to diagnostics thanks to new methodologies, improve the
capacity of the workplace (effects), what we can prove by the number of examined patients, and
by demonstrating new procedures (evidence) with an impact on quality and efficiency of
provided healthcare with the particular provider (impacts).
We obtained the data about output groups and subgroups from the projects and their budgets;
we have standardized effects and their impacts as a part of methodology creation. When
evidencing effects and their impacts we were only examining finalized projects, as effects and
impacts can be supported with evidence in time only with these. In spite of that, certain timing
relationships since the termination of the projects are minimal; therefore the data on the
numbers of examined/treated patients after termination of projects rather reflect a tendency than
represent a true picture of contribution of the investments. The above-stated is also modified by
processes of contracting (or non-contracting) of new procedures by individual health insurance
companies.
NHIC and individual beneficiaries of NFC were the sources of information. We have not
eventually obtained the planned information from VšZP. The data from NHIC supplemented,
inter alia, also statistical information related to the database of medical technology and
mortality. We obtained the data/evidence from providers in the form of questionnaires – we sent
23 questionnaires (all finalized projects as of 30 June 2012 and the Faculty Hospital in Nitra),
and received 22 of them. In total we asked 350 questions and obtained 265 answers.
5.2.2
Financial prospects of project outputs as per Groups and Subgroups
Below we are presenting all output Groups and Subgroups defined on the basis of the process
defined in the chapter 5.2.1 and their occurrence in individual priority axes and OPH measures,
with the exception of the NTBS national project (OP 2.2).
Explanations to the tables below:
•
The first column of the table defines the type of the group or subgroup (identified by
margins).
•
The second column expresses, in the lines of subgroups, the number of projects in which the
particular type of device/output occurred; in the lines of groups there are two figures – the
higher one in the brackets is the total sum of occurrence calculated by adding up the
occurrence in subgroups, the highlighted figure is the sum of the number of projects in
which the particular output type occurred (i.e. the figure cannot exceed the number of
projects).
•
The third column shows how many pieces (e.g. of devices) / times (e.g. reconstructions)
there are in all OPH projects.
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ABCD
•
The fourth column shows how many pieces (e.g. of devices) / times (e.g. reconstructions)
have been delivered in 22 finalized projects as of 30 June 2012.
•
The fifth column shows the total value in EUR for the particular group / subgroup.
•
The sixth column expresses the percentage proportion of the financial value of the group /
subgroup from the contracted funds for OPH.
Table 18: Summary of the numbers and funds of outputs as per Groups and Subgroups
for OPH (without 2.2)
Group / Subgroup
Bronchoscopes
Density meter
ECHO – ultrasound diagnostic equipment
Gastroscopes and duodenoscopes
Other new diagnostic equipment
Colonoscopes, sigmoidoscopes and rectoscopes
Laboratory technology
Mammographs
Equipment for scanning, reproducing and recording bioelectric
Equipment for examining airways
X-ray diagnostic equipment
Computer tomography (CT)
USG – ultrasound diagnostic equipment
Equipment for assessing X-ray images
Equipment for special examination (angiography)
Surgical endoscopes (laparoscopes, arthroscopes)
Other new surgical devices
Colonoscopes, sigmoidoscopes and rectoscopes
Medical lasers
Hyperbaric chamber
Other new therapeutic equipment
Linear accelerators
Litotriptors
X-ray therapeutic equipment
Devices for treatment with light, heat and water
Simulation walking training for patients with spinal chord
Improvement of the condition of Emergency department
New Emergency department equipment
Improvement of the condition of departments of intensive
New equipment of departments of intensive care (DEIM, ICU)
Resuscitation and intensive-care beds
Improvement of condition of operating rooms
Other equipment of operating rooms
Other equipment
Functional equipment for operation
Furniture
Reconstruction
Reconstruction of buildings - utilities
Reconstruction of buildings - functionality
Reconstruction of buildings – facilities for disabled
Creation of new premises for healthcare provision
ICT
PACS
Software
PC and accessories
Total
In how
many
projects
The
total of
how
many
pieces /
times
57 (136)
6
3
7
7
41
7
2
7
2
1
2
19
5
22
1
4
23 (30)
4
22
2
2
11 (14)
1
5
3
1
1
2
1
2 (2)
2
11 (17)
11
6
7 (10)
7
3
24 (37)
34
3
51 (118)
40
32
46
19 (19)
19
31 (36)
7
4
25
65 (419)
697
6
3
9
12
549
13
14
7
2
3
2
25
5
39
3
5
309
4
299
4
2
42
1
17
3
1
1
18
1
87
87
1456
1360
96
495
360
135
3522
3308
214
205
40
32
133
19
19
318
7
0
311
7150
The total of
how many
pieces / times
in finalized
projects
110
3
1
3
0
65
1
10
2
1
0
8
3
8
0
5
139
2
135
1
1
17
1
13
2
0
0
0
1
65
65
655
616
39
138
138
0
1730
1564
166
56
6
5
45
4
4
105
4
0
101
3019
In what ∑
EUR value
% share of
total
contracted
NFC funds
42 893 769 €
15,73%
978 213 €
0,36%
374 295 €
0,14%
1 494 284 €
0,55%
1 195 802 €
0,44%
10 487 307 €
3,84%
459 915 €
0,17%
747 098 €
0,27%
1 951 473 €
0,72%
3 444 801 €
1,26%
431 777 €
0,16%
86 599 €
0,03%
5 867 970 €
2,15%
3 054 537 €
1,12%
4 950 706 €
1,81%
236 120 €
0,09%
7 132 874 €
2,62%
12 040 746 €
4,41%
486 242 €
0,18%
10 750 608 €
3,94%
571 454 €
0,21%
232 442 €
0,09%
16 123 843 €
5,91%
240 781 €
0,09%
232 621 €
0,09%
14 084 031 €
5,16%
474 009 €
0,17%
404 283 €
0,15%
243 906 €
0,09%
444 212 €
0,16%
621 448 €
0,23%
621 448 €
0,23%
13 133 744 €
4,81%
11 632 356 €
4,26%
1 501 388 €
0,55%
16 642 208 €
6,10%
9 195 355 €
3,37%
7 446 853 €
2,73%
15 868 492 €
5,82%
15 329 694 €
5,62%
538 798 €
0,20%
65 705 867 €
24,09%
19 356 724 €
7,10%
46 349 142 €
16,99%
(nedostupné údaje)
88 777 177 €
32,55%
88 777 177 €
32,55%
960 056 €
0,35%
364 766 €
0,13%
31 010 €
0,01%
564 280 €
0,21%
272 767 349 €
100%
33
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27. máj 2013
Table 19: Summary of numbers and funds of outputs as per Groups for the Measure 1.1
In how
many
projects
Group / Subgroup
Improvement of the condition of departments of intensive care
(DEIM, ICU)
Other equipment
Reconstruction
ICT
Total
The
total of
how
many
pieces /
times
The total of
how many
pieces / times
in finalized
projects
% share of
total
contracted
NFC funds
In what ∑
EUR value
10 (17)
3 (3)
4 (6)
-
75
8
18
-
103
136
17
-
10 083 295,00 €
520 010,00 €
3 649 429,00 €
-
43,91%
2,26%
15,89%
0,00%
2 (4)
2 (2)
4 (5)
3 (5)
-
274
86
238
5
-
274
138
1730
11
-
2 (2)
11 (44)
2
706
4
2726
1 942 564,00 €
1 280 225,00 €
1 051 589,00 €
4 255 858,00 €
178 085,00 €
22 961 055,00 €
8,46%
5,58%
4,58%
18,54%
0,00%
0,78%
100,00%
In how
many
projects
Group / Subgroup
The
total of
how
many
pieces /
times
The total of
how many
pieces / times
in finalized
projects
% share of
total
contracted
NFC funds
In what ∑
EUR value
12 (25)
57
93
13 114 247 €
6,46%
8 (13)
210
139
9 627 742 €
4,74%
2 (3)
3
15
11 350 416 €
5,59%
(DEIM, ICU)
2 (2)
87
65
621 448 €
0,31%
9 (13)
1182
381
11 191 179 €
5,51%
4 (7)
408
138
15 331 583 €
7,55%
Other equipment
11 (12)
2856
1730
12 588 257 €
6,20%
Reconstruction
15 (31)
83
56
44 938 688 €
22,12%
41,35%
9 (9)
9
4
83 996 443 €
ICT
6 (8)
133
105
377 193 €
0,19%
15 (123)
5028
2726
203 137 197 €
100,00%
Total
In how
many
projects
The
total of
how
many
pieces /
times
The total of
how many
pieces / times
in finalized
projects
35 (94)
565
110
19 696 227 €
42,20%
12 (14)
91
137
1 892 995 €
4,06%
5 (5)
21
13
1 123 998 €
2,41%
-
-
-
-
0,00%
Group / Subgroup
(DEIM, ICU)
% share of
total
contracted
NFC funds
In what ∑
EUR value
-
-
-
-
0,00%
1 (1)
1
138
30 400 €
0,07%
Other equipment
19 (20)
428
1564
2 228 645 €
4,78%
Reconstruction
33 (82)
117
56
16 511 320 €
35,38%
10 (10)
10
4
4 780 734 €
10,24%
ICT
23 (26)
183
105
404 778 €
0,87%
Total
38 (252)
1416
2116
46 669 097 €
100,00%
34
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Chart 1: Summary of financial volumes of groups as per Measures
83 996 443€
50 000 000,00 €
45 000 000,00 €
40 000 000,00 €
35 000 000,00 €
30 000 000,00 €
25 000 000,00 €
20 000 000,00 €
15 000 000,00 €
10 000 000,00 €
5 000 000,00 €
0,00 €
Measure 1.1
5.2.3
Measure 1.2
Measure 2.1
Improvement of condition of central receipt
Improvement of condition of departments of intensive care
Other equipment
Reconstruction
ICT
Outputs and outcomes of projects divided into Groups and Subgroups
Based on the assessment of OPH outputs it may be stated that allocations of funds were
distributed mainly to such operations of providers which have a direct impact on diagnostics and
treatment of ‘diseases of group 5’. It is natural that a part of the investments also overlaps with
other diseases beyond the group 5 (more details in the chapter 5.2.4).
At this point outputs related to all projects are known; however, we consider the effects of
outputs to be outcomes and in relation to these we could only obtain relevant data from finalized
projects. On the basis of this we describe and assess outputs together for all Measures (except
for the Measure 2.2.). Naturally, we have a differentiated view of processes which are different,
but we consider those which are equal (diagnostics, surgeries, outpatient procedures, bed care,
etc.) as sufficiently similar to be grouped for the purpose of assessment of outputs or outcomes
(if also finalized projects are affected). A deeper individual analysis (e.g. classification as per
measures) would result in a decrease of relevance of assessments due to too little figures;
therefore the above-explained partially aggregated approach has been selected for the subchapters below.
5.2.3.1
‘New diagnostic equipment’ group
With its structure, the group of diagnostic equipment (15.73% of total OPH investments) is
focused on the group 5. The subgroup of ‘Other diagnostic equipment’ (3.84% of total
investments of the group) stands out of the given area as well as the ‘Laboratory technology’
(0.27% of total investments of the group) where it is not possible to define and verify a clear
relation to ‘diseases of group 5’ and other diseases.
From the point of view of diagnostic equipment it may be stated that investments in displaying
non-invasive methods (USG, ECHO, standard X-ray, angiography, CT, NMR) have brought
capacity increase to individual providers documented by the number of new examinations –
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27. máj 2013
altogether 47,169 new diagnostic procedures in finalized projects only have been added to the
system. In certain cases it is an increased capacity of the existing workplaces which varied
between 5% and 56% (e.g. density metering in NÚRCH Piešťany 20%), elsewhere it is
introduction of brand new methods (e.g. C-arm in one-day orthopaedics and traumatology in
Žilpo, s.r.o.). A special area is becoming independent from the provider of sub-supplier services
(SÚSCH Banská Bystrica in the area of conventional radiology). In certain cases the number of
procedures reported to health insurance companies has also increased, which can have a positive
effect on provider’s economy, elsewhere the contracting of certain new methods and related
procedures is still only underway. Due to a short timing relationship since the termination of the
projects, it is not possible to assess this view now. While with certain methods new equipment
has no effect on duration of one examination (bronchoscopy, colonoscopy, angiography), with
others 20% more patients can be examined in a time unit (USG, X-ray, mammography, density
metering).
As for patients, these investments have brought them a higher-quality diagnostics and a lower
radiation exposure (documented by parameters of new equipment) - this is clearly lower with
new digital technologies (X-ray and mammographs) by 33% to 90%, while it remains equal
with new angiographs (as the comparison was made with other already existing digital
angiographs). As almost all purchased displaying equipment is digital, it also improves the
availability of results in real time and decrease the costs of archiving the results in the future,
thus contributing to a more efficient operation in individual medical facilities.
Implementing new methods is a significant contribution of investments in modern diagnostic
technology, which brings a more exact and faster diagnosing with the potential of a more
effective and efficient treatment. New methods have been implemented with finalized projects
in bronchoscopy, echocardiography, ultrasonography of joints, skiascopy of lungs, angiography
and interventional radiology and gamagraphy. Other potential is hidden in endoscopy where
implementation of capsule endoscopy in diagnosing diseases of digestive system with several
outpatient care providers is greatly expected. In view of the fact that now the projects are
unfinished, these effects cannot be quantitatively verified at the time of assessment.
As for healthcare providers with bed departments, the diagnostic equipment had a minimum or
no demonstrable impact on decreasing the average hospitalisation time. A relevant shortening
was only seen in NÚRCH Piešťany (by 2.95 days). The impact on re-hospitalisations is
negligible.
5.2.3.2
‘New surgical equipment’ group
In the group of surgical equipment the investments have been allocated in modern surgical
methods (laparoscopic, arthroscopic, thoracoscopic instruments, lasers, etc.), supplementation to
pre-operational diagnostic methods (operational bronchoscopes, colonoscopes, etc.) and other
equipment enhancing the comfort of the operational team and safety of patients (slabs, lights,
anaesthesiological equipment, equipment for quick sterilisation).
Effects of these investments were manifested with finalized projects in increasing the number of
surgeries of individual providers in the first year after finalization of the projects (by 2,056
surgeries) with an increasing trend. The impact on decreasing the average hospitalisation time,
pre-operational complications and late complications of surgeries (nosocomial infections)
cannot be assessed now.
In view of the fact that the current reporting system towards health insurance companies defines
surgery as a part of hospitalisation, effects of investments on implementing new methods in
surgeries from the point of view of SR cannot be expressly statistically assessed either. In spite
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of that, we would like to state two examples below which clearly bring new quality for patients
also from this point of view.
In spite of an absence of a sufficient number of figures, at least two finalized projects (ORL
Humenné, s.r.o., and OFTAL, s.r.o, Zvolen) have brought significant qualitative and
quantitative outputs for patients in the area of modern surgery with the help of laser equipment.
5.2.3.3
‘New therapeutic equipment’ group
In the group of therapeutic equipment, several investments were spent on smaller devices
intended for rehabilitation (equipment for treatment with light, heat and water), (5.91% OPH),
extra-corporal lithotripsy, etc.
Purchases of 3 new linear accelerators seem to be important (East-Slovakian Oncologic Institute
– hereinafter referred to as KE, a.s., Hospital with Policlinics Žilina – hereinafter referred to as
ZA, Faculty Hospital Nitra – hereinafter referred to as NR), which is almost a half of such
‘heavy’ technology bought in Slovakia for the above-mentioned period (the second trio was
performed by a purchase covered from subventions from the national budget and only one was
purchased from the sources of the healthcare provider). In view of a long-term lack of
investment in the area of radiation oncology in the SR 1 this investment may be considered as
an important contribution to quality and availability. On the basis of this particular investment
there were 1,221 new therapeutic procedures in the first year of use. With two providers the
number of procedures increased by 31% (KE) or 22% (ZA) respectively; with one of them it
was a brand new investment, i.e. further increase in procedures may be expected after the
workplace has obtained sufficient experience. With two providers the waiting time for
examination dropped by one half (on average 13.6 days). Modernisation has brought capacity
increase (10% - KE or 20% - ZA respectively) for a time unit in comparison with old
equipment, and/but mainly more exact dosage and aim for radiation bursts and thus a lower risk
of damage to healthy tissues as well as higher radiation comfort and improved homogenity of
distribution of radiation doses in target volume, which also decreased the dose on surrounding
healthy tissues. The fact that e.g. with tumours of head and neck we can decrease the number of
radiations from 35 to 30 thanks to a more exact specification of the radiated volume of tissues
also contributes to overall comfort of patients and efficiency of treatment. With early diagnosed
lung tumours we can even decrease the number of radiations from 30 to 5 or 3 thanks to the
possibility of more exact targeting of the radiated volume.
Other two individual investments of nation-wide importance – purchase of a hyperbaric
chamber and purchase of a highly sophisticated rehabilitation device ‘Lokomat Nanos‘ are
significant within the group.
By purchasing the hyperbaric chamber (second one in the territory of SR) for a Highlyspecialized geriatric institute of St. Lucas in Košice, the range of diagnoses which may be
treated is widened, as well as the number of treated patients (impact on availability). At the
same time, this enables substitutability for cases of failure of the existing device in the burn
centre in Košice. 44 patients were treated with the device in the first year and 942 procedures
were provided to them.
Lokomat Nanos is a device which is one of its kind in Slovakia, and its location in NRC
Kováčová corresponds to its purpose – to reproduce the model of carriage of body and walking
mainly in the first stages of rehabilitation of patients with accident damage to brain and spinal
cord and thus to help decrease or eliminate their social dependence. In the first year of use the
1
Report on current development in the Slovak healthcare system and on performed and planned measures of the
Government of the Slovak Republic in the healthcare system, material No 47, debate of the Government of 6.6.2007
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27. máj 2013
device was used by 82 patients, while each of them underwent at least 10 exercise units. The
objective contribution for individual patients cannot be assessed in one hospitalisation now.
5.2.3.4
‘Improvement of the condition of Emergency department’ group
A significant contribution to enhancing the quality and efficiency of provided healthcare is the
support of investments in reconstructions and equipment of Emergency departments, in view of
their irreplaceable role for early diagnostics and treatment of emergency conditions in medicine.
There were three investments of a regional and supra-regional importance (FNsP Žilina, FN
F.D. Roosvelt Banská Bystrica and UN L. Pasteura in Košice). The impact of these investments
cannot be assessed separately from a system point of view. From international experience it is
known though that a well working Emergency department has an impact on a higher-quality and
faster treatment of conditions treated in outpatient care (fewer patients were received for bedstays) and forms an open door to further (hospital) care for the purpose of next diagnostic and
therapeutic procedures for life and health threat patrients.
5.2.3.5
‘Improvement of the condition of departments of intensive care (DEIM and ICU)
group
The group of investments directed at improvement of the condition of departments of intensive
care (DEIM and ICU) is another separately assessed allocation. Investments in equipment
(respirators, monitors, systems for automatic administration of drugs, etc.) and equipment with
modern (positionable and anti-decubitus) beds for intensive treatment were assessed separately
in the subgroups and almost always they were also connected with reconstruction of premises
(10 out of 11 projects). It may be stated within the assessment that for the monitored providers
they brought quality increase in equipment, environment and hygienic standard which was
manifested in decreasing the number of nosocomial infections (by 20% to 100% with finalized
projects), which is a significant impact on the quality of provided healthcare for patients, shorter
hospitalisation time and saving of resources for future treatment.
5.2.3.6
‘Improvement of condition of operating rooms’ group
The projects, mainly the Measure 1.2., also included investments from the group of improving
the condition of operating rooms as a defined space for provision of surgical treatment. A
connection with increasing the quality and efficiency is obvious from increasing the capacity
and efficiency. There were 886 new surgeries with finalized projects only in the first year of
use; other surgeries can be expected in the reconstructed infrastructure. A significant impact on
the quality of the provided healthcare may be deducted from the decrease in the occurrence of
nosocomial infections with operated patients (by 25-71%) as well as the drop in the number of
re-hospitalisations as a result of the same diagnosis (up to 25%). With certain projects brand
new operating rooms have been built/are being built, while patients used to be transported from
one building to another before and after a surgery (e.g. DFNsP Banská Bystrica).
5.2.3.7
‘Other equipment’ group
Investments in other equipment represent a quite heterogeneous group. It is functional
equipment for operation (small instruments, devices, sterilizers) and furniture, including beds
for bed departments. From the investment point of view, it is a significant (5.82% investments)
group. While it is very difficult to determine a direct relation of these investments to individual
diseases (of group 5), it is obvious that they contribute to subjective quality perceived by
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patients and staff, and objectively they can contribute to a higher hygienic standard of
departments. In the finalized projects we may observe a decrease in occurrence of nosocomial
infections (by 38% - SÚSCH Banská Bystrica, a.s. and by 66% - ORL Humenné, s.r.o.). It is a
direct influence of the investment as well as an indirect influence of investments of a similar
nature (after finalization of new premises and their furnishing with new furniture and
equipment, usually processes related with sanitary standards and anti-infectious measures are
usually re-assessed and innovated.
5.2.3.8
‘Reconstruction’ group
In 7 out of 22 finalized projects we have identified investments into the facilities in the form of
building reconstructions. From the provider’s data we assessed their impact on economic
efficiency of operation (lower energy costs), contribution to functionality in view of the purpose
of use (provision of healthcare) and creation of barrier-free areas.
It may be stated within the assessment that reconstructions have decreased energy consumption
(on average for m2, 4-7% with large construction objects, 20-44% with small construction
objects) in 6 finalized projects, which is a contribution to efficiency by using resources for the
provision of healthcare itself. From the point of view of functionality we have observed a slight
decrease in the number of nosocomial infections and in the number of re-hospitalisations with
these providers. Enhancement of barrier-free facilities was a part of projects of all providers
with finalized projects (7 projects), while with all of them we have observed such modifications
which eliminated or decreased barriers for ill and handicapped people. Other significant
contribution to barrier-free facilities is expected with other 25 unfinished projects.
From the formal monitoring indicators of the Programme we are choosing 'Thermally insulated
area' for finalized projects 11,195.17 m2 and for unfinished ones it is 120,292.44 m2 (expected
outcome); and the indicator ‘Total area of technically enhanced objects’ 124,516.74 m2 for
finalized projects and for unfinished ones it is 290,455.66 m2 (expected outcome).
5.2.3.9
‘Constructional extension of premises’ group
We have separately assessed investments in construction through extension of premises of
beneficiaries for healthcare provision. We have identified such investments with 19 providers,
out of that 4 in duly finalized projects. In finalized projects their impact on enhancing the
capacity was seen with two providers – 1. University hospital Martin – increase in
hospitalisations in a newly-built pavilion by 168 in 12 months, representing 4%; 2.
Imunoalergology Dzurilla, s.r.o. – increase in the number of examinations by 11,832,
representing 38%. Others are the Hospital Žilina – here it enabled a faster and thus safer option
to transfer patients in critical conditions from the emergency reception department to the
department of anaesthesiology and intensive medicine of the Children’s Faculty Hospital with
Policlinics Banská Bystrica; here surgeries were transferred from FNsP FDR directly to DFNsP
BB. The above-mentioned investments also had qualitative characteristics equal with
reconstructions. Their impact on the drop of the number of nosocomial infections was up to
26%; a decrease in the number of re-hospitalisations was seen in the University Hospital in
Martin – by 14%. All projects extending the capacities have been performed, or are planned, as
barrier-free.
From the formal monitoring indicators of the Programme we are choosing 'Total area of new
objects' for finalized projects 38,985 m2 and for unfinished ones it is 164,069 m2 (expected
outcome).
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27. máj 2013
5.2.3.10 ‘ICT’ group
Thanks to the current digitalisation and informatization processes of the healthcare system the
OPH's contribution in supplying hardware technology and software solutions is positive,
generally amounting to 0.35% of the investments. From the OPH funds about 324 PCs and
about 7 PACSs have been purchased (these values as well as other ICT components are stated in
their approximate value, as the project documentation did not always contain a detailed
breakdown.) From the point of view of impact we have not verified these investments;
nonetheless, we can predict their impact on quality (displays of a higher quality with an option
of ex-post diagnostics), availability (in real time, faster for medical staff remote from the
examination place) and efficiency (lower costs of operation and archiving).
From formal monitoring indicators of the Programme we are choosing the ‘Number of
established connections to WAN (Internet)’ - 324 pieces for finalized projects, 993 for
unfinished projects (expected outcome).
5.2.4
Outputs of Projects as per 'Diseases of Group 5'
The main focus of OPH was to support such investments which have a direct impact on
improvement of diagnostics and treatment of 'diseases of group 5', in view of their significant
share in morbidity and mortality in the SR. (see chapter 5.5.2)
In individual priority axes we gradually examined the internal structure of investments with
every beneficiary individually, while we allocated them to individual diseases of group 5. It
means that if they were providers with bed departments (Measures 1.1. and 1.2.), we allocated
investments according to the number of beds and their proportion to the total bed fund of the
provider; investments in common operations and investments in operations beyond the group 5
were counted as other diseases. If they were providers of outpatient care, we allocated
investments according to specialization of the established outpatient departments or operations,
devices selectively and reconstructions of constructions according to the proportion of
outpatient departments; common investments and investments in operations beyond the group 5
were again counted as other diseases. The table shows this basic classification in percentage of
investments
Table 22: Total contracted NFC divided as per the 'group 5'
Circulatory
system diseases
Tumours
27 %
13 %
External causes
Respiratory
Digestive
of diseases and
system diseases system diseases
deaths
11 %
14 %
The charts below detail this distribution as per individual measures.
40
13 %
Other diseases
22 %
ABCD
Measure 1.1
3%
Measure 2.1
Measure 1.2
1%
0% 3%
12%
20%
29%
25%
13%
43%
11%
53%
12%
14%
14%
16%
19%
12%
Circulatory system diseases
Tumours
Respiratory system diseases
External causes of diseases and deaths
Digestive system diseases
Other diseases
Naturally, this approach has its weak points as well, which we mainly saw in allocation of more
general investments (functional equipment, reconstructions of emergency, larger displaying and
laboratory equipment for common operations, constructions and reconstructions) among
individual diseases, where we allocated investments in the proportion corresponding to
representation of individual medicinal departments in the hospitals or policlinics.
Due to this weak point we are offering one more view where we allocated only a clear relation
to ‘diseases of group 5’ to individual medical (diagnostic, surgical and therapeutic) technologies
summarized from the whole OPH (i.e. without constructions, reconstructions and equipment
which could not be allocated). This view brings a slightly different output – altogether 75
purchases were identified of such equipment (390 pieces) which was clearly intended for one or
several diseases. The table shows a distribution of purchases in percentage:
Table 23: Contracted part of NFC spent on equipment divided as per ‘diseases of group 5’
Circulatory system
diseases
Tumours
22,38%
29,96%
External causes of Respiratory system
diseases and deaths
diseases
20,58%
12,64%
Digestive system
diseases
14,44%
In summary, it may be concluded that the distribution of investments is slightly in favour of
circulatory system diseases, tumours and external causes of diseases of deaths; however,
respiratory system diseases are not undersized in OPH either. Correlation to causes of diseases
and deaths (chapter 0) seems to be sufficient from the point of view focus on ‘diseases of group
5’
5.3
Impacts of OPH Projects
When assessing the impacts, we used the views on quality, efficiency and availability as
follows:
When assessing OPH we understood the contribution to quality in healthcare provision as all
those aspects which correspond (are the content) of the following definitions:
Quality healthcare is the degree in which the care provided by medical facility to individuals or
specific populations increases the likelihood of desired medical outcomes; it is consistent with
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27. máj 2013
current expert knowledge and at the same time brings the satisfaction of both patients and
medical staff (Organization for Economic Co-Operation and Development);
High-quality healthcare as the level which, when providing healthcare in line with current
expert knowledge, the likelihood of achieving the determined objectives in the area of health
condition of an individual or population increases to (Joint International Committee for
Accreditation of Medical facility);
High-quality healthcare is the highest achievable level of professionalism, with efficient use of
resources, with a minimum risk for patients, resulting in a positive effect on health (definition of
the World Health Organization).
We mostly took into consideration the definition of the Organization for Economic CoOperation and Development.
In OPH assessment we understood contribution to efficiency in healthcare provision as all the
moments contributing to quality:
•
by efficiency as an extent in which the healthcare is provided in a correct way, in view of
the current condition, available resources, with the aim to achieve a desirable/expected
result with patients;
•
by efficiency as an optimal use of available resources to achieve the maximum benefit or
outcomes;
•
by efficiency as the level of achieving desirable outcomes – improvement of health and
quality of life.
The contribution to availability mainly as:
5.3.1
•
availability in time, e.g. the rate in which the patients are provided healthcare in the most
suitable and the most necessary time (this dimension involves both time availability and
coordination of care);
•
availability at a place (domicile), with an effect on availability in time, i.e. availability as
such.
Logical framework of transition from outputs through effects to impacts
As we have mentioned in the chapter 5.2.1 the assessment team has created and fulfilled a
structured approach of allocation of outputs, effects and impacts to identify causal relations. The
effects and impacts themselves are final and most important outputs of investments from OPH,
as they are directly related to the objective of the Programme – to positively influence the
quality, efficiency and availability of healthcare in prevention, diagnostics and treatment of
‘diseases of group 5’. The model itself and the form of its fulfilment is shown in the following
graphical image where we can see that e.g. a purchase of a new digital X-ray device (output of
the project) brings an increased capacity of the workplace, quality of performance and a
decreased radiation load of patients (effects); we can prove these effects by studying the records
regarding the number of procedures, new procedures, the number of re-hospitalisations and
parameters of equipment (evidence). Then the stated effects have the potential to influence the
quality (by shortening the performance, decreasing the radiation), efficiency (increasing the
number of examinations – capacity) and availability (increased capacity, the existence of the
equipment itself which was not there until then):
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Table 24: Causal relations of project outputs
Outputs
Selection/
Overview/
Summary of
facts
We consider a
material or
objective
matter which
happened
thanks to the
project and is
finalized,
measurable
and useful at
the point of
project
termination to
be the output
of the project
Effects
Resulting
contribution
s
Evidence
Starting point
Form of
assessment of
adequacy
Contributions
resulting from
outputs, i.e. the
effect which
comes after
using outputs
of the project
on the basis of
causal relation
Evidence of the
focus of the
contribution in
objective values
and from an
objective source
(e.g. statistics)
Impact
on
Quality
Impact on
Efficiency
Impact on
Availability
Impact on a
relevant
part of the
Programme
Impact on a
relevant part of
the Programme
Impact on a
relevant part of
the Programme
X
X
Example of fulfilment
Increased
capacity
X-ray
displaying
system
Report
on
outpatient
procedures and the
number
of
hospitalised
patients per device
Increased
performance
quality
Duration
of
performance and
of
rehospitalisation
X
Lower
radiation
Parameters of the
device per patient
vs. old device and
the length of the
procedure
X
Data source: KPMG
Then we assessed the impact on quality, efficiency and availability (see the chapter 5.3.3) based
on a statistic assessment of the number of impacts in individual categories in relation to all
impacts in all categories. Then we expressed this proportion in percentage where 100% is the
group of all allocated impacts.
If you are interested, a full allocation map for effects is included in the attached report.
43
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27. máj 2013
5.3.2
Justification of the evaluation’s focus of only on finalized projects
We obtained the data of output groups and subgroups from the projects and their budgets; we
standardized effects and their impacts as a part of methodology creation. When evidencing
effects and their impacts we were only examining finalized projects, as effects (impacts) can be
supported with evidence in time only with these. In spite of that, certain timing relationships
since the termination of the projects are minimal; therefore the data on the numbers of
examined/treated patients after termination of projects rather reflect a tendency than represent a
true picture of contribution of the investments. The above-stated is also modified by processes
of contracting (or non-contracting) of new performances by individual health insurance
companies.
NHIC and individual beneficiaries of NFC were the sources of information. We have not
eventually obtained the planned information from VšZP. The data from NHIC supplemented,
inter alia, also statistical information related to the database of medical technology and
mortality. We obtained the data/evidence from providers in the form of questionnaires – we sent
23 questionnaires and received 22 filled-in questionnaires. Altogether we asked 350 questions
and received 265 answers.
5.3.3
Summaries of OPH contributions, as per output Groups, to Quality, Efficiency and
Availability
As we have mentioned above, we examined the expected and actual impacts through defined
effects and their defined impacts on quality, efficiency and availability of healthcare. The result
of this examination is a number of assessments on the level of impacts of individual effects.
After their mathematic summation (100%) and creation or relations among them, these
assessments offer a percentage view of impacts for individual output subgroups. It is a
quantification of the method approved by the focus group.
Table 25: Contribution of output Groups to Quality, Efficiency and Availability
quality
efficiency
availability
43,77%
33,21%
23,02%
47,83%
32,61%
19,57%
57,50%
17,50%
25,00%
66,67%
0,00%
33,33%
75,00%
25,00%
0,00%
35,00%
50,00%
15,00%
Other equipment
100,00%
0,00%
0,00%
Reconstruction
53,85%
38,46%
7,69%
42,86%
14,29%
42,86%
ICT
54,55%
27,27%
18,18%
57,70%
23,83%
18,46%
Output groups
Improvement of the condition of Emergency
department
Improvement of the condition of departments of
intensive care (DEIM and ICU)
Total
Data source: KPMG
44
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5.3.3.1
‘New diagnostic equipment’ group
With its focus, the group of diagnostic equipment has 43.77% impact on improvement of
quality of the provided healthcare through the impact on the quality of procedures itself (newer
diagnostic device with a better optical output, handling options, etc. - gastric fibroscopy, capsule
endoscopy), by bringing new diagnostic methods, enhances the diagnostic accuracy (displaying
equipment with a higher resolution and ex-post processing option – digital X-ray, CT, NMR),
the option to introduce brand new types of procedures (combination of two independent
techniques until then – bronchoscope with ultrasonographic device). These qualitative qualities
of new diagnostic equipment also have an implied impact on quality for patients in shortening
the duration of the diagnostic procedure itself, accelerating the diagnostic process (availability
of results in time) and the possibility to receive treatment faster. In a broader context, for
patients quality also means reduction of waiting time for examinations. If diagnostic equipment
is a part of bed-care, it has the potential to shorten hospitalisation, which is another quality for
the patient.
From the point of view of efficiency of the provided healthcare there is 33.21% impact. This is
manifested through efficiency of processes of the healthcare provider itself in the sense of
shortening the diagnosing period (examination of several patients for a certain time/working
time), more accurate diagnosing decrease the costs of treatment and bed-stays, thus reducing the
costs connected with the length of hospitalisation. Such obtained capacities in diagnostic
operations as well as free beds can be valued with regard to competition for patients (providing
there are contractual limits by health insurance companies).
In the context of the above-stated effects, we have assessed the impact of new diagnostic
equipment on availability of healthcare for 23.02%. There are mainly outcomes of faster
diagnosing, more accurate diagnosing (possibility to eliminate repeated examinations) and new
procedures and methods. In such way patients of a catch area will receive treatments faster
(reduction of the waiting time) and have also procedures available which were not available in
their region.
5.3.3.2
‘New surgical equipment’ group
In the group of surgical equipment we have seen the contribution to quality amounting to
47.83%. They are such surgical instruments which improve the performance quality itself
through comfort provided to the team of surgeons thanks to better displaying (modern optical
outputs of laparoscopic and arthroscopic sets), better instruments of these sets as well as other
equipment modifying surgical techniques with a view to high-quality haemostasia, etc. (e.g.
harmonic scalpel) and more accurate surgical and micro-surgical techniques which are friendly
to surrounding tissues (surgical lasers in ORL and eye surgery). These sophisticated instruments
have a potential to bring new methods which bring higher safety for patients with a maximum
potential of therapeutic effect. At the same time, they bring better healing of surgical wounds.
The potential of new surgical equipment to efficiency is 32.61% and it is given by shortening
the operation time and the option to increase the capacity of surgery provision. In bed
departments and with more demanding performances, the hospitalisation period is shorter and
the occurrence of nosocomial infections and re-hospitalisations is lower.
Even though through investments in new surgical equipment the availability of surgery as such
need not necessarily increase, enhancing the capacities (on the basis of shortening the time of
the operation itself and of subsequent hospitalisation), the availability for patients in the catch
area may increase. Availability of new methods which were not available in the region until
then is a major impact. We have assessed this parameter with surgical equipment for 19.57%.
45
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27. máj 2013
5.3.3.3
‘New therapeutic equipment’ group
Similarly to diagnostic equipment, in the group of therapeutic equipment the highest impact
is on quality of the provided care – it had 57.5% impact on the quality. As for equipment with
radiation effect (X-ray therapeutic, linear accelerators) the quality is given by the accuracy
through which it is possible to have an effect on pathologic processes. As a result, patients get
less radiation in end effect (reduction of unwanted effects), but with a higher effect. In some
cases it is possible to subsequently reduce also the number of treatment visits, which is another
transferred quality on the quality of lives for patients.
The above-stated qualities are a basis of higher efficiency – in the area examined by us there
was 17.5% impact. Efficiency is given by shortening therapeutic visits themselves and the
possibility to treat more patients for a time unit. In cases when equipment was purchased to
already existing workplaces, e.g. linear accelerator for the Eastern-Slovakian Oncologic
Institute, the efficiency is also given by servicing of the same staff.
Availability of treatment on the basis of widening and supplementation of therapeutic
equipment is manifested through reduction of waiting time – availability in time, and through
improved regional availability. We assessed the contribution to improvement of availability for
25%. The device intended for rehabilitation of patients after accidents of the central nervous
system with a subsequent disorder of motoric functions Lokomat Nanos is unique in the
territory of Slovakia and therefore its placement in the National Rehabilitation Centre in
Kováčova is absolutely legitimate.
5.3.3.4
‘Improvement of the condition of Emergency department’ group
Improvement of the condition of central/emergency reception leads through reconstruction
of equipment to improvement of the quality of environment for staff as well as an outcome
for patients (examination methods available at one place in real time). This helps to efficiently
use the time and to shorten the waiting times for patients. From the system point of view,
there is a contribution to efficiency by decreasing the number of hospitalisations indicated at
emergency reception (increasing the option of diagnosing, observing patients on expectation
beds and therapeutic procedure). This output is currently only an expected effect, as the
systemic output can only be seen from the data of health insurance companies, but also due to
short timing relationship and a small number of projects it need not be identifiable at all. From
the point of view of the provider we have not expected/examined an impact on efficiency,
therefore the resulting figure in the Table 25 is 0%. As not brand new capacities were built
within OPH in the group of emergency receptions (in the case of construction of new ones,
these replaced the original ones, such as L.Paster in Košice and FNsP Žilina), the contribution
to availability may only be assessed through shorter waiting times for patients. In view of a
small amount of data and predictions, we have not quantified this area.
5.3.3.5
‘Improvement of the condition of departments of intensive care (DEIM and ICU’
group
Investments in improvement of the condition of departments of intensive care (DEIM and
ICU) are significant allocations within OPH. We have assessed the contribution to quality for
75%, while the main resulting effects are patient safety and increase of sanitary standards.
While the patient safety is given by modern resuscitation equipment (more accurate setting of
ventilation regimes and more sensitive monitoring of vital functions), higher hygienic standards
are related to modern (anti-decubitus) resuscitation beds. In the case, which is almost a rule in
OPH projects, that the revitalisation of the premises is also connected with reconstruction
46
ABCD
(layout of beds, closed boxes, modern air ventilation), the qualitative potential is rocketing.
These parameters are also manifested in higher efficiency (25%) as there is a potential of
shortening an average hospitalisation time. From the point of view of availability, we cannot
see any contribution of this group.
5.3.3.6
‘Improvement of condition of operating rooms’ group
Improvement of condition of operating rooms (thorough reconstruction of premises and other
equipment) is closely related to increasing the quality of surgeries. Effects will be or are
manifested in decreasing the number of nosocomial infections, by shortening the operation time
itself as well as the period between operations. Environment of the operating room and of the
operating ward (size, microclimate, social premises) contributes to a higher work performance
of teams of surgeons, bringing benefits to patients. We have identified the contribution to
increasing the quality for this group on the level of 35%.
All measures lead to effects with a direct impact on efficiency amounting to 50%, as they
increase the capacity through acceleration of processes and their quality. Efficiency is also given
by a smaller amount of complications during and after operations (nosocomial infections) with a
direct impact on lower consumption of drugs, special material and shorter hospitalisation period.
The impact on availability of services can be predicted on the basis of better capacity
permeability given by factors of quality and efficiency and subsequent shortening of waiting
times on the regional level. We have identified this impact on the level of 15%.
5.3.3.7
‘Other equipment’ group
As we have mentioned above we have included furniture and other functional equipment for
operation in the group of other equipment. In view of the above-stated we define this group as
100% contribution to quality which is/will be manifested through better environment for
patients, higher sanitary standards and a subsequent decrease in nosocomial infections.
Perception of subjective environment quality by patients and staff is a side effect.
5.3.3.8
‘Reconstruction’ group
Another significant element of the Programme form the point of view of the amount of
investments is reconstructions. In relation to other groups (emergency receptions, departments
of intensive care) the contribution to quality is obvious (53.85%). Qualitative effects are/will
be manifested in higher hygienic standards and subsequent lower number of nosocomial
infections and subjective quality perceived both by patients and staff. It is mainly decreasing the
number of beds in patient rooms, supplementation and reconstruction of sanitary facilities and
rooms of attending staff. Improving internal logistics, shortening an average hospitalisation time
and decreasing energy consumption bring higher efficiency - 38.46%. From the point of view
of availability the only, yet extremely important outcome, are barrier-free areas (with all
projects) and we assess this impact on availability for 7.69%.
5.3.3.9
‘Constructional extension of premises’ group
Constructional extension of premises is, from the point of view of assessed effects, the
highest form of contribution in all categories. While effects are the same as with
reconstructions, from the point of view of outcomes they are on a higher qualitative level. In the
case of extending provider’s capacities (e.g. University Hospital in Martin) regional availability
47
ABCD
27. máj 2013
is also higher. When expressing effects in percentage, the contribution of this group to quality
is 42.86%, to efficiency 14.29% and to availability 42.86%.
5.3.3.10 ‘ICT’ group
Informatization of providers, in connection with other investments (mainly diagnostic
technology), is also of great importance. Contribution to quality of services is given by the
quality of the displayed diagnostic result itself, the speed of availability of this result and the
possibility of subsequent treatment. We assess this contribution for 54.55%. As for efficiency,
faster diagnosing brings the possibility to examine and treat more patients for a time unit. In
implementation of PACS systems, efficiency is manifested by decreasing the demands for space
(archiving) and staff (preparation of records). We assess this contribution for 27.27%. From the
point of view of availability (18.18%) it is mainly availability in time for patients and staff,
which has an effect on total shortening of examination/treatment in outpatient care. Similarly,
availability of results in high quality is transferred also in the case of consultations at other
workplaces.
5.3.4
Summary of OPH contribution to equipment in SR
Modernisation of healthcare technology is one of the most important investment activities of
healthcare providers and has a direct impact on quality, efficiency and availability of provided
services. In view of a long-term lack of funding of the healthcare system in the SR, a number of
devices used mainly in Slovak hospitals (but also in outpatient departments) are morally and
technologically obsolete. Due to the above-stated, we consider the assessing view of this issue
to be meritorious. When examining individual projects, we classified equipment according to
the method stated in the equipment database of NHIC, and then compared this database from
two points of view:
1. according to the number of devices purchased from OPH to all existing ones in Slovakia;
2. according to the number of devices purchased from OPH to all purchases in the monitored
period of 2007-2011.
As the project documentations were compendious to a limited extent, we could assess the
above-stated accordingly in groups of diagnostic, surgical and therapeutic equipment.
We can see the highest contribution in extending displaying technology (X-ray, CT,
mammographs, angiographs) but also in the quality of these purchases (digital technology).
Purchase of a significant number of USG and especially ECHO USG devices plays a major role
as well. Endoscopic equipment for examination of respiratory and digestive systems
(bronchoscopes, gastroscopes and duodenoscopes, rectoscopes and colonoscopes) represents a
smaller share in diagnostic and therapeutic technology. An extremely important investment in
oncology is extending the therapeutic technology by other linear accelerators.
48
ABCD
Table 26: Summary of the impact of OPH on the number of devices in SR
% of
Total No Purchase
purchases
Existing
of pcs
d in SR
from OPH
Output
Outputs
in SR
purchased altogethe
vs.
group
subgroup
altogethe
within
r 2007purchases
r
OPH
2011
in SR
2007-2011
% shift of
the total
No in
Slovakia
thanks to
OPH
New diagnostic
equipment
Equipment for
special
examination
(angiography)
5
14
46
35,71%
10,87%
New diagnostic
equipment
Bronchoscopes
6
34
146
17,65%
4,11%
New diagnostic
equipment
X-ray diagnostic
equipment
25
156
733
16,03%
3,41%
New diagnostic
equipment
ECHO –
ultrasound
diagnostic
equipment
9
17
44
52,94%
20,45%
New therapeutic
equipment
Linear
accelerators
3
7
16
42,86%
18,75%
New diagnostic
equipment
USG –
ultrasound
diagnostic
equipment
39
334
978
11,68%
3,99%
New surgical
equipment
Medical lasers
2
57
225
3,51%
0,89%
4
232
879
1,72%
0,46%
17
41
215
41,46%
7,91%
New surgical
equipment
New surgical
equipment
Surgical
endoscopes
(laparoscopes,
arthroscopes)
Colonoscopes,
sigmoidoscopes
and rectoscopes
New diagnostic
equipment
Computer
tomography (CT)
5
36
81
13,89%
6,17%
New diagnostic
equipment
Equipment for
magnetic
resonance
2
11
38
18,18%
5,26%
New diagnostic
equipment
Mammographs
7
26
76
26,92%
9,21%
12
86
273
13,95%
4,40%
22,81%
7,38%
New diagnostic
equipment
Total average
Gastroscopes and
duodenoscopes
Data source: MOH SR, NHIC, Data current on 30.6.2012 – Project documentation, 31.12.2011 - NHIC
From the point of view of moral obsoleteness, technical obsoleteness and depreciation of assets,
it would be generally expected that most equipment in healthcare will be replaced on a 5-year
basis; that corresponds to the monitored period of 2007-2011. It is obvious in the table above
that there was a renewal or rather supplementation of equipment base in Slovakia in the range
49
ABCD
27. máj 2013
from 0.46% (surgical equipment – arthroscopes, laparoscopes) to 20.45% (diagnostic equipment
– ECHO USG); i.e. on average for all types of equipment there has been a 7.38% increase. In
the 5-year period OPH significantly participated in supplementation/renewal of equipment (on
average up to 22.81%).
An important area of investments which has an impact on all major conditions in medicine,
starting from accidents through acute cardiology up to respiratory failures, are investments in
reconstructions and equipment of departments of intensive care (DEIM and ICU). In this area
investments through OPH were made in 17 departments out of the total number of 246 (out of
that 73 – DEIM) of such departments in the SR.
5.4
Regional analysis of OPH allocation and outputs
5.4.1
Summary of regional classification of projects and financial allocation
In the tables below we are presenting regional classification of OPH (based on the address of the
supported medical facility) as per the number of projects and allocated funds.
Table 27: Regional classification of OPH as per the number of projects
Priority axis
Priority axis 1
TT
TN
NR
ZA
BB
PO
KE
all
regions
Total
1.1
1
0
1
0
3
3
3
0
11
1.2
Priority axis 2
Number of projects classified as per their impact on STU
Measur
e
2.1
2.2
1
1
2
2
4
3
2
0
15
2
1
3
2
7
6
5
0
26
4
1
5
5
6
15
2
0
38
0
0
0
0
0
0
0
1
1
4
1
5
6
6
15
3
1
39
Total
6
2
8
7
13
21
7
1
65
9%
3%
12%
12%
19%
31%
12%
3%
-
Percentage of projects in STU
out of all OPH projects
•
It may be concluded from the summary that most projects are carried out in the region of
Prešov, and on the contrary, the fewest ones in the region of Trenčín.
•
This summary needs to be assessed together with the needs in the Topic 2, i.e. mortality and
hospitalisation rate in regions (5.4.3).
50
ABCD
Table 28: Regional classification of OPH as per allocated funds
Priority axis
Measure
Funds allocated within OPH projects as per their impacts on STUs
all
TN
NR
ZA
BB
PO
KE
regions
TT
Priority axis 1
1.1
1.2
491 070 €
0
1 662 276 €
0
7 467 123 €
5 911 639 €
7 017 234 €
0
13 579 358 € 3 640 000 € 30 800 526 € 28 198 533 € 43 316 252 € 43 946 777 € 40 832 774 €
0
14 070 428 € 3 640 000 € 32 462 802 € 28 198 533 € 50 783 375 € 49 858 416 € 47 850 008 €
0
2.1
6 208 255 €
1 167 675 €
7 381 061 €
7 151 726 €
2.2
0
0
0
0
6 208 255 €
1 167 675 €
7 381 061 €
7 151 726 €
Total
Percentage of funds expended
per STU
Average contracted amount per
project
20 278 683 € 4 807 675 € 39 843 863 € 35 350 259 € 59 274 323 € 63 812 066 € 51 432 629 € 7 257 415 €
Priority axis 2
8 490 949 € 13 953 650 € 3 582 620 €
0
0
0
8 490 949 € 13 953 650 € 3 582 620 €
Total
22 549 342 €
204 314 219
€
226 863 562
€
0
47 935 936 €
7 257 415 €
7 257 415 €
7 257 415 € 55 193 351 €
282 056 912
€
7%
2%
14%
13%
21%
23%
18%
3%
-
3 379 780 €
2 403 837 €
4 980 483 €
5 050 037 €
4 559 563 €
3 038 670 €
7 347 518 €
7 257 415 €
4 339 337 €
5.4.1.1
•
It may be concluded from the summary that the rate of financial support correlates with the
number of projects, i.e. the region of Prešov was most supported, and on the contrary, the
region of Trenčín was least supported.
•
Average allocation per project is highest in the region of Košice, lowest in the region of
Trenčín, but it is also low in the region of Prešov in contrast to the number of projects. The
region of Prešov is characterized by focusing on projects focused on marginalized Roma
communities. The objective of a maximal possible coverage of this group influenced the
number of projects and also an average allocation. These projects are characterized by their
lower budget allocation.
Comparison of actual regional allocation vs. indicative regional allocation
In the tables below we compare the indicative allocation based on update made in 2011 in
comparison with the actual regional allocation which is a result of the final set of contracted
projects, taking into consideration the address of the medical facilities (place of project
execution).
Table 29: Indicative regional EU allocations for 2007-2013
Grant from EU funds for 2007-2013 in EUR
Region
Trnava region
Nitra region
Trenčín region
Western Slovakia
Banská Bystrica region
Žilina region
Central Slovakia
Košice region
Prešov region
Eastern Slovakia
Total
PA 1
PA 2
7 433 387
33 112 363
27 030 500
67 576 250
34 753 500
23 169 000
57 922 500
29 733 550
37 842 700
67 576 250
193 075 000
OP total
5 730 368
7 258 465
6 112 392
19 101 225
6 790 602
7 067 770
13 858 372
7 908 797
8 231 606
16 140 403
49 100 000
13 163 755
40 370 828
33 142 892
86 677 475
41 544 102
30 236 770
71 780 872
37 642 347
46 074 306
83 716 653
242 175 000
% of indicative
regional
allocation
5,44%
16,67%
13,69%
35,79%
17,15%
12,49%
29,64%
15,54%
19,03%
34,57%
Data source: MOH SR, Data current on 30.6.2012, EUR – EU resources
51
ABCD
27. máj 2013
Indicative regional financial allocations for the Priority axis 1 have been calculated based on the
number of beds of institutional healthcare (hospitals) in individual self-governing regions
(NUTS III). Indicative regional financial allocations for the Priority axis 2 have been calculated
based on statistical data on the number of citizens in individual self-governing regions (NUTS
III).
Table 30: Comparison of actual regional allocation vs. indicative regional allocation
Variation
% of
% of
Amount of contracted funds
–
actual
indicative
for 2007-2013 in EUR
difference
regional regional
actual –
Region
PA 1
PA 2
OP total allocation allocation indicat.
Trnava region
11 959 864
6 050 439
18 010 303
7,70%
5,44%
2,26%
Nitra region
27 593 382
7 214 972
34 808 354
14,88%
16,67%
-1,79%
Trenčín region
3 094 000
1 760 416
4 854 416
2,07%
13,69%
-11,61%
Western Slovakia
42 647 245
15 025 827 57 673 072
24,65%
35,79%
-11,14%
Banská Bystrica region
43 165 868
8 109 561
51 275 429
21,91%
17,15%
4,76%
Žilina region
23 968 753
6 999 128
30 967 880
13,24%
12,49%
0,75%
Central Slovakia
67 134 621
15 108 689 82 243 310
35,15%
29,64%
5,51%
Košice region
40 672 507
4 386 430
44 323 405
18,76%
15,54%
3,22%
Prešov region
42 379 654
12 796 104 55 911 290
22,98%
19,03%
3,95%
Eastern Slovakia
83 052 161
17 182 534 100 234 695 42,84%
34,57%
8,27%
Total
192 834 027 47 317 050 240 151 077
Data source: MOH SR, Data current on 30.6.2012, EUR – contracted EU resources
•
It may be concluded from the summary that the Western Slovakia has seen the biggest
variation in favour of Eastern and Central Slovakia.
52
ABCD
5.4.1.2
Summary of funds in projects as per territorial impact
Table 31: Summary of contracted funds taking into account the scope of activity of entities
Total
contracted
funds taking
into account
the scope of
activity of the
entity
No of
projects, less
supraregional and
national ones
No of
projects
with supraregional
scope of
effect
BB
345 453 €
1
1
KE
928 927 €
2
Measure /
Region /
Scope of
activity
No of projects
Net
with national classification of
scope of effect
funds, not
considering the
scope of
activity of the
entity
No of all
projects
1.1
PO
NR
2
5 455 721 €
2
1
7 467 123 €
3
2
7 473 152 €
4
1
1 662 276 €
1
491 070 €
1
TT
1
Supra-regional
14 828 588 €
National
6 446 375 €
Total
22 549 343 €
3
4
4
PO
17 553 776 €
2
1
0
43 946 777 €
BB
10 247 016 €
2
11
1.2
KE
NR
3
2
0
43 316 252 €
4
2
0
40 832 774 €
2
1
0
30 800 526 €
2
8 298 478 €
1
TN
3 640 000 €
1
0
3 640 000 €
1
TT
13 579 358 €
1
0
13 579 358 €
1
1
1
0
28 198 532 €
2
ZA
13 262 075 €
Supra-regional
137 733 516 €
Total
204 314 219 €
8
7
0
15
2.1
PO
13 565 452 €
14
0
0
13 565 452 €
14
BB
8 490 949 €
6
0
0
8 490 949 €
6
KE
1 787 858 €
2
1
0
3 970 818 €
3
NR
7 381 061 €
5
0
0
7 381 061 €
5
TN
1 167 675 €
1
0
0
1 167 675 €
1
TT
6 208 255 €
4
0
0
6 208 255 €
4
ZA
7 151 726 €
5
0
0
8 287 068 €
5
Supra-regional
2 182 960 €
Total
47 935 936 €
37
1
0
38
0
0
1
1
2.2
National
6 168 803 €
Total
6 168 803 €
Total
282 610 430 €
Data source: MOH SR, Data current on 30.6.2012, EUR – Contracted eligible NFC amount
•
Source data for determining the scope of effect of the particular project was characteristics
of the provider in the OPH project documentation (usually the structure of patients and catch
53
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27. máj 2013
areas of equipment). The actual and exact catch area percentage from VšZP data was not
available, thus it is not possible to proportionally allocate the above-stated funds.
•
The scope of activity of providers is classified into the national (SR), supra-regional (W, C,
E), regional (region), sub-regional (district/town) and local (municipality).
•
Net classification of funds regardless of the scope of effect represents classification of funds
allocated as per the address of medical facilities. PA 2.2 is an exception; here it is possible
to specify an exact allocation proportion for individual regions, as it only contains one
national project.
•
Total contracted funds considering the scope of activity of the entity – in this column there
are funds from individual regions which are bound to projects (particular medical facilities)
with supra-regional or national scope of effect.
•
There is a need resulting from the summary in the table above to value the regional
allocation not only as per region where the beneficiary carried out the project but also from
the point of view of scope of activity of the particular beneficiary. E.g. by valuing the catch
area of the provider or of affected services and its potential change based on the project. It
may also be concluded based on the high number of supra-regional projects that an actual
exact regional allocation would have a different profile than stated above.
5.4.2
Process of determining and ensuring OPH regional allocation
5.4.2.1
Setting the financial plan and allocation
In the OP Health the MOH SR as the Managing Authority for this OP has twice changed the
initial financial plan which was approved by the EC on 8 November 2007.
1. By per rollam procedure, the Monitoring Committee for OPH approved updating of the
financial plan (as of 31 October 2008) for the Priority axis 2 in such a way that from the
Measure 2.1 it reallocated funds to the Measure 2.2 in the amount of € 1,236,859.50 (source
EU) 2
2. By per rollam procedure, the Monitoring Committee for OPH approved updating of the
financial plan (as of 26 May 2011) for the Priority axis 2 in such a way that from the
Measure 2.2 it reallocated funds to the Measure 2.2 in the amount of € 3,700,869.25 (source
EU) 3.
As it was reallocation of funds within the Priority axis, this change had no impact on the change
of the amount of indicative regional allocations, as within OPH these are defined on the level of
Priority axes.
5.4.2.2
Checking, assessment and selection of applications for NFC
As a part of implementation, the Managing Authority for the OP Health uses the system of
submission of applications for NFC based on announcing calls for submission of applications
for NFC and in one case it performed direct assignment. Calls are announced for a particular
Priority axis and Measure. From the point of view of regional division of SR, each call defines
eligible areas, i.e. particular STUs within which healthcare infrastructure of eligible
beneficiaries is located which is the subject of the project. For Measures 1.1, 1.2 and 2.1 of OPH
2
1 455 129 EUR – source EU + national budget of SR
3
4 353 964.00 – source EU + national budget of SR
54
ABCD
such territory is the territory of the self-governing regions of Trenčín, Žilina, Trnava, Nitra,
Banská Bystrica, Prešov and Košice. The Managing Authority for the OP defines types of
eligible beneficiaries for individual Measures, while only these entities may submit applications
for NFC.
After announcing a call, eligible beneficiaries submit applications for NFC, while elaboration
and submission of applications for NFC has a voluntary nature. The MA for OPH cannot force
individual entities to submit or not to submit applications for NFC.
After applications for NFC have been submitted and after closing the call, the MA will record
the applications and check their formal correctness; this includes checking eligibility,
completeness, and a preliminary financial check. Those applications for NFC which met all
conditions of the check of formal correctness proceed to the assessment procedure. The
assessment procedure in OPH is set in such a way as to assess the quality, elaboration and
contribution of individual applications for NFC as objectively as possible, so that these project
contribute to fulfilment of OPH objectives as much as possible. After assessment of all projects
by expert assessors, individual projects together with assessment results were forwarded for
decision to the Selection Committee4 (hereinafter referred to as the ‘Committee‘) formed by the
MA for OPH. Projects which did not meet the criteria of expert assessment were not forwarded
for decision to the Committee.
The Committee suggested applications for NFC for approval based on results of expert
assessment, while only those applications for NFC which met the condition of formal
correctness and expert assessment could be supported, i.e. those which in the expert assessment
achieved at least 60% of the maximum total number of points, and at the same time 50% of the
maximum number of points in the relevant group of assessment criteria. Then, applying two
selection criteria, i.e.:
•
Number of points in individual groups of criteria and the total number of points of the
application; and
•
Complexity of the project;
individual applications for NFC are sorted according to the number of points achieved, while by
applying a third selection criterion – allocation of funds for the particular call for submission of
applications for NFC and regional financial allocation for the Priority axis for OPH applications for NFC are selected based on their order in the extent of allocated funds for the
particular call for submission of applications for NFC and the total indicative regional allocation
earmarked in OPH for the particular region.
When selecting the applications for NFC, the MA first applied the first two criteria (number of
points in individual groups of criteria and the total number of points of the application and the
complexity of the project) and then assessed the total allocation for the call and the indicative
regional allocation. When assessing the overrun of allocation of the call, the first application for
NFC which exceeded the allocation was the first application which was not approved. When
assessing the overrun of the indicative regional allocation, the first application for NFC which
exceeded the allocation was the last approved application. For a Committee meeting, the MA
prepares a list of applications in the order which resulted from applying the selection criterion
No 2 in the extent of allocated funds for the particular call for submission of applications for
NFC and the total indicative regional allocation earmarked in OPH for the particular region. If
4
On 9.11.2012 the role of the Selection Committee of the Ministry of Health of the SR in approving applications for
non-returnable financial contributions for the Operational Programme Health was taken over by the “Advisory
Committee of the Ministry of Health of the SR for application of selection criteria for selection and approval of
applications for non-returnable financial contribution for the Operational Programme Health“
55
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27. máj 2013
there were some remaining funds in a regional allocation which did not cover the whole amount
of the requested NFC for the application which follows in the order after applying the selection
criteria No 1 and 2, and at the same time it was possible to support it from the allocation
earmarked for the call, the Committee proposed this application for approval, as in line with the
Management System of SF and CF for the 2007-2013 programming period, the Committee has
no right to change the order of applications for NFC which was determined based on the
selection criteria No 1 and 2. The above-stated could result / resulted in over-drawing of
allocation of certain regions and under-drawing of allocations of other regions.
5.4.2.3
Assessment of contracting of projects from the point of view of indicative regional
allocation
Indicative regional allocation is defined on the level of NUTS II in the Operational Programme
Health. In the Programme Guideline for the Operational Programme Health, it is defined up to
the level in NUTS III though. The indicative amount of regional allocation is specified for the
ERDF source.
The assessment group created a detailed summary of gradual contracting of the indicative
ERDF allocation after termination and assessment of individual calls. Based on the status of
contracting as of 30 June 2012 the following may be concluded for individual Priority axes:
Priority axis 1
Over-contracting of the indicative regional allocation on the level of NUTS III was brought
about by contracting the approved applications for NFC of the Call No OPH 2008/1.2/01 in the
region of Žilina by € 799,752.61. The indicative regional allocation was also exceeded on the
level NUTS II, but only after contracting the approved applications for NFC from the last
announced Call. No OPH 2009/1.2/01. At this point the overrun of the contracted funds on the
NUTS II level for Eastern Slovakia (PO and KE) is quantified by the group of assessors in the
amount of € 15,475,910.65 (overrun by 22.90%), for Central Slovakia (BB and ZA)
€ 9,212,121.09 (overrun by 15.90%) and for the Western Slovakia (TT, TN and NR) underdrawing of funds in the amount of € 24,929,004.63 (36.89%). It also results from the abovestated that on the level of the particular Priority axis the contracted ERDF amount did not
exceed the total allocation. The available balance amounts to € 240,972.89 EUR (0.12 %).
Priority axis 2
In the case of the Priority axis 2 the contracting of the indicative regional allocation on the level
of NUTS III was first exceeded in the Call No OPH 2010/2.1/02 in the Eastern Slovakia (PO in
the amount of € 3,078,850.51. In relation to that, medical facilities located in the self-governing
region of Prešov could not be the subject of applications for NFC in the following call
announced for the Measure 2.1 (OPH 2011/2.1/01) as a result of exceeding regional allocation
of projects approved until then within the self-governing region of Prešov. In the Call No OPH
2011/2.1/01 the indicative regional allocation on the level of NUTS III was exceeded again and
on the level of NUTS II it was exceeded for the first time. On the level of NUTS III in Central
Slovakia (ZA in the amount of € 947,188.97) and Western Slovakia (TT in the amount of €
320,070.92). On the level of NUTS II in Central Slovakia, allocation was exceeded in the
amount of € 613,998.52, while meeting the rules specified in the section 5.4.2.2.
Indicative regional allocations were further exceeded on the levels NUTS II and NUTS III by
contracting approved applications for NFC of the Call No 2011/2.1/02. Although the regional
allocation in the region of Prešov was exceeded even during the Call No OPH 2010/2.1.02, the
MA approved and then contracted also projects in the Eastern Slovakia - in the region of Prešov,
increasing the overrun of the indicative regional allocation of NUTS III to € 4,564,497.63. The
56
ABCD
MA took this step due to the nature of the announced call which was focused on beneficiaries
from approved Local Strategies of the comprehensive attitude. In this case the MA could not
exclude beneficiaries from the regions with highest concentration of marginalized Roma
communities from involvement in the call due to the need of meeting the complexity of
approved Local Strategies. Another region which exceeded the regional allocation on the level
of NUTS III within this call was the region of Banská Bystrica (Central Slovakia) in the amount
of € 1,318,959.20, increasing the overrun of the allocation on the level of NUTS II to
€ 2,266,148.17.
In the case of calls for beneficiaries within Local Strategies of the comprehensive attitude the
selection criteria were applied which did not observe the overrun of regional allocation due to
their preliminary approval by the Office of the Plenipotentiary of the Government of SR for
Roma Communities.
We may generally state, based on the status of contracting of OPH as of 30 June 2012, that for
the PA 2 the overrun of indicative allocations on the level of NUTS II in the Eastern Slovakia
amounted to € 1,042,130.66 (overrun by 6.46%) and in Central Slovakia € 2,266,148.17
(overrun by 16.35%). In the Western Slovakia the contracted amount did not exceed the
indicative regional allocation. The available balance amounts to € 4,075,399.24 EUR (21.34%).
When selecting projects, the MA followed the set selection criteria approved by the Monitoring
Committee. When selecting applications for NFC, the MA also monitored the development
within the indicative regional allocation.
5.4.3
Regions from the point of view of ‘diseases of group 5’
5.4.3.1
Morbidity and mortality of group 5 as per regions
Status of health represented by morbidity, mortality and hospitalisation rate within regions
represents a demand for improvement of healthcare services. The tables below are summaries as
per ‘diseases of group 5’ in view of mortality
Table 32: Morbidity rate of population of SR as per selected causes of hospitalisation and
regions (per 100,000 persons) for 2007
WS
Cause of death
Circulatory system
diseases
Tumours
TT
TN
NR
578,30
523,38
577,66
622,14
246,25
220,40
54,18
External causes of
diseases and deaths
57,26
52,18
270,25
206,84
60,56
60,66
54,33
61,38
606,93
227,06
71,21
63,29
523,38
54,77
62,22
577,66
189,97
246,25
220,40
51,27
66,23
54,18
50,19
57,26
58,38
66,64
KE
509,57
62,30
57,61
51,01
PO
65,78
54,51
57,61
BB
216,65
60,20
66,23
ZA
517,75
BA
SR
Group
5
474,42
542,18
235,74
221,51
55,50
58,46
52,22
54,94
60,08
55,26
ES
561,02
247,03
Respiratory system
diseases
Digestive system
diseases
CS
52,18
46,38
39,40
53,61
Data source: NHIC, Data current on 26.10.2012 for 2007
57
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27. máj 2013
Table 33: Mortality rate of population of SR as per selected causes of death and regions
(percentage of total mortality in SR) for 2007
Cause of death
Circulatory system
diseases
Tumours
Respiratory system
diseases
External causes of
diseases and deaths
Digestive system
diseases
All selected
WS
TT
TN
CS
NR
54,52%
51,75%
57,05%
21,76%
5,35%
54,04%
23,70%
21,59%
5,15%
5,31%
5,04%
94,35%
56,62%
4,76%
20,63%
5,29%
5,29%
5,68%
5,72%
94,18%
94,07%
5,89%
5,49%
5,74%
5,84%
20,88%
5,60%
6,46%
6,41%
54,84%
20,76%
20,59%
6,06%
94,18%
94,00%
55,05%
6,33%
KE
55,69%
6,40%
5,55%
5,70%
PO
21,07%
5,14%
5,66%
BB
54,56%
5,68%
6,55%
ZA
54,56%
23,29%
24,35%
ES
5,67%
5,07%
5,64%
4,59%
93,77%
5,51%
92,61%
93,49%
92,42%
92,78%
BA
SR
Group 5
50,22%
54,38%
24,95%
22,22%
5,87%
5,86%
5,53%
5,54%
6,36%
5,51%
92,93%
93,52%
Table 34: Morbidity rate of population of SR as per selected causes of hospitalisation and
regions (per 100,000 persons) for 2011
WS
Cause of death
Circulatory system
diseases
Tumours
Respiratory system
diseases
External causes of
diseases and deaths
Digestive system
diseases
TT
TN
CS
NR
535,53
496,81
529,84
226,98
571,56
49,80
258,60
53,00
67,84
50,14
485,16
559,67
210,35
220,87
57,49
75,54
65,37
58,94
56,77
496,81
252,01
49,94
58,89
58
71,04
46,98
53,00
42,33
36,34
242,02
49,80
41,96
57,14
456,31
226,98
54,35
55,70
BA
529,84
197,60
54,32
65,81
KE
477,51
57,88
59,71
62,37
PO
66,33
58,89
57,14
BB
215,50
58,35
55,70
ZA
521,63
246,39
252,01
ES
48,50
59,59
SR
Group
5
505,94
223,66
60,57
53,18
52,27
ABCD
Table 35: Mortality rate of population of SR as per selected causes of death and regions
(percentage of total mortality in SR) for 2011
Cause of death
Circulatory system
diseases
Tumours
Respiratory
system diseases
External causes of
diseases and
deaths
Digestive system
diseases
All selected
WS
TT
50,00
%
25,36
%
5,61%
TN
52,28%
54,76
%
0,24 %
23,46
%
5,70%
5,15%
CS
NR
52,06
%
23,55
%
6,18%
ZA
5,48%
BB
PO
54,32%
56,05
52,74
%
%
0,22 %
21,97
22,95
%
%
6,18%
6,24%
6,51%
7,25%
5,90%
5,95%
KE
53,21%
52,67
53,70
%
%
0,22 %
22,84
21,19
%
%
6,77%
5,75%
5,75%
ES
6,40%
5,83%
5,45%
5,18%
5,99%
5,42%
5,65%
93,00
%
93,61%
94,02
%
93,74
%
93,40%
93,57
93,25
%
%
SR
Group 5
48,08
%
52,61%
25,50
%
23,26%
7,49%
6,30%
4,95%
5,44%
6,28%
5,53%
92,29
%
93,13%
4,77%
4,12%
5,54%
6,28%
5,89%
BA
5,37%
4,82%
4,39%
5,21%
92,58%
93,03
92,16
%
%
Data source: Statistical Office, Data current on 21.03.12 for 2011
From the point of view of development of mortality in ‘diseases of group 5’ in 2011 and the
reference year of 2007 (the start of the programming period), we may state that a significant
share of diseases of this group in total mortality continues. While in 2007 these diseases caused
93.52% of all deaths, in 2011 it was 93.13%. At the same time, the order of these causes
between the monitored years did not change.
There were slight shifts of shares in the causes of death among individual diseases of the group.
In 2007 circulatory system diseases amounted to the share of 54.38%, in 2011 it was 52.61%; a
slight increase was seen with tumours – 22.22% vs. 23.26%; while a slight increase was also
seen with respiratory system diseases 5.86% vs. 6.3%. With digestive system diseases the share
remained almost equal 5.51% vs. 5,53%. External causes of death slightly dropped: 5.54% vs.
5.44%.
From the point of view of the target area of convergence we may state that in all NUTS III
regions mortality caused by circulatory system diseases dropped, while in the region beyond
assistance (Bratislava) a significantly smaller decrease was seen. Tumour diseases had a
stabilized occurrence in the Western and Central Slovakia; they were increasing in the Eastern
Slovakia, mainly in the region of Košice, and similarly in the region of Bratislava. Mortality
caused by diseases of respiratory system has similar characteristics; the highest increase can be
seen in the region of Bratislava though. External causes of deaths were decreasing in all regions,
and their drop may be attributed to extra-medicinal influences of external environment. A slight
increase in mortality caused by diseases of digestive system can be seen in the West Slovakia
(mainly the region of TT) and a drop in all other regions and districts in the area of
convergence; an unchanged situation can be seen in the region of Bratislava.
We may conclude that decreasing mortality in the area of convergence caused by diseases of
group 5 is visible, though statistically little important in comparison with the area beyond
convergence (the region of Bratislava) where outcomes are slightly worse.
59
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27. máj 2013
Analysis of healthcare needs of regions as per ‘diseases of group 5’ from the point of view of
hospitalisations is shown in the tables below.
Table 36: Number of hospitalisations as per ‘diseases of group 5’ in the NUTS III regions
in 2005
NUTS
II
region
NUTS Circulatory
III
system
Tumours
region
diseases
External
causes of
diseases
and
deaths*
Respiratory Digestive Selected
system
system diseases diseases
diseases
Total
Percentage
share of
selected
diseases in
all diseases
All
diseases
TT
13841
10080
9127
7278
9547
49873
51,07%
97657
TN
20434
11052
10311
9787
11688
63272
51,63%
122553
NR
19612
12220
10554
10294
14059
66739
50,35%
132552
Total
53887
33352
29992
27359
35294
179884
50,99%
352762
ZA
18204
11106
10542
10501
12369
62722
49,31%
127187
BB
22060
10823
11899
11223
12850
68855
53,00%
129920
Total
40264
21929
22441
21724
25219
131577
51,17%
257107
PO
27520
13462
12761
18108
14931
86782
49,66%
174760
KE
26596
14577
12311
15151
15379
84014
49,78%
168770
Total
54116
28039
25072
33259
30310
170796
49,71%
343530
Objective
“Convergence”
148267
83320
77505
82342
90823
482257
50,58%
953399
WS
CS
ES
BA
15943
11642
10447
6908
10632
55572
48,70%
114122
SR
164210
94962
87952
89250
101455
537829
50,42%
1067521
60
ABCD
Table 37: Number of hospitalisations as per ‘diseases of group 5’ in the NUTS III regions
in 2011
NUTS
II
region
WS
CS
ES
Tumou
rs
TT
12 997
10 987
8 811
6 222
10 553
49 570
49,44%
100 258
TN
21 792
11 663
11 336
9 382
13 251
67 424
52,36%
128 764
NR
19 712
13 340
10 273
9 132
14 238
66 695
49,55%
Total
54 501
35 990
30 420
24 736
38 042
183 689
50,51%
134 614
363 636
ZA
20 787
11 843
11 902
8 693
14 202
67 427
47,83%
140 982
BB
23 553
12 273
10 373
14 028
72 817
52,71%
Total
44 340
24 116
12 590
24 492
19 066
28 230
140 244
50,24%
138 141
279 123
PO
30 106
13 882
13 959
16 687
17 708
92 342
49,84%
185 286
KE
31 161
17 092
13 146
14 255
16 665
92 319
51,18%
61 267
30 974
27 105
30 942
34 373
184 661
50,50%
180 365
365 651
160 108
91 080
82 017
74 744
100 645
508 594
50,44%
1 008 410
16 890
14 036
10 962
92 979
6 610
10 898
59 396
49,03%
81 354
111 543
567 990
50,28%
121 135
1 129 545
Total
Objective
“Convergence”
BA
SR
External
Respira
causes of
tory
diseases and system
deaths
diseases
Percentage
share of
selected
diseases in
all diseases
Circulat
ory
system
diseases
NUTS
III
region
176 998 105 116
Digestiv
e system
diseases
Selected
diseases Total
All
diseases
From the point of view of number of hospitalisations we may see an increase in hospitalisations
in the categories of circulatory system diseases, tumours and digestive system diseases in
comparison of the years 2005 (status at the time of defining OPH) and 2011. The only drop in
the number of hospitalisations can be seen in respiratory system diseases. This condition is
equal both in the regions of convergence as well as in the region of BA.
Generally we could expect to see the ‘trend’ of increasing the number of hospitalisations and
shortening their duration; however, when comparing data from the whole SR for the years under
discussion, this trend is not confirmed. While the number of hospitalisations negligibly
fluctuates from the statistical point of view, the average period of hospitalisation is slightly
increasing. Data for 2011 is still not available.
Table 38: Bed establishments in SR in total
average hospitalisation period
2010
2007
2005
8,9
8,7
8,2
Source: NHIC, Medical year-books 2005, 2007, 2010
5.4.3.2
Summary of coverage of healthcare needs of regions as per ‘diseases of group 5’ by
OPH projects
The chart below presents the rate of coverage of needs of regions by OPH projects in the
context of 'diseases of group 5'.
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27. máj 2013
Chart 2: Demand rates of OPH coverage as per regions
60,0%
50,0%
40,0%
30,0%
20,0%
10,0%
0,0%
PO
BB
KE
NR
TN
TT
OPH intervention - Circulatory system diseases
Need
- Circulatory system diseases
OPH intervention - Tumours
Need
- Circulatory system diseases
OPH intervention - Respiratory system diseases
Need
- Respiratory system diseases
OPH intervention - External causes of diseases and deaths
Need
- External causes of diseases and deaths
OPH intervention - Digestive system diseases
Need
- Digestive system diseases
OPH intervention - Other diseases
Need
- Other diseases
ZA
Data source: MOH SR, Statistical Office of SR, Data current on 30.6.2012 and 21.3.2012 for 2011
5.4.3.3
•
The need represents a proportional classification of mortality of the particular ‘diseases of
group 5’ and regions for 2011 according to statistics of the Statistical Office of SR, i.e. by
dividing 100%.
•
OPH intervention represents the distribution of funds as per location of individual projects
and assessment of their impact on 'diseases of group 5' expressed in a percentage proportion,
i.e. by dividing 100% on the impact of individual 'diseases of group 5' and other diseases.
•
The need with weakest coverage seems to be the need related to circulatory system diseases,
i.e. project funds were expended on other types of diseases to the detriment of the circular
system, yet not only in the ‘group 5’ but also beyond it.
Summary of the focus of OPH projects in the context of ‘group 5’ and regions
The chart below presents a summary of the type of interventions of OPH projects from the point
of view of ‘diseases of group 5’ and regions from the point of view of financial perspective.
62
ABCD
Chart 3: Summary of financial interventions as per ‘diseases of group 5’and individual
regions for the whole OPH
70 000 000€
60 000 000€
50 000 000€
40 000 000€
30 000 000€
20 000 000€
10 000 000€
0€
PO
BB
KE
NR
TN
TT
ZA
Tumours
Other diseases
Chart 4: Summary of financial interventions as per ‘diseases of group 5’ and individual
regions for OP 1.1
8 000 000 €
7 000 000 €
6 000 000 €
5 000 000 €
4 000 000 €
3 000 000 €
2 000 000 €
1 000 000 €
0€
PO
BB
KE
NR
TN
TT
ZA
Tumours
Other diseases
63
ABCD
27. máj 2013
regions for OP 1.2
50 000 000 €
45 000 000 €
40 000 000 €
35 000 000 €
30 000 000 €
25 000 000 €
20 000 000 €
15 000 000 €
10 000 000 €
5 000 000 €
0€
PO
BB
KE
NR
TN
TT
ZA
Tumours
Other diseases
regions for OP 2.1
16 000 000€
14 000 000€
12 000 000€
10 000 000€
8 000 000€
6 000 000€
4 000 000€
2 000 000€
0€
PO
BB
KE
NR
TN
TT
ZA
Tumours
Other diseases
64
ABCD
5.4.3.4
OPH contribution per one hospitalised patient as per diseases and regions
Below we are presenting s summary of financial OPH contribution per one patient. This view
takes into consideration the structure of hospitalisation for 2011 and also the structure of the
focus of individual OPH projects executed in the particular regions.
Table 39: OPH contribution per one hospitalised patient as per diseases and regions
PO
BB
KE
NR
TT
TN
ZA
Circulatory
system
diseases
601 €
726 €
267 €
613 €
148 €
336 €
481 €
Tumours
577 €
215 €
321 €
518 €
75 €
264 €
791 €
Respiratory
system
diseases
854 €
560 €
693 €
454 €
99 €
215 €
334 €
External
causes of
diseases and
deaths
330 €
589 €
751 €
404 €
17 €
178 €
236 €
Digestive
system
diseases
498 €
414 €
587 €
291 €
59 €
152 €
257 €
Infectious
diseases
99 €
314 €
107 €
124 €
13 €
62 €
105 €
Data source: KPMG and NHIC, Data current on Hospitalisation rate 26.10.2012 for 2011
This view presented through the table and the chart represents a significantly objective
comparison of the contribution in individual regions in the area for improvement of coverage of
a particular disease of the ‘group 5’. The objectiveness of the comparison arises through
considering the needs of regions through hospitalisations, i.e. it takes into account the number of
hospitalised patients for the particular disease in the region, thus creating an objective
comparable basis among individual regions.
Chart 7: OPH contribution per one hospitalised patient as per diseases and regions
900 €
800 €
700 €
600 €
500 €
400 €
300 €
200 €
100 €
0€
PO
BB
KE
Tumours
NR
TT
TN
ZA
Data source: MOH SR, Data current on 30.6.2012, EUR – OPH amount for the particular disease and region / number of
hospitalisations for the particular disease and region
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27. máj 2013
5.4.4
View of regions through selected output Groups
5.4.4.1
Distribution of equipment as per types in EUR
Chart 8: Distribution of the types of equipment as per regions
35 000 000 €
30 000 000 €
25 000 000 €
20 000 000 €
15 000 000 €
10 000 000 €
5 000 000 €
0€
PO
BB
KE
NR
TN
TT
ZA
ICT
Other equipment
Data source: MOH SR, Data current on 30.6.2012, EUR – value of equipment based on project documentation
•
The chart shows frequent presence of diagnostic equipment in all regions, with the highest
one in BB. The region of KE stands out with representation of all categories.
•
The chart also shows the nature of beneficiaries in individual regions, e.g. a higher presence
of therapeutically focused entities in the region of NR.
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ABCD
5.4.4.2
Distribution of equipment as per types in pieces
Chart 9: Distribution of the types of equipment as per regions in pieces
700
1054
1492
600
500
(ks)
strojov
í
400
pr
300
Poč et
200
100
0
PO
BB
KE
NR
TT
TN
ZA
ICT
Other equipment
Data source: MOH SR, Data current on 30.6.2012, Number of devices – value based on project documentation
•
•
5.4.4.3
The chart reveals predominance of the region of BB in the number of devices, mainly
equipment and small instruments for departments of intensive care.
The category of other equipment is most numerous almost in every region, as it is small
additional equipment of a variable nature and usually of a lower procurement value.
Average prices for equipment as per regions
Chart 10: Average price for equipment as per the type of equipment and region
3 020 757€
5 308 903 €
1 400 000 €
1 200 000 €
1 000 000 €
1 015 789 €
800 000 €
600 000 €
400 000 €
200 000 €
0€
PO
BB
KE
ICT
NR
TN
TT
ZA
Other equipment
Limit of 500t EUR
67
ABCD
27. máj 2013
5.4.4.4
•
The chart distinctively shows a high procurement value of linear accelerators in KE, NR and
ZA in the category of therapeutic equipment.
•
We can also see that the most expensive diagnostic equipment was procured in the region of
TT; here surgical equipment was exceptionally expensive as well in comparison with other
regions.
Distribution of equipment above EUR 1 million for device as per regions
Chart 11: Distribution of equipment exceeding the value of €1 million as per regions
9 000 000 €
8 000 000 €
7 000 000 €
6 000 000 €
5 000 000 €
4 000 000 €
3 000 000 €
2 000 000 €
1 000 000 €
0€
PO
BB
KE
NR
TN
TT
Linear accelerators
Equipment for special examining (angiography)
ZA
Computer tomography equipment
•
Alltogether OPH included 13 pieces of equipment exceeding the value of €1 million.
•
It results from the chart above that the regions of PO and TN did not obtain any equipment
above € 1 million within OPH.
•
NR obtained the highest number of devices of this type; here also most funds were spent on
linear accelerator.
Angiographs in the regions of BB, KE and NR also had a significant financial
representation.
•
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ABCD
5.4.5
View of regions in cartographic summaries
5.4.5.1
Summary of the number of OPH projects as per regions
ZA
7
PO
21
TN
2
BA
BB
13
TT
6
KE
7
NR
8
5.4.5.2
Summary of the financial volume of OPH projects as per regions
ZA
13%
TN
2%
PO
23%
35 350 259 €
63 812 066 €
4 807 675 €
BA
BB
21%
TT
7%
KE
18%
51 432 629 €
59 274 323 €
20 278 683 €
NR
14%
39 843 863 €
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27. máj 2013
5.4.5.3
Summary of the need of regions as per hospitalisations vs. OPH intervention
9%
29%
14%
4%
11%
15%
9%
19%
36%
11%
14%
13%
41%
22%
6%
16%
15%
13%
8%
16%
18%
52%
6%
7%
9%
50%
17%
9%
10%
8%
9%
48%
10%
10%
7%
11%
9%
32%
10%
17%
13%
13%
17%
9%
47%
11%
13%
21%
8%
51%
6%
9%
15%
9%
10%
49%
8%
23%
10%
7%
33%
10%
9%
10%
50%
8%
7%
8%
10%
17%
9%
10%
12%
10%
Intervention
41%
10%
5%
12%
11%
16%
Need (Hospitalisation rate)
Tumours
Other diseases
44%
12%
12%
15%
The need in the form of hospitalisation is based on the data from 2011. Intervention takes into
account the structure of the focus of projects in view of ‘diseases of group 5’.
5.4.5.4
Summary of the need of NUTS II as per hospitalisations vs. intervention OPH (PA 1)
17%
16%
8%
50%
9%
50%
7%
8%
9%
15%
7%
9%
10%
10%
50%
19%
7%
8%
27%
35%
17%
10%
11%
9%
26%
10%
13%
18%
10%
23%
8%
30%
Intervention
9%
9%
16%
10%
Tumours
Other diseases
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ABCD
5.4.5.5
Summary of the need of NUTS II as per hospitalisations vs. intervention OPH (PA 2)
17%
16%
8%
50%
9%
50%
7%
8%
9%
7%
9%
10%
15%
0%
2%
10%
9%
50%
9%
7%
14%
9%
36%
8%
51%
16%
10%
15%
0%
22%
17%
13%
43%
13%
13%
18%
Intervention
Tumours
Other diseases
5.4.5.6
Summary of geographic distribution of project funds, proportional size and impact –
Measure 1.1
The size of the circle expresses the percentage of expended funds in the particular Measure. The
shadow of the circle is the impact of the particular intervention, i.e. if it stretches beyond the
borders of the region, if yes; the supported project has a supra-regional nature as for the scope of
its effect.
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27. máj 2013
5.4.5.7
Measure 1.2
shadow of the circle is the impact of the particular intervention, i.e. if it stretches beyond the
borders of the region, if yes, the supported project has a supra-regional nature as for the scope of
its effect.
5.4.5.8
Measure 2.1
shadow of the circle is the impact of the particular intervention; i.e. if the shadow is a double of
the circle, it is a supported project with a supra-regional nature as for the scope of its effect
(even though it does not stretch beyond the borders of the region), if there is no shadow it is a
project of a sub-regional nature, and if the shadow is small, it is a project of a regional scope of
effect.
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ABCD
5.4.5.9
Summary of the classification of funds for the Measure 1.1
5.4.5.10 Summary of the classification of funds for the Measure 1.2
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27. máj 2013
5.4.5.11 Summary of the classification of funds for the Measure 2.1
5.4.5.12 Summary of the classification of funds for OPH (less the Measure 2.2)
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ABCD
5.5
Measure 2.2 – National project – National Blood Transfusion Service
SR
5.5.1
Outputs of the project
Within the Final construction of infrastructure of the National Blood Transfusion Service
SR project
€ 8,638,568.78 was invested in total. The structure of investments is as follows:
5.5.2
•
56 pieces of laboratory technology intended for blood processing in the value of
€ 2,006,887.4, i.e. 23.23%;
•
518 pieces of other equipment intended for taking and storing blood and blood preparations
in the value of € 2,998,609.6, i.e. 34.71%;
•
9 vehicles for mobile blood taking and transportation of blood and blood preparations in the
value of € 770,574 i.e. 8.92%
•
Reconstruction of blood-taking and processing centre in Košice in the value of
€ 2,862,497.78, i.e. 33.13%.
Outputs of the project divided into Groups and Subgroups
Investments allocated within the “Final construction of infrastructure of the National Blood
Transfusion Service SR” national project are, similarly to other projects, divided into three basic
areas (output groups) which have an effect on output effects in view of the objective of the
project – to provide higher-quality and more efficient production and distribution of blood
transfusion preparations within the whole SR. New diagnostic equipment, other equipment and
reconstruction are involved in the above-stated.
The group of new diagnostic equipment is focused on laboratory technology. 56 pieces of
laboratory equipment and equipment which is directly intended for blood diagnostics and
processing were purchased from the OPH funds. This helped to supplement and modernize the
equipment in view of legislative requirements for production of blood preparations. (40% of
borrowed equipment will be gradually replaced by equipment from the project).
The group of other new equipment is divided into functional equipment (equipment intended for
blood taking and storing blood and blood preparations after taking, on transportation and
storage) and vehicles. 518 pieces of functional equipment were purchased with uniform
distribution to all blood taking and processing centres of the NBTS. Altogether 9 vehicles were
purchased – out of that 6 ambulance vehicles intended for mobile blood taking and
transportation and 3 for transportation of blood and blood preparations.
As for the reconstruction, brand new premises of the blood taking and processing centre in
Košice were built, intended to serve the Eastern-Slovakian region.
5.5.3
Impacts of the project
We have assessed the impacts of the project based on a visit and interview with the director and
project manager of the NBTS. Then we created a set of 11 questions through which we have
assessed impacts of the project and mainly potential impacts (project finalized on 31 March
2013) in view of strategic identification of the function of NBTS in the healthcare system in SR
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ABCD
27. máj 2013
and its share in the production and delivery of blood preparations for the needs of healthcare
providers in SR (83%).
The group of new diagnostic laboratory equipment has an impact on self-sufficiency and
independence of NBTS from supplier relations. Their potential in modernisation is significant
with the effect of increasing the percentage of deleukocyting of blood preparations – purchasing
6 afferetic devices will increase the number of 100% deleukotized thrombotic concentrates. ,
Equipment allocated in three processing (9 before the project) centred also enable a more
efficient use of labour force. The number of examined patients per device has not increased, as
parameters of the purchased devices are equal to those borrowed before. However, three
processing centres are increasing their production as follows:
Before centralization: Bratislava 120 takings, Banská Bystrica 50 takings, Košice 70 takings.
After centralization: Bratislava 300 takings, Banská Bystrica 250 takings and Košice 160
takings. In view of the above-stated, it is a significant contribution to efficiency of the centres.
Released capacities of original processing centres will be reflected in higher performance in the
area of takings. In the blood-taking centres we count with an increased number of takings by
about 15% as a result of saving the working time when the blood-taking centres were processing
blood. At the same time, the number of takings and affereses increases as a result of purchasing
new ambulance vehicles for the needs of the blood-taking centres. Increasing remote takings,
i.e. driving to the place of the donor, increases the availability for donors and the increased
likelihood of donating as such. Currently there are 20% of mobile takings and the plan is to
increase them to 30%.
From the point of view of availability, the availability of blood preparations in emergency
situations in crucial, when an increased concentration of blood preparations in three processing
centres in ensured – BA, BB and KE.
The last assessed group is reconstruction - in the blood taking and processing centre in Košice it
has brought lowering of the building’s energy class from ‚E‘ to ‚D‘. However, they are not
direct savings; new air ventilation system with air conditioning was built as a part of
reconstruction which was absent in the premises.
5.5.4
Summary of OPH contribution to equipment in SR (NBTS)
Table 40: Summary of the structure of project funding
NBTS investments throughout the project own resources
Equipment and devices
894 916 €
Vehicles
12 424 €
Constructions and reconstructions
28 786 €
OPH
5 037 374 €
770 399 €
1 437 303 €
76
Total
5 932 290 €
782 823 €
1 466 089 €
ABCD
5.6
Evaluation of potential overlap of strategic priorities of the Slovak
healthcare system and priorities and objectives of the EU Cohesion
Policy and the Europe 2020 strategy
5.6.1
Basic frameworks for implementation of the Cohesion Policy after 2013
Europe 2020
The European Union has defined its own medium-term development objectives in the Europe
2020 strategy. Objectives related to economic growth and creation of new work opportunities
have become the starting point for elaboration of relevant policies of the EU and of Member
States; or rather new policies have to clearly demonstrate contributions to the objectives of the
strategy. Mechanisms of coordination and interrelation among individual management levels
have been adjusted to efficient and effective implementation of the Europe 2020 strategy.
In the future programming period the Cohesion Policy will become the main EU tool for
fulfilment of the strategic objectives of the Europe 2020 strategy. It is therefore necessary to
know the thematic focus of objectives of the underlying strategy. Its purpose is to eliminate
structural problems and to bring sustainable solutions in relation to using funds, population
aging and weakened competitiveness. The initiated growth should be:
• Intelligent
through investments in education, research and innovation, digitalization;
• Sustainable
thanks to transition to low-carbon economy and focus on competitive
industries; and
• Inclusive
emphasizing the creation of jobs, social and territorial cohesion.
The National Reform Programme is directly linked to the strategy and integrated guidelines for
the Europe 2020 strategy. It has to be fully taken into consideration in creation of the
Partnership Agreement as the fundamental document for utilization of support within the
Cohesion Policy after 2013.
Scheme 1: Basic framework for the Cohesion Policy
Europe
2020
strategy
Europe 2020
integrated
guidelines
Multi-year
financial
framework
for 20142020
Common
Strategic
Framework
National
Reform
Programme
EU
legislation regulations
Partnership
Agreement
Operational
Programmes
Areas of priority for the Europe 2020 strategy are: research and innovation, education,
digitalisation, economic competitiveness, energy, employment and combating poverty.
Healthcare is not considered as crucial in view of meeting the objectives of the Europe 2020
strategy. The natural reason is that the support of healthcare or provision of healthcare does not
primarily contribute to economic growth and to creation of work opportunities. In the context of
the EU objectives until 2020, implementation of e-Health is the only explicit reference relevant
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for the healthcare system. It is necessary to emphasize here though that e-Health is a part of the
thematic priority for development of digital Europe.
Drafts of regulations and the Common Strategic Framework
Objectives of the Europe 2020 strategy aiming at an intelligent, sustainable and inclusive
growth are transformed into 7 flagship initiatives and 11 thematic objectives within the
Cohesion Policy. In the 2014-2020 programming period, the limitation of support to 11 thematic
objectives should help focus the attention and funds on those areas which have the highest
potential to contribute to recovery of economic growth of the EU and its Member States,
accompanied by creation of new work opportunities. In particular, they are the following
thematic objectives:
1 Strengthening research, technological development and innovation;
2 Enhancing access to, and use and quality of, information and communication technologies;
3 Enhancing the competitiveness of small and medium-sized enterprises;
4 Supporting the shift towards a low-carbon economy in all sectors;
5 Promoting climate change adaptation, risk prevention and management;
6 Protecting the environment and promoting resource efficiency;
7 Promoting sustainable transport and removing bottlenecks in key network infrastructures;
8 Promoting employment and supporting labour mobility;
9 Promoting social inclusion and combating poverty;
10 Investing in education, skills and lifelong learning;
11 Institutional capacity and efficient public administration.
The main sources of investments on the EU level which are supposed to help Member States
recover and increase their growth and ensure a recovery bringing new jobs, while at the same
time ensuring sustainable development in compliance with the objectives of the Europe 2020
strategy are: European Regional Development Fund (EFRD), European Social Fund (ESF),
Cohesion Fund (CF), European Agricultural Fund for Rural Development (EAFRD) and the
European Maritime and Fisheries Fund (EMFF). Two funds are relevant for funding
interventions in healthcare:
•
ERDF will contribute to all thematic objectives and will focus on the areas of interventions
where companies are active (infrastructure, business services, support of business activities,
innovations, ECT and research) and on provision of services for people in certain areas
(energy, e-services, education, healthcare, social and research infrastructure, availability,
environmental quality).
•
ESF will be planned in view of four thematic objectives: employment and supporting labour
mobility; education, skills and lifelong learning; promoting social inclusion and combating
poverty as well as developing administrative capacities. Measures supported from ESF will
also contribute to fulfilment of other thematic objectives.
Contrary to the ongoing programming period, after 2013 programmes/priority axes can be
funded from several funds (multi-funded). In this way the EC is creating scope for application
of an integrated approach to development of Member States and regions.
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ABCD
Each thematic objective contains a set of the so-called investment priorities, identifying main
areas of support within the thematic objective. If the selected thematic objectives of the
Cohesion Policy in principle represent a level of priority axes, the selected investment priorities
will be the lowest level in the context of the programme. Suitable specific objectives and
indicators will be matched with selected investment priorities through them it will be possible to
verify their fulfilment.
The topic of healthcare does not appear on the level of thematic objectives and does not form a
separate investment priority either. However, in several thematic objectives it is possible to
identify certain investment priorities enabling direct interventions in healthcare. Those thematic
objectives and investment priorities explicitly mention support of healthcare as necessary to
fulfil the specified objectives. Here we can see the greatest potential for healthcare support to
become a part of objectives on the level of new operational programmes/priority axes. It means
that selected elements of healthcare must be systematically addressed on the programme level,
i.e. through a set of projects. In particular, they are the following investment priorities:
•
2 c) Strengthening ICT applications for e-government, e-learning, e-inclusion, e-culture
and e-health;
•
9 a) investments in healthcare and social infrastructure in order to improve the access to
healthcare and social services and to mitigate inequalities in the area of healthcare with a
particular focus on marginalized groups, such as the Roma and the people threatened by
poverty;
•
ESF a(vi) Active and healthy aging (thematic objective 8);
•
ESF b(ii) Inclusion of marginalized groups, such as the Roma (thematic objective 9);
•
ESF b(iv) Improvement of access to affordable, sustainable and high-quality services
including healthcare and social services of general interest (thematic objective 9).
Along with the above-mentioned investment priorities creating a scope for integration of
healthcare support among top priorities of new operational programmes, in the investment
priorities below we can see a scope for healthcare support on the level of area of support/group
(of interrelated) projects:
•
ESF c(iii) Improving the access to lifelong learning, recovery of skills and competencies of
labour force and enhancing the relevance of systems of education and expert preparation
from the point of view of labour market (thematic objective 10);
•
ESF d(i) Investments in institutional capacities and in efficiency of public administrations
and public services in view of reforms, better regulation and good governance of public
matters (thematic objective 11);
•
1 b) Supporting business activities, investments in innovations and research, connection
among companies, R&D centres and higher education.
The main reason is that the mentioned thematic objectives and investment priorities are
generally formulated and provide a large scope for addressing potential needs of the healthcare
system and relevant institutions. In the case of the thematic objective 10 Investing in education,
skills and lifelong learning in the 2007-2013 programming period, the MOH SR in the function
of the intermediary body performs activities in the area of lifelong learning of medical staff as a
part of an independent priority axis OP Education. Therefore interventions in this area could
represent a natural continuation, while considering new priorities of this area till 2030. On the
other hand, MOH SR has not used SF funds to enhance professional and institutional capacities
necessary to enhance the efficiency of its activities until now. This area prospectively includes
the whole public administration in Slovakia, so there is again a wide range of possibilities how
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27. máj 2013
to use the funds in order to enhance the quality of functioning of the healthcare area. As a
prospective area of support we have also mentioned the investment priority 1 b), as one of key
areas within the support of research, technologic development and innovation should also be
medicinal (bio-medicinal) technologies in the 2014-2020 programming period in Slovakia.
In the case of other thematic objectives and investment priorities, there are options to fund
selected elements, but then these would probably have the form of individual projects as there is
no clear and direct connection to targets in these areas. The thematic objectives 4 Supporting the
shift towards a low-carbon economy in all sectors, and 7 Promoting sustainable transport and
removing bottlenecks in key network infrastructures, provide no scope to support investments in
healthcare.
We may conclude that current setting of objectives of Europe 2020 strategy and their thematic
reflection in the Cohesion Policy creates the largest scope for healthcare support on the
programme level within the thematic objectives focused on employment, education, combating
poverty and modern public administration (thematic objectives 8 – 11). These should be
primarily funded from ESF, even though a part of investment priorities containing healthcare
infrastructure will be supported from ERDF. Another significant area is e-Health which should
be supported as a part of the thematic objective 2 Enhancing access to, and use and quality of,
information and communication technologies. We expect that the investment priority 1 b)
within the thematic objective 1 Strengthening research, technological development and
innovation will be focused on applied research in healthcare in line with the elaborated national
strategy of intelligent specialisation S3 of the Slovak Republic.
5.6.2
Thematic focus of the Cohesion Policy after 2013 in the Slovak Republic
Position Paper
Common preparation for the new programming period also involves the Position Paper of the
Commission related to elaboration of the Partnership Agreement and programmes in Slovakia
for 2014-2020. Contrary to the 2007-2013 programming period when the Position Paper served
as the official EC response to the first draft of programming documents, in connection to the
period of 2014-2020, the Position Paper is a significant input in the whole programming process
of the Cohesion Policy after 2013. In conditions of the Slovak Republic this input was even
more important due to the fact that at the time of disclosing the document (October 2012) there
were no starting points and an official position to the 2014-2020 programming period. In
connection to a brief analysis, the EC introduced 5 areas of priority which Slovakia should focus
on after 2013:
•
Business environment supporting innovation;
•
Infrastructure for economic growth and creation of work positions;
•
Growth of human capital and better participation in labour market;
•
Sustainable and efficient use of natural resources;
•
Modern and professional public administration.
Healthcare system was not a subject of a specific analysis and it did not appear in areas of
priority for support from investment and structural funds for Slovakia for the 2014-2020
programming period either. On the contrary, in the Position Paper the EC expressed the opinion
that in spite of a significant progress in OPH implementation in the 2007-2013 programming
period, in the future interventions aimed at increasing the efficiency of functioning of the
Slovak healthcare system should be primarily funded from national resources. In this way the
80
ABCD
EC confirmed that healthcare will not be an area of priority of support from the Cohesion Policy
and funding options will be limited. In the context of the new programming period it does not
mean though that healthcare support in Slovakia will not be possible. Investments in healthcare
will have to be clearly connected with the national concept of development of healthcare in the
long-term period and with the support focused on selected aspects of the system. These
requirements should contribute to concentration of investments into efficient and sustainable
solutions in healthcare. The basic criterion for assessment of relevance of support by EC will be
the connection to thematic objectives and investment priorities specified for 2014-2020, or
specific target groups such as the socially excluded, poor and marginalized Roma communities.
The support should represent an added value for the Community which means that it should not
only become a substitute of national resources. Therefore it is necessary to see potential
interventions in healthcare as complementary activities in the context of wider thematic
objectives (investment priorities), enhancing the quality and availability of healthcare while
considering the expected demographic changes.
Partnership Agreement
In the Slovak Republic the preparation process of the 2014-2020 programming period actually
started only in January 2013, in connection to specification of the structure of operational
programmes and managing authorities responsible for their preparation. The structure of
operational programmes basically corresponds with priority areas of support specified in the
Position Paper. In the Resolution of the Government Council for Partnership Agreement for the
period of 2014-2020, the following operational programmes have been approved for the
Cohesion Policy:
•
Operational programme Research and Innovation (OP RaI);
•
Operational programme Integrated Infrastructure (OP II);
•
Human resources (OP HR);
•
Environmental quality (OP EQ);
•
Integrated regional operational programme (IROP);
•
Efficient public administration (OP EPA); and
•
Technical support (OP TS).
Along with a clear thematic specification of priorities for funding from Cohesion Policy
resources in the 2014-2020 programming period, the EC expressed a requirement to minimise
the number of operational programmes. This is one of the reasons why interventions in
healthcare will not be performed through an independent operational programme in the future.
Relevant operational programmes
Strategic documents and legislation adopted on the EU level in the new programming period
creates preconditions for funding interventions for healthcare preferably in relation to thematic
objectives 8 – 11. On the level of those objectives and relevant investment priorities it is
possible to treat the support of healthcare as an independent area on the level of a programme;
i.e. in the form of a priority axis or its separate part. The Resolution of the Government of SR
No 139/2013 of 20 March 2013 related to proposed structure of OPs funded from the European
structural and investment funds for the 2014-2020 programming period and related to the
structure and content of the Partnership agreement, which specifies the MOH SR as the
intermediary body for OP Human resources, was a response to the above-mentioned fact. Along
with the investment priority 9a funded by ERDF and ESF within the OP HR, there is a thematic
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relation to OP EPA, IROP and OP II. OP EPA represents a separate programme which should
systematically address modernisation and professionalization of public administration in
Slovakia (thematic objective 11). In view of its society-wide importance and share in public
expenditures, healthcare system should have a noticeable position. Support will probably have a
form of complex projects, not an independent priority axis. Contrary to OP EPA, IROP is
thematically broadly formulated (thematic objectives 5, 6, 7, 9 and 10), but its purpose is to
form the basis for implementation of integrated strategies on the regional and local level. There
is sufficient scope for systemic changes in functioning of the healthcare system within the
thematic objective 2 (OP II), mainly in relation to implementation and development of e-Health
in Slovakia). Activities within the investment priority 1b) will be performed in order to support
research and innovations, while one of the most prospective areas in Slovakia are medicinal
(bio-medicinal) technologies, but there is no direct connection to the system of healthcare
provision.
5.6.3
Development prognosis
Similarly to most EU countries, Slovakia also has to face demographic trends which are
manifested in overall population aging. The prognosis of demographic development in Slovakia
until 2030 expects a significant increase of the population group aged 45+ to the prejudice of a
younger population group. In particular, the share of population aged 45+ should increase from
the current 39.82% up to 52.16%.
Table 41: Prognosis of age structure of population
Age
Number
Number
0 – 17
18 - 44
45 - 64
65 +
997 456
2 252 974
1 459 902
690 448
5 400 780
876 435
1 678 101
1 631 935
1 153 779
5 340 250
Total
Source: Infostat
Along with the trend of population aging, from 2015 a gradual decreasing of the total number of
population of the Slovak Republic is expected. Demographic development (including the upper
medium life expectancy) will be one of key factors determining the scope and nature of the
demand for healthcare. In the context of the demographic prognosis, the healthcare system will
have to respond to the increasing share of the older population group and specific needs of this
target group. In practice it will mean a higher number of procedures of social and health care. In
practice it will increase the pressure on closer connection of the affected services and their
availability for this particular target group.
On the basis of OECD data it is possible to identify the trend of increasing total expenditures on
health, expressed as a proportion to GDP, as well as the volume of funds per one citizen. Also
as a result of broader demographic and social changes, public expenditures on health in
Slovakia (as a share in GDP) should considerably increase in the medium term. It may also be
expected that the current trend of quick decreasing of the relative share of public resources in
total expenditures in the healthcare system will continue in the future in the context of
consolidation of public funds; and in this way the gap between Slovakia and OECD average will
further deepen. This process will create a natural pressure on increasing the efficiency of
healthcare provision in Slovakia and execution of systemic changes in the healthcare system.
Another important aspect of healthcare provision is a decreasing number of medical staff in
Slovakia. This situation is a result of a missing medium-term concept of development of
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medical staff, low attractiveness of this area for graduates and a significant number of qualified
doctors and nurses working abroad. It causes that the average age of medical staff in selected
establishments and specializations is very high and there is no sufficient number of young staff.
In its analysis, the Financial Policy Institute of the Ministry of Finance of SR pointed out to the
deteriorating status of Slovak healthcare system from the point of view of efficiency. It states
that even when we consider major factors, our healthcare system has the worst results in OECD
countries. In the middle of the last decade the efficiency of the Slovak healthcare system started
to deteriorate and now it is one of the least efficient countries together with Hungary. A crucial
finding is that a higher volume of funds in the system, contrary to other countries, has not been
manifested in better results.
5.6.4
Priorities of the Slovak healthcare system
The basic requirement (ex-ante conditionality) for using European investment and structural
funds to support healthcare in 2014-2020 is the existence of a national/regional strategic
healthcare framework. As for its content, the strategic framework should at least define:
mutually coordinated measures to improve the availability of healthcare, measures to enhance
the efficiency of the healthcare system and a system of monitoring the progress achieved in
fulfilment of the specified objectives.
The ex-ante conditionality for the 2014-2020 programming period is in line with intentions of
the Ministry of Health of the SR to elaborate a conceptual document of development of the
Slovak healthcare system in a longer time period. In the course of assessment, the Ministry
started to prepare the Strategic Framework in Healthcare for the period of 2013-2030. In the
final stage of assessment the assessor was provided with a non-official draft containing longterm priorities of the Slovak healthcare system.
The document draft responses to the international context, in particular to a common political
framework, Health 2020, administered by the World Health Organization, which Slovakia has
also accepted. It defines the following areas of priority:
Priority area 1: Investment in one's own health throughout the life cycle and creation of
possibilities for strengthening the responsibility of people for their health;
Priority area 2: Addressing the major challenges in the region: contagious and non-contagious
diseases;
Priority area 3: Strengthening health systems in the centre of interest of which there are people,
enhancing the capacities of the public healthcare system and of preparedness, surveillance and
the possibility to respond to emergency situations;
Priority area 4: Creating healthy communities and supporting environment for human health.
The priority tasks which the Ministry of Health of SR plans to deal with in the next years
include:
•
performing a residential programme with general practitioners or in other specializations
with a long-term shortage of experts in Slovakia;
•
performing the programme of recovery or restructuring of infrastructure of bed
establishments in the course of fifteen years;
•
building an integrated model of healthcare provision based on a strengthened position of a
GP (gatekeeping), shift of a part of healthcare from bed-based to community-oriented
outpatient care and functional exchange of information (eHealth);
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•
implementing programmes to improve public health in the area of socially significant
diseases based on a multi-resort cooperation and on construction of a monitoring system;
•
supporting prevention programmes in preventing contagious and non-contagious diseases in
primary contact.
Priorities and particular tasks defined in the Strategic Framework in Healthcare for the period of
2013-2030 will be monitored through a set of quantifiable targets and indicators. The working
version of the Strategic Framework in Healthcare contains a high number of measurable
objectives (and relevant indicators) which should be achieved until 2030. The expected changes
would bring improvement in comparison with the current condition of healthcare provision in
Slovakia and bring the current performance closer to the average of OECD countries or the
average of the best OECD countries. However, it is highly probable that other OECD countries
will further systematically improve the efficiency of their healthcare systems in the future,
which could further deepen the differences between the Slovak Republic and the OECD
average. From this point of view it is also possible to work with a dynamic development model
in other highly-developed countries.
5.6.5
Potential funding of healthcare from Cohesion Policy funds
Approaches in other EU countries
In order to compare and get an overview of attitudes to utilization of Cohesion Policy funds for
development of the healthcare system, we have analyzed the support of interventions for
healthcare in the 2007-2013 programming period and the funding intentions after 2013 in 6 EU
countries (Bulgaria, Czech Republic, Greece, Hungary, Estonia and Latvia). In the current
programming period of 2007-2013 there were interventions in the healthcare system in these
countries funded, similarly to Slovakia, from ERDF and ESF within several operational
programmes. The support involved both investment and non-investment activities, while a
major part of the assistance was aimed at improving the condition of infrastructure. It results
from the fact that with the exception of Greece, all analyzed countries were a part of the
Communist block and for the last 20 years their healthcare systems and the systems of
healthcare provision have been undergoing a substantial transformation. In spite of different
models of healthcare provision in individual countries, a common problem is an insufficient
quality of healthcare infrastructure, while structural funds have played a major role in its
renewal.
Unlike the Slovak Republic, in certain analyzed countries the utilization of assistance from SF
was based on an existing strategy of the healthcare system (Greece, Bulgaria, Latvia, Estonia).
An important aspect is that authorities in charge have practically used strategies/concepts of
healthcare development not only in the programming process, but also then in the
implementation stage or during assessment of the contribution of interventions to fulfilment of
objectives of relevant strategies. In these countries the focus of interventions on particular
healthcare areas and support of systemic changes in healthcare are obvious. When a strategy in
the healthcare system was missing, the main argument for funding interventions in the
healthcare area from structural funds was an unfavourable state of health of population and its
economic impacts.
The most frequently supported areas are:
•
improvement of healthcare infrastructure;
•
purchase of equipment and technology;
• energy efficiency of medical facilities;
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•
implementation and development of e-health;
•
education of medical staff;
•
quality of management of medical facilities;
•
systemic measures in the healthcare system.
Contrary to the Slovak Republic, the EC directly responded to the situation in healthcare or the
status of health of the population in the Position Papers for the analyzed EU countries. In
several Position Papers it explicitly mentions the area of healthcare as a significant area of
support in the context of fulfilment of the objectives of Europe 2020.
All 6 countries consider investments in healthcare in the future programming period as
important, though currently there are no particular volumes of funds for this area available. As a
matter of fact, interventions will be primarily performed within the thematic objective 9, while it
will be a combination of funds from ERDF and ESF (investment and non-investment activities).
In some cases (Bulgaria) the capacities for creation and implementation of policies and
strategies will be supported in the context of the thematic objective 11 Enhancing institutional
capacities and efficient public administration.
In a closer analysis we can see a trend to concentrate resources in a relatively limited number of
areas, their thematic interconnection and coordination, while emphasis is laid on the support of
centres (municipal areas) covering broader catchment areas. The basic argument for utilization
of funds from the Cohesion Policy for healthcare after 2013 is improvement of access and
quality of healthcare (and social) services. The most frequently mentioned areas of support are:
•
integration of social and medical service;
•
transition from institutional healthcare to community healthcare;
•
prevention in relation to selected risk groups and increasing awareness;
•
purchase of specialized medical technology for selected types of equipment/selected types
of diagnoses.
Relevant thematic objectives and programmes
interventions in the healthcare system should be primarily funded from national resources, there
are options to support selected parts of the healthcare system. The largest scope for supporting
the healthcare system from funds of the Cohesion Policy may be seen in thematic objective 9
Promoting social inclusion and combating poverty, and within the thematic objective 11
Enhancing institutional capacity and efficient public administration. In our conditions the
above-mentioned thematic objectives should cover the OP Human resources and the OP
Efficient public administration. Interventions in healthcare could represent separate programme
parts (priority axes or specific targets of priority axes) in the respective programmes with an
option of direct involvement of the MOH SR in implementation as the intermediary body.
In line with the EC requirement (relevant ex-ante conditionality) for the existence of a national
strategic framework for healthcare system, funding from resources of Structural Funds should
be justified by the need to systematically address shortcomings of the Slovak healthcare system
(reforms). Efficiency and sustainability of healthcare provision and enhancement of its quality
and availability, while considering the demographic trends, should become a priority. Transition
to an integrated model of healthcare provision and linking the health and social care should be
an important part of the strategy.
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Transition to a new (integrated) model of healthcare provision represents a crucial change in the
system. Yet more important is a careful preparation for launching transformation which should
be first tested in selected establishments or regions. The purpose of the National Strategic
Framework in Healthcare for the period of 2013-2030 is to determine basic priorities which
should be then fulfilled through particular strategies and measures. These should be processed
and performed after approval of priorities for the healthcare system. Specific strategies and
systemic measures are crucial for focusing of interventions in the healthcare system and actual
utilisation of EU funds in the 2014-2020 programming period. In view of the nature of the
Strategic Framework and the valid ex-ante conditionality for healthcare support after 2013, it
will be necessary to elaborate a proposed approach (measures) in the Strategic Framework itself
or in a related strategy to address a particular challenging area. It is important that strategic
documents contain an integral framework for addressing identified shortcomings in healthcare
and mutual logical connections of individual measures. Such attitude will not only strengthen
the position of MOH SR (relevant managing authority) in the process of negotiations with the
EC, but will also significantly increase preparedness for utilization of funds in the new
programming period.
Expectations of the MOH SR that the transformation into a new model of healthcare provision
will contain new processes, higher quality and availability of human resources and changes in
infrastructure are fundamentally correct. Support of the respective areas is justified in the
context of planned systemic changes. The question is if the MOH SR will be able to clearly
define basic parameters (standards) for the new model in the programming process or if
respective activities will be performed within a new generation of projects. In this regard it is
probably possible to use a part of funds of technical support of OP Healthcare. We expect that in
the implementation stage it will be necessary to first perform projects which, based on
strengthened capacities of the MOH SR, will prepare standards and human resources for the
new healthcare model.
The proposed basic areas of healthcare support, i.e. processes and services, human resources
and modernisation of infrastructure, can be basically funded from European investment and
structural funds. In our opinion the key role of the MOH SR today will be to detail:
•
common purpose of healthcare support in the future programming period;
•
define basic frameworks of a new integrated model of healthcare provision and
requirements for its application;
•
clearly prove the importance and logical connection (synergies) of the proposed activities.
Here it is possible, to a certain extent, to use findings from performance of the tasks 1 and 2 of
this assessment. These have confirmed that the financial support within the OP Healthcare was
generally beneficial for the healthcare system and for the supported entities in improving
availability, efficiency and quality of healthcare. It is also true that a more general thematic
focus of assistance on diseases of ‘group 5’, which represent a substantial part of all diseases,
has decreased potential contributions due to its weakened thematic concentration. A broad range
of medical establishments (parts) and also activities were supported within the Programme.
Therefore in the future the support from the European investment and structural funds should be
focused on a narrow group of systemic measures which can be comprehensively performed and
which have the capacity to bring long-term effects. In this case comprehensive means
transformation, transition to a new more efficient model of healthcare provision which includes
infrastructure, services, processes and staff. Measures should be performed in the context of
expected demographic changes and their impacts on healthcare provision.
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Non-returnable forms of funding
On the basis of available information, no EU Member State used financial engineering tools in
the 2007-2013 programming period to support interventions in the healthcare system. Generally,
the repayable financial assistance has been only a marginal tool in the use of Structural funds
until now when the form of non-repayable assistance prevails (grants). In the 2014-2020
programming period, it is the intention of the EC to increase the share of returnable financial
assistance to approximately 15% of the total volume of Cohesion Policy funds and that would
significantly increase their leverage effect. Application of returnable forms of assistance will
require a detailed analysis of blank areas in the market for a particular market segment. Such
process would be necessary also if the MOH SR (relevant managing authority) considered
using such tool. The purpose of the text stated below is to provide basic information and
orientation in possibilities of utilization of returnable forms of funding in the healthcare system.
Technology transfer funds – transfer of technology may be defined as the process of
transformation of R&D outcomes into products and services marketable in the particular
market. This transfer or transformation may be achieved in several ways, mainly in the form of
cooperation between research institutes and industry, licensing in the area of intellectual
property rights, establishment of new companies or the so-called spin-off companies. Transfer
of technology is becoming a strategic area, as new technologies and outcomes cannot be fully
utilized, unless they become attractive for users and investors.
Risk capital – in this tool attention is focused on construction of necessary infrastructure of risk
capital of the private sector with the aim to identify blank areas and opportunities in the
respective market and thus to increase the attractiveness of risk capital as an alternative category
of assets. The purpose is to provide funds to innovative SMEs in the initial stage of their activity
and in the process of their growth. The main reason is that such companies are often too risky
for the banking sector and then face financial problems. They also represent excellent
investment opportunities and growth potential.
Funds connecting business angels – business angels are natural persons and legal entities with
free capital who want to increase its value by investing in other projects. The most common
form of investment is a property share of an investor in a company or an investor joining the
company as a silent partner. This tool is intended for companies which have a project prepared
with commercial potential and are looking for resources for its execution.
Securing – another option is cooperation with institutions providing funds or securities for
funding of SMEs. Cohesion Policy resources may be used to decrease funding of the risk of
SMEs. Main securing products supporting companies in their access to funds: (i) improvement
of the quality of loans / secured funding tools; and (ii) securities / counter-securities for
portfolios of microloans, loans for SMEs or hires/leasing.
Microloans – micro funding mainly consists of microloans (with amounts lower than EUR
25,000) which are customized to very small (micro) companies and persons who would like to
become self-employed but they have to face problems in the access to common banking
services. The European microfinancing market is a quite young, but a quickly-growing segment,
mainly in new Member States.
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6
Evaluation Questions
6.1
Topic 1
6.1.1
AQ1 – What is the impact of the approved OPH projects on increasing the quality
of the provided healthcare within the infrastructure of supported healthcare
providers?
Programme as a whole
The approved projects have a positive impact on increasing the quality of the provided
healthcare. The contribution to quality is given in the following areas:
•
new methods and procedures in diagnosing and treatment of diseases and conditions through
the purchased diagnostic, surgical and therapeutic equipment;
•
enhancing the quality of existing methods through purchasing more advanced diagnostic,
surgical and therapeutic equipment;
•
enhancing the quality of environment in which patients are diagnosed and treated through
improvement of sanitary parameters of departments of intensive care, operating rooms and
emergency receptions in hospitals;
•
enhancing the quality of internal communication through a high digitalisation rate and
implementation of information technologies for expert medical staff;
•
enhancing the subjective quality of environment for expert medical staff and patients in the
reconstructed and new infrastructure;
•
potential to enhance the quality of other processes which are both directly and indirectly
connected with investments in facilities and reconstructions.
In objectively measurable parameters the contribution to quality is already manifested (with
finalized projects – the figure in the brackets on a yearly basis, if it is known) and have the
potential to be further manifested (with unfinished projects) as follows:
•
by increasing the number of performed diagnostic and therapeutic procedures (number of
new methods and procedures in diagnosing and treatment of diseases and conditions (47,169
diagnostic procedures; 2,056 surgeries; 2,983 new therapeutic procedures);
•
shortening waiting times (by days to months, more details to be found in individual
measures);
•
decreasing the hospitalisation time (now only a minimum impact);
•
lowering the number of undesired effects of treatments (decrease of re-hospitalisations up to
25%);
•
decreasing the number of nosocomial infections (up to 71% with operated patients, up to
66% with the non-operated ones);
•
transfer of certain procedures into outpatient care (not quantified);
•
better identification of early forms of diseases in secondary and tertiary prevention (not
quantified).
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We evaluate the average contribution of approved projects to quality, based on our supporting
documents, for 59.25%.
Measure 1.1
The approved projects have a positive impact on enhancement of quality of the provided
healthcare in specialized hospitals through implementation of new methods and procedures in
diagnostics and treatment, enhancing the quality of the existing/currently not used methods
through purchasing more advanced technology, enhancing the quality of internal
communication through a high rate of digitalisation and informatization for expert medical staff.
At the same time the subjective quality of environment has been improved for expert medical
staff and patients in the reconstructed and new infrastructure and there is a potential to enhance
the quality of other processes which are both directly and indirectly connected with investments
in facilities and reconstructions.
In objectively measurable parameters the contribution to quality is already manifested with
finalized projects and has the potential to be further manifested (with unfinished projects). On a
12-month basis the number of performed diagnostic procedures was increased by 13,871 and
1,810 procedures in new methods. At the same time, the number of surgeries increased by 2,527
and therapeutic procedures by 942 in the hyperbaric chamber and 820 in Lokomat Nanos.
Waiting time for diagnostic and therapeutic angiographies is shorter by up to 7 months in
VUSCH Košice, waiting time for treatment with a linear accelerator was shortened by 50%
in Košice and Žilina. Shortening of the waiting time has a minimum impact now, it can be
detected only in NURCH Piešťany, namely by 2.95 days. All the above-mentioned parameters
had an impact on decreasing the number of undesired effects of treatment up to 16%),
decreasing the number of nosocomial infections (by up to 71% with the operated patients, up to
66% with non-operated ones, mainly in departments of intensive care). There is also a potential
to improve identification of early forms of diseases in a secondary and tertiary prevention, it
cannot be quantified though.
Measure 1.2
The approved projects have a positive impact on enhancement of quality of the provided
healthcare in general hospitals through implementation of new methods and procedures in
diagnosing and treatment, enhancement of quality of the existing/currently not used methods
through purchasing more advanced technology, enhancement of the quality of environment in
which patients are diagnosed and treated, through improvement of sanitary parameters of
departments of intensive care, operating rooms and emergency receptions in hospitals,
enhancement of quality of internal communication through a high rate of digitalisation and
informatization for expert medical staff. At the same time the subjective quality of environment
has been improved for expert medical staff and patients in the reconstructed and new
infrastructure and there is a potential to enhance the quality of other processes which are both
directly and indirectly connected with investments in facilities and reconstructions.
12-month basis the number of performed diagnostic procedures increased by 19,757. From the
point of view of waiting times, a significant contribution is shortening the waiting time for
treatment with a linear accelerator in FN Žilina from 14 to 7 days. The number of surgeries did
not increase directly; however, the number of nosocomial infections with operated patients (up
to 20%) decreased. Specific quality can be seen at DFNsP in Banská Bystrica – it became
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independent thanks to their own operating premises for surgeries of hospitalised patients and
patients in one-day surgery. All the above-mentioned parameters had an impact on decreasing
the number of undesired effects of treatment (up to 16%), decreasing the number of nosocomial
infections (up to 20%, mainly in departments of intensive care). There is also a potential to
improve identification of early forms of diseases in a secondary and tertiary prevention, it
cannot be quantified though.
Measure 2.1
The approved projects have a positive impact on enhancing the quality of the provided
healthcare in policlinics through implementation of new methods and procedures in diagnosing
and treatment, enhancing the quality of the existing/currently not used methods through
purchasing more advanced technology, enhancing the quality of environment in which patients
are diagnosed and treated. At the same time the subjective quality of environment has been
improved for expert medical staff and patients in the reconstructed and new infrastructure and
there is a potential to enhance the quality of other processes which are both directly and
indirectly connected with investments in facilities and reconstructions.
12-month basis the number of performed diagnostic procedures increased by 13,541 and
surgeries by 1,183. There is also a potential to improve identification of early forms of diseases
in secondary and tertiary prevention, it cannot be quantified though.
Measure 2.2
As for the Measure 2.2. only one project was executed; and its activities are terminated (as of 30
April 2013).
The project has a positive impact on enhancing the quality of the provided healthcare in the area
of the blood transfusion service in SR. The contribution to quality is given in the following
areas:
•
enhancing the quality of the existing methods through purchasing more advanced diagnostic
technology;
•
enhancing the quality of environment in which blood is taken from donors;
•
enhancing the quality of environment in which blood derivatives are processed and stored;
•
enhancing the subjective quality of environment for expert medical staff and patients in the
reconstructed and new infrastructure;
•
potential to enhance the quality of other processes which are both directly and indirectly
connected with investments in facilities and reconstructions.
In objectively measurable parameters the contribution to quality is not directly manifested yet.
We evaluate the average contribution of the project to quality, based on our supporting
documents, for 57.7%.
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6.1.2
AQ2 – What is the impact of the approved OPH projects on increasing the
efficiency of the provided healthcare within the infrastructure of supported
healthcare providers?
Approved projects have a positive impact on increasing the efficiency of the provided
healthcare. The contribution to efficiency is given in the following areas:
•
increasing the number of treated patients through improved logistics in the reconstructed
infrastructure;
•
decreasing the number of treatment sessions with the same therapeutic effect achieved;
•
decreasing the costs of energy and maintenance of buildings and premises;
•
new methods and procedures reported to health insurance companies performed by the same
expert team in diagnosing and treatment of diseases and conditions through the purchased
diagnostic, surgical and therapeutic equipment;
•
enhancing the quantity of existing methods through purchasing more advanced and faster
working diagnostic, surgical and therapeutic equipment;
•
enhancement of efficiency of internal communication through a high digitalisation rate and
by implementing information technologies for expert medical staff;
•
decreasing the need for premises and labour force in relation to digital diagnostics and
archiving;
•
potential enhancement of efficiency of other processes which are directly or indirectly
related to investments in facilities and reconstructions (e.g. rationalisation of cleaning and of
disinfection programme, improved record-keeping in electronic form, other use of human
resources).
In objectively measurable parameters the contribution to efficiency is already manifested with
finalized projects and has the potential to be further manifested (with unfinished projects) as
follows:
•
decreasing the number of nosocomial infections and decreasing the costs of ATB treatment
(costs of treatment are not quantified);
•
increasing the number of performed diagnostic and therapeutic procedures during the
working time by the same staff (projects are not connected with employment increasing);
•
shortening the hospitalisation time and subsequent decreasing the costs of terminated
hospitalisation;
•
improving identification of early forms of diseases in secondary and tertiary prevention
create the potential for systemic saving of resources through more successful and cheaper
treatment;
•
decreasing the number of undesired effects of treatment and subsequent decreasing the costs
of their treatment;
•
decreasing the costs of energy and maintenance of buildings and premises;
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We evaluate the average contribution of the approved projects to efficiency, based on our
supporting documents, for 23.83%.
Measure 1.1
The approved projects (due to their focus mainly on supplementation of equipment) have a
positive impact on increasing the efficiency of the provided healthcare through a higher number
of treated patients, lower number of treatment sessions with the same therapeutic effect
achieved, new methods and procedures reported to health insurance companies and performed
by the same expert team in diagnosing and treatment of diseases and conditions, enhancing the
quantity of existing methods through purchases of more advanced and faster-working
diagnostic, surgical and therapeutic equipment, improving the efficiency of internal
communication through a high rate of digitalisation and introduction of information
technologies, decreasing the need for premises and labour force in relation to digital diagnostics
and archiving, a potential increase of efficiency of other processes which are both directly and
indirectly connected with investments in facilities and reconstructions (e.g. improved recordkeeping in electronic form, other use of human resources).
In objectively measurable parameters the contribution to efficiency is already manifested (with
finalized projects) and has the potential to be further manifested (with unfinished projects).
Occurrence of nosocomial infections decreased by up to 71% with a potential impact on
decreasing costs of ATB treatment. The number of performed diagnostic and therapeutic
procedures during the working time by the same staff increased (projects are usually not
connected with employment increase) by 13,871 and 1,810 procedures with new methods. At
the same time, the number of surgeries increased by 2,527 and therapeutic procedures by 942 in
the hyperbaric chamber and 820 in Lokomat Nanos. Shortening of the hospitalisation time with
a following drop in costs of finalized hospitalisation was only seen with one provider (NURCH
Piešťany), namely by 2.95 days. In some cases the number of necessary therapeutic procedures
with the same diagnoses decreased (e.g. treatment with modern linear accelerator). The period
necessary for patient diagnosing is shorter, in some cases by up to 20%. In laboratory systems
capacity is higher (by up to 25%) through shorter examinations.
Improved identification of early forms of diseases in secondary and tertiary prevention
represents a potential for systemic saving of resources through more successful and cheaper
treatment, decreasing the number of undesired effects of treatment and subsequent decreasing of
costs of their treatment mean that the resources may be invested elsewhere.
Measure 1.2
The approved projects have a positive effect on increasing the efficiency of the provided
healthcare through a higher number of treated patients thanks to better logistics in the
reconstructed infrastructure, lower number of treatment sessions with the same therapeutic
effect achieved, lower costs of energy and maintenance of buildings and premises, new methods
and procedures reported to health insurance companies and performed by the same expert team
in diagnosing and treatment of diseases and conditions, higher number of existing methods
through purchasing more advanced and faster-working diagnostic, surgical and therapeutic
equipment, higher efficiency of internal communication through a high rate of digitalisation and
introduction of information technologies, smaller need for premises and labour force in relation
to digital diagnosing and archiving, potential increased efficiency of other processes which are
both directly and indirectly related with investments in facilities and reconstructions (e.g.
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rationalisation of cleaning and of disinfection programme, improved record-keeping in
electronic form, other use of human resources).
finalized projects) and has the potential to be further manifested (with unfinished projects).
Occurrence of nosocomial infections decreased by up to 25% with a potential impact on
decreasing costs of ATB treatment. The number of performed diagnostic and therapeutic
procedures during the working time by the same staff increased (projects are usually not
connected with employment increase) by 19,757. A clear connection to shortening the
hospitalisation period was not confirmed.
Measure 2.1
Approved projects have a positive effect on increasing the efficiency of the provided healthcare
by a higher number of treated patients thanks to better logistics in the reconstructed
infrastructure, lower costs of energy and maintenance of buildings and premises, new methods
and procedures reported to health insurance companies and performed by the same expert team
in diagnosing and treatment of diseases and conditions, higher number of existing methods
through purchasing more advanced and faster-working diagnostic, surgical and therapeutic
equipment, higher efficiency of internal communication through a high rate of digitalisation and
introduction of information technologies, smaller need for premises and labour force in relation
to digital diagnosing and archiving.
finalized projects) and has the potential to be further manifested (with unfinished projects). The
number of diagnostic and therapeutic procedures performed during the working time by the
same staff (projects are not connected with employment increasing) increased. On a 12-month
basis the number of performed diagnostic procedures increased by 13,541 and surgeries by
1,183. Therapeutic procedures are shorter by 20-40%.
Measure 2.2
As for the Measure 2.2. only one project was executed; and its activities are terminated (as of 30
April 2013).
The project has a positive effect on increasing the efficiency of processes related with provision
of blood transfusion preparations as follows:
Allocation of equipment to 3 blood processing (9 before the project) centres enables more
efficient use of the labour force. The number of examined patients per one device did not
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increase, as parameters of the purchased devices are equal to the borrowed devices used before.
However, three processing centres are increasing their production as follows:
Before centralization: Bratislava 120 takings, Banská Bystrica 50 takings, Košice 70 takings.
After centralization: Bratislava 300 takings, Banská Bystrica 250 takings and Košice 160
takings. In view of the above stated, it is a significant contribution to efficiency of the centres.
Released capacities of original processing centres will be reflected in higher performance in the
area of takings. In the blood-taking centres we count with an increased number of takings by
about 15% as a result of saving the working time when the blood-taking centres were processing
blood. At the same time, the number of takings and affereses increases as a result of purchasing
new ambulance vehicles for the needs of the blood-taking centres. Increasing remote takings,
i.e. driving to the place of the donor, increases the availability for donors and the increased
likelihood of donoring as such. Currently there are 20% of mobile takings and the plan is to
increase them to 30%.
Reconstruction in the blood taking and processing centre in Košice has brought lowering of the
building’s energy class from ‚E‘ to ‚D‘. However, they are not direct savings; new air
ventilation system with air conditioning was built as a part of reconstruction which was absent
in the premises.
6.1.3
AQ2 – What is the impact of the approved OPH projects on increasing the
availability of the provided healthcare within the infrastructure of supported
healthcare providers?
The approved projects have a positive impact on increasing the availability of the provided
healthcare. The contribution to availability is given in the following areas:
•
new methods and procedures in diagnosing and treatment of diseases and conditions through
the purchased diagnostic, surgical and therapeutic equipment the availability of which was
missing in the territory of the SR or in certain regions;
•
increasing the capacity availability of individual providers and decreasing the number of
treatment sessions with the same therapeutic effect achieved as a scope for availability in
time with the particular provider (shorter waiting times);
•
finalization and construction of healthcare infrastructure, mainly in relation to availability
for excluded groups (the Roma) through investments in small outpatient establishments;
•
availability of results in real time through digitalisation and informatization;
•
availability as substitutability of exceptional methods also with unit purchase (hyperbaric
chamber in KE);
•
improving access for seriously ill and handicapped by enhancing barrier-free facilities in
reconstructed and new premises;
finalized projects) and has the potential to be further manifested (with unfinished projects) as
follows:
•
increasing the number of performed diagnostic and therapeutic procedures within SR and on
the regional level;
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•
shortening the hospitalisation time and subsequent increasing of capacity permeability with
individual healthcare providers.
We evaluate the average contribution of approved projects to availability, based on our
supporting documents, for 18.46%.
Measure 1.1
The approved projects have a positive impact on increasing availability of the provided
healthcare in specialized hospitals by increasing the number of new methods and procedures in
diagnosing and treatment of diseases and conditions through the purchased diagnostic, surgical
and therapeutic equipment the availability of which was missing in the territory of SR or in
some regions (specific rehabilitation of patients after injuries of brain and spinal cord in NRC
Kováčová, USG-bronchoscopy in NÚTaRCH Vyšné Hágy), increasing the capacity
permeability in individual providers (VÚSCH Košice in the area of angiography and
interventional methods, VOÚ Košice in the area of treatment of tumours through a linear
accelerator, ORL Humenné – number of laser operations) and decreasing the number of
treatment sessions with the same therapeutic effect achieved as a scope for availability in time
with the particular provider (shorter waiting time), availability of results in real time through
digitalisation and informatization, availability as substitutability of exceptional methods even
with a unit purchase (hyperbaric chamber in VÚG Košice; a specific moment is increasing
availability for seriously injured and handicapped persons by improving barrier-free facilities in
the reconstructed and new premises. These form the content of all projects with construction
activity with 5 executed measures, while no other are expected.
Measure 1.2
The approved projects have a positive impact on increasing availability of the provided
healthcare in general hospitals by increasing the number of new methods and procedures in
diagnosing and treatment of diseases and conditions through the purchased diagnostic, surgical
and therapeutic equipment the availability of which was missing in the territory of SR or in
some regions (linear accelerator in FN Nitra), increasing the capacity permeability of individual
providers, availability of results in real time through digitalisation and informatization (CT in
NsP Hlohovec); a specific moment is increasing availability for seriously injured and
handicapped persons by improving barrier-free facilities in the reconstructed and new premises.
These form the content of all projects with a construction part with 37 executed measures, while
other 29 are still expected.
Measure 2.1
The approved projects have a positive impact on increasing the availability of the provided
healthcare in policlinics and outpatient departments by increasing the number of new methods
and procedures in diagnosing and treatment of diseases and conditions through purchased
diagnostic, surgical and therapeutic equipment the availability of which was missing in certain
regions (standard USG and ECHO-cardiography, capsule endoscopy, mammography, NMR,
etc.), by finalizing the construction and reconstruction of healthcare infrastructure, mainly in
connection to availability for socially excluded groups (the Roma) through investments into
small outpatient establishments (14 projects). Within the projects the access for seriously ill and
handicapped persons is improving by improving barrier-free facilities in the reconstructed and
new premises (40 measures performed, other 37 are expected).
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Measure 2.2
There are two contributions to availability – increasing availability for potential donors through
fostering mobile takings; and an exceptionally essential area from the point of view of
availability is availability of blood preparations in emergencies when a higher concentration of
blood preparations is provided in three processing centres – BA, BB and KE.
6.2
Topic 2
6.2.1
AQ1 – What is the contribution of the approved OPH projects to decreasing the
regional differences in the context of the existing healthcare needs of regions as per
‘diseases of group 5’? (evaluation criterion of availability)
The answer to this evaluation question is closely related with map overviews in the chapter  as
well as with the overview on the basis of ratio indicators in the chapter0.
•
The existing healthcare needs in the context of ‘diseases of group 5’, i.e. their total
contribution to mortality and hospitalisations as well as their internal proportional structure
and status in individual regions remained more or less unchanged for the period from
defining the OPH 2005 objectives, the start of the programme 2007, until 2011.
•
The contribution of individual OPH projects to decreasing regional differences from this
point of view cannot be identified. What can be assessed though is the allocation rate as per
regions and the nature of projects and their outputs.
•
Allocation for individual NUTS II regions is not uniform; it does not manifest significant
differences though, with certain exceptions. A significant difference is undersizing within
the region of Trenčín where a low rate of approval, resulting from low assessment of
requirements, was achieved in comparison with other regions. The demand rate can be
considered as uniform in all regions.
•
The allocation itself did not directly consider the structure of morbidity in individual
regions. The disparity of the OP assistance is mainly visible in the table of the contribution
per one hospitalised patient in the region (chapter 5.4.3.4), but also generally in the context
of the needs of individual regions (0).
•
‘Heavy machinery above EUR 1 million per piece is distributed uniformly with the
exception of the region of Trenčín and Prešov; while in the region of Prešov this fact is
balanced by the number of projects (21) and the total largest volume of funds (23%); this is
not the case in the region of Trenčín.
•
From the point of view of individual measures a detailed graphic overview as per ‚diseases
of group 5‘ and regions is elaborated in the chapter ; and their map expression is to be
found in . Here we can see how individual types of providers determine, with their nature
and location, the classification of intervention as per diseases and regions (e.g. specialized
vs. general hospitals). Presentation of the contribution of projects on the level of individual
priority axes to decreasing regional differences on the level of NUTS II regions can be
found in the chapters 0 and 5.4.5.5.
•
The indicative allocation itself was not exactly maintained within OPH (see the chapter
5.4.1.1); although after evaluation of outputs and impacts we may state that this did not have
a negative impact on outcomes, i.e. similarly to outputs of projects, so also impacts were,
with their nature and outcome, in line with OPH objectives and did not cause shortcomings
from the point of view decreasing regional differences.
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It is important to understand the above-mentioned findings in relation to this question in a
global thematic context where the two most important points which have a strong impact on
OPH possibilities are:
6.2.2
•
It is necessary to emphasize that the financial volume of OPH in the context of the total
volume of the healthcare system of the SR represents a marginal fraction. On the basis of
the above-stated it is necessary to understand the OPH possibilities to help decrease regional
differences as limited.
•
Another input element is the structure of healthcare providers and their geographic
representation in the SR and individual catch areas. Performance of providers’ activities
does not take into consideration regional territorial division and so the zone of activity; i.e.
catch area of the provider, depends on a number of factors which are given by geographic
and infrastructural conditions. OPH can reach individual regions only through the existing
network of providers and so the same is a limitation for mathematically ideal allocation.
AQ2 – Are the criteria specified in OPH for calculation of the indicative regional
allocation on the level of priority axes and NUTS II regions relevant and suitable?
(evaluation criterion of relevance)
•
•
•
The used allocation criteria – the number of beds for the priority axis 1, and the number of
citizens for the priority axis 2 - are not ideal criteria for calculation of the indicative regional
allocation, though in conditions of the healthcare system in the SR they are clearly relevant
for the following reasons:
-
PA 1 – the number of beds - provides a view of capacities of individual regions from the
point of view of the ability to hospitalize, but does not take into consideration catch
areas exceeding the borders of regions or the existing and requested focus areas.
-
PA 2 – number of citizens in the region provides a view of how large the group of
people is whom the outpatient area has to attend; it does not take into consideration the
existing and missing capacity and its condition, and it does not take into consideration
catch areas stretching beyond the borders of regions, even though these are marginal
with outpatient providers.
Suitability of the specified criteria for the regional allocation is conditioned by availability
of more detailed structured parameters which are more extensive in their types. Key
parameters achieving the highest rate of suitability, as used, are stated below:
-
detailed list of distribution of healthcare providers;
-
exact geographic catch areas for individual healthcare providers;
-
population in the region in combination with the age structure;
-
specification of morbidity profile based on the types of procedures;
-
detailed list of ‘heavy machinery’ and its capacity possibilities as well as the forms of
contracting;
-
overview of the status of constructional objects of providers.
If the above-stated parameters and their combination for calculation of the indicative
regional allocation are not available in a sufficient quality, granularity and topicality, we
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may state that the used criteria are most suitable as there are no parameter available which
would be more exact.
6.3
Topic 3
6.3.1
AQ1 - What is the content potential of overlap of priorities of strategic
development of the healthcare system in Slovakia until 2020 with priorities and
objectives of new EU Cohesion Policy for the 2014-2020 period and the Europe
2020 strategy?
The following areas are considered to ensure economic growth and creation of new work
positions in the European Union: research and innovation, education, digitalisation, economic
competitiveness, energy, employment and combating poverty. The EU Cohesion Policy should
substantially contribute to fulfilment of objectives of the Europe 2020 strategy in the following
programming period. Support from the European investment and structural funds will naturally
focus on key areas to achieve the specified objectives on the national and EU level. In particular
there are 11 thematic objectives and related investment priorities. These represent a set of
thematically delimited and separated objectives/areas to which support from the Cohesion
Policy will be directed. Relevance to the selected thematic objectives and investment priorities
will be the basic criterion to define eligible activities of the programme.
The topic of healthcare does not appear on the level of thematic objectives and does not form a
separate investment priority either. However, in several thematic objectives it is possible to
identify certain investment priorities enabling direct interventions in healthcare. Those thematic
objectives and investment priorities explicitly mention support of healthcare as necessary to
fulfil the specified objectives. Here we can see the greatest potential for healthcare support to
become a part of objectives on the level of new operational programmes/priority axes. It means
that selected elements of the Slovak healthcare system must be systematically addressed on the
programme level or on the level of priority axes. In particular, they are the following investment
priorities:
•
2 c) Strengthening ICT applications for e-government, e-learning, e-inclusion, e-culture
and e-health;
•
9 a) investments in healthcare and social infrastructure in order to improve the access to
healthcare and social services and to mitigate inequalities in the area of healthcare with a
particular focus on marginalized groups, such as the Roma and the people threatened by
poverty;
•
ESF a(vi) Active and healthy aging (thematic objective 8);
•
ESF b(ii) Inclusion of marginalized groups, such as the Roma (thematic objective 9);
•
ESF b(iv) Improvement of access to affordable, sustainable and high-quality services
including healthcare and social services of general interest (thematic objective 9).
Along with the above-mentioned investment priorities creating a scope for integration of
healthcare support among top priorities of new operational programmes, in the investment
priorities below we can see a scope for healthcare support on the level of area of support/group
(of interrelated) projects:
•
ESF c(iii) Improving the access to lifelong learning, recovery of skills and competencies of
labour force and enhancing the relevance of systems of education and expert preparation
from the point of view of labour market (thematic objective 10);
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•
ESF d(i) Investments in institutional capacities and in efficiency of public administrations
and public services in view of reforms, better regulation and good governance of public
matters (thematic objective 11);
•
1 b) Supporting business activities, investments in innovations and research, connection
among companies, R&D centres and higher education.
The current setting of objectives of Europe 2020 strategy and their thematic reflection in the
Cohesion Policy creates the largest scope for healthcare support on the programme level within
the thematic objectives focused on employment, education, combating poverty and modern
public administration (thematic objectives 8 – 11). On the basis of information obtained from
other EU Member States, healthcare funding should be primarily performed through the
thematic objective 9. The thematic objectives 8 - 11 should be primarily funded from ESF, even
though a part of investment priorities containing healthcare infrastructure will be supported
from ERDF.
The underlying document for identification of areas which should be funded from European
investment and structural funds in Slovakia in the 2014-2020 programming period is the
Position Paper. In the Position Paper the EC expressed the opinion that in the future
interventions to increase the efficiency of the Slovak healthcare system should be funded
primarily from natural resources. In this way the EC confirmed that healthcare will not be an
area of priority of support from the Cohesion Policy and funding options will be limited. In the
context of the new programming period it does not mean though that healthcare support in
Slovakia will not be possible. Investments in healthcare will have to be clearly connected with
the national concept of development of healthcare in the long-term period and with the support
focused on selected aspects of the system. These requirements should contribute to
concentration of investments into efficient and sustainable solutions in healthcare.
It may be stated that strategic documents and legislation adopted on the EU level in the new
programming period creates preconditions for funding interventions intended for healthcare. On
the level of the respective objectives and relevant investment priorities it is possible to treat the
support of healthcare as a separate area on the level of a programme, i.e. in the form of a priority
axis or its separate part. The Resolution of the Government of SR No 139/2013 of 20 March
2013 related to proposed structure of OPs funded from the European structural and investment
funds for the 2014-2020 programming period and related to the structure and content of the
Partnership agreement, which specifies the MOH SR as the intermediary authority for OP
Human resources, was a response to the above-mentioned possibility.
Along with the investment priority 9a funded by ERDF and ESF within the OP HR, there is a
thematic relation to OP EPA, IROP and OP II. OP EPA represents a separate programme which
should systematically address modernisation and professionalization of public administration in
Slovakia (thematic objective 11). In view of its society-wide importance and share in public
expenditures, healthcare system should have a noticeable position. Support will probably have a
form of complex projects, not an independent priority axis. Contrary to OP EPA, IROP is
thematically broadly formulated (thematic objectives 5, 6, 7, 9 and 10), but its purpose is to
form the basis for implementation of integrated strategies on the regional and local level. There
is sufficient scope for systemic changes in functioning of the healthcare system within the
thematic objective 2 (OP II), mainly in relation to implementation and development of e-Health
in Slovakia). Activities within the investment priority 1b) will be performed with the aim to
support research and innovation, while one of the most prospective areas in Slovakia is
medicinal (bio-medicinal) technology. In spite of the EC’s standpoint in the Position Paper
where it expressed the opinion that interventions in the healthcare system should be primarily
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funded from national resources, there are options to support selected parts of the healthcare
system. The largest scope for supporting the healthcare system from funds of the Cohesion
Policy may be seen in thematic objective 9 Promoting social inclusion and combating poverty,
and within the thematic objective 11 Enhancing institutional capacity and efficient public
administration. In our conditions the above-mentioned thematic objectives should cover the OP
Human resources and the OP Efficient public administration. In line with the EC requirement
(relevant ex-ante conditionality) for the existence of a national strategic framework for
healthcare system, funding from resources of Structural Funds should be justified by the need to
systematically address shortcomings of the Slovak healthcare system (reforms). Efficiency and
sustainability of healthcare provision and enhancement of its quality and availability, while
considering the demographic trends, should become a priority. Integrated and sustainable
solutions will require a suitable connection of processes and services, human resources and
modernization of infrastructure, which can be funded in the programming period of 2014-2020.
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7
Conclusions and Recommendations
7.1
Conclusions
•
Evaluation of OPH’s impacts identified a clear relation and contribution of projects and
their outputs to the quality, efficiency and availability of healthcare.
-
The rate of impact on quality, efficiency and availability of healthcare could not be
quantified by an adequate quantifiable parameter due to non-existing definition of these
aspects and their target indicators as well as due to broad range of supported outputs. On
the basis of that mainly qualitative assessments were used in the evaluation and the ratio
between individual aspects was assessed.
-
An average distribution of impact among quality, efficiency and availability has been
assessed as follows: 57.7% for quality, 23.83% for efficiency and 18.46% for
availability.
•
The OPH impact itself has to be perceived in the context of defined objectives, however, for
the purpose of evaluation also the view of the impact on the health of population has been
chosen where it is also possible to expect a positive impact mainly thanks to increased
quality and availability through new equipment. However, currently it is not possible to
quantify these impacts or support them with evidence.
•
OPH objectives and strategy were set with non existence of the basic strategic framework
for systemic transformation of the Slovak healthcare system, which could be specifically
addressed and align individual investments with. As a result of this fact the extent of OPH is
defined fairly generally.
-
Outputs and effects of OPH projects were directed to a wide range of areas; they are
fragmented from the point of their focus and together do not represent a compact set of
changes which would be connected with a broader strategic intention.
-
The general extent of the objectives also influenced an insufficient connection between
OPH objectives with suitable outcome indicators.
-
However, in spite of the above-stated facts, OPH helps ensure a various support of
different needs of medical establishments for which OPH represented a key opportunity
to a significant improvement of infrastructure in line with the basic strategic objective.
•
Unavailability of relevant data collected by health insurance companies (VšZP) made it
impossible to quantify the impacts of structural funds in the healthcare system through the
counterfactual methods. It was not possible either to quantify a direct and indirect
connection of investments with effects and impacts due to a lack of data.
•
In general it can by concluded that OPH has met the targets of its focus – to support
healthcare infrastructure through reconstructions, construction and purchase of medical
equipment. The proportion of expenditures spent on individual cost areas seems to be
appropriate.
-
Within the whole OPH, the proportion of costs of medical equipment represents 44.25%
(OP 1.1 – 80.31%, OP 1.2 – 38.32%, OP 2.1 – 47.05%, OP 2.2 – 80.03%), costs of
constructional modifications and reconstructions 55.35% (OP 1.1 – 18.86%, OP 1.2 –
61.51%, OP 2.1 – 51.78%, OP 2.2 – 19.82%).
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•
-
The Programme itself did not define proportions for these areas and so the achieved
proportion is a valuable presentation of the need and demand of individual types of
providers.
-
It is necessary to emphasize that the dispersion in the types of outputs and thus also in
the form of impacts significantly complicates the evaluation and the possibility to obtain
aggregated and quantifiable conclusions for the whole programmme.
Individual outputs of OPH projects and their proportion within the defined measures reflect
the needs and priorities of relevant healthcare facilities as well as their nature:
-
Measure 1.1 – Specialized hospitals – 43.91% used for new diagnostic equipment;
15.89% for new therapeutic equipment; 18.54% for reconstructions;
-
Measure 1.2 - General hospitals - 7.55% used to improve the condition of operating
rooms; and 4.74% for new operating equipment; 22.12% for reconstructions and 41.35%
for construction;
-
Measure 2.1 – Outpatient healthcare providers – 42.20% used for new diagnostic
equipment; 35.38% for reconstructions and 10.24% for construction;
-
The measure 2.2 is formed by a single national project for NTS (National Blood
Transfusion Service) where 57.94% was used for equipment, 8.92% for special vehicles
and 33.13% for reconstructions.
•
Investments within OPH significantly contributed to total modernization of available high
cost equipment in the SR. The total percentage volume of most significant types of
equipment represented 22.81% on average of equipment of the particular type purchased
between 2007 and 2011.
•
OPH fulfils the focus on ‘diseases of group 5’ (chapter 5.2.4), representing a specified
priority which is based in the mortality data (around 92%) as well as on hospitalisation
(around 50%). In the cases when impact on other diseases was identified (generally 22%
within OPH), individual healthcare providers must be understood as complex entities which,
with their nature and scope of activities, cover a broader range of healthcare, i.e. it is not
possible to earmark only a particular medicinal area and focus only on it with intervention
(e.g. reconstruction or laboratory technology have an impact on all medicinal areas
addressed by the provider).
•
From a regional point of view it is possible to conclude that the OPH’s contribution
positively fulfils the specified objectives to improve the healthcare infrastructure. There are
both similarities and differences among individual regions in the starting condition, and also
the OPH contribution has certain similar and certain different characteristics from the point
of view of financial allocation, groups of outputs, focus on 'diseases of group 5', as well as
from the point of view of individual measures. In view of individual regions, generally the
contribution seems to be in line with the OPH objectives and strategy.
-
A shortcoming in evaluating the contribution to balancing regional differences is a
significant lack of a more detailed/structured coverage of data on infrastructure, its
status, related investments and their resources. Available regional data related to the
status of health of population based on the data on mortality and hospitalisations do not
take into consideration the existing available healthcare infrastructure.
-
The difference of the achieved status of allocation of funds in comparison with
indicative regional financial allocation was assessed in the evaluation in view of
nature and amount of needs, outputs and impacts as a slight deviation in relation to
indicative value, not affecting achievement of objectives in the area of regions or
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global OPH strategy. Such deviation must also be understood as minor in view of the
accuracy and the nature of used allocation keys.
•
7.2
-
Steps taken by the managing authority when ensuring compliance with the indicative
regional allocation were in accordance with the determined criteria and no shortcomings
were identified in it.
-
The used allocation keys seem to be relevant from the point of view of OPH setting and
objectives. They could be improved with a closer specification of intentions and
objectives in individual areas in case of availability of more detailed parameters of the
supported environment, which are quite limited though.
interventions in the healthcare system should be primarily funded from national resources,
there are options to support selected parts of the healthcare system. The largest scope for
supporting the healthcare system from funds of the Cohesion Policy may be seen in thematic
objective 9 Promoting social inclusion and combating poverty, and within the thematic
objective 11 Enhancing institutional capacity and efficient public administration. In our
conditions the above-mentioned thematic objectives should cover the OP Human resources
and the OP Efficient public administration. In line with the EC requirement (relevant exante conditionality) for the existence of a national strategic framework for healthcare
system, funding from resources of Structural Funds should be justified by the need to
systematically address shortcomings of the Slovak healthcare system (reforms). Efficiency
and sustainability of healthcare provision and enhancement of its quality and availability,
while considering the demographic trends, should become a priority. Integrated and
sustainable solutions will require a suitable connection of processes and services, human
resources and modernization of infrastructure, which can be funded in the programming
period of 2014-2020.
Recommendations
•
For a further evaluation process it is our recommendation to pre-define the indicators of
output and impact within the whole programme and also for all projects so that these are
able to prove specific project interventions and also are linked to programme indicators. It is
our recommendation to apply the approach and logics created within this evaluation of
impacts, i.e. definitions of quality, efficiency, availability, logics of the output, outcome and
impact, and for the set of current projects to apply the assessment through 10 output groups
and their subgroups for detailed data, which can further be aggregated to record and
continuously re-assess the identified evidence for individual effects allocated to output
groups and subgroups. On the basis of such approach it is possible to create a set of
indicators for the whole programme which can be aggregated.
•
Further it is also our recommendation to create and implement a system focused on
increasing the efficiency of continuous collection of information about the course of the
projects as a part of monitoring, mainly in the context of new indicators and of the fact that
some logical and functional separate parts of projects are sometimes even long before the
total finalization of projects fully finalized.
•
For the purpose of targeting interventions into individual areas or regions, it is our
recommendation to focus on possibilities to identify, ensure availability and continuous
collection of other necessary data. It is mainly such type of data the collection and
processing of which exceeds the framework of current assessment of the programme and its
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projects (e.g. summary of investments, monitoring of selected procedures and their
parameters, development tendencies, catch area, structure of patients, etc.).
•
When determining indicative regional allocations in the future, it is our recommendation to
use other parameters and related criteria which are more suitable than those used currently,
i.e.:
-
detailed list of distribution of healthcare providers;
-
geographic catch areas for individual healthcare providers;
-
population in the region in combination with the age structure;
-
specification of morbidity profile of regions based on the types of procedures;
-
detailed list of ‘heavy machinery’ and its capacity possibilities as well as the forms of
contracting by health insurance companies;
-
summary of the status of construction objects and other provider’s infrastructure.
•
It is our recommendation to plan a next evaluation of impacts of the Programme at the time
when it is possible to quantify impacts of at least two thirds of OPH projects after their
termination, in order to add individual impacts and assessment of implementation of
recommendations as well as data prerequisites (amount, quality and system of collection)
for a fully-fledged ex-post evaluation.
•
Successful performance of an evaluation is preconditioned by appropriate data availability
and cooperation with key owners of this data, mainly VšZP, NHIC or HCSA. Key data from
health insurance company/companies necessary for quantitative aspects of assessment are
currently unavailable due to legislative barriers.
•
For a potential further evaluation, it is our recommendation to focus on two specific
thematic areas, namely quantitative specification of added value in increasing energy
savings on the basis of reconstruction and thermal insulation of buildings of healthcare
providers, and assessment of quality improvement of an exactly determined performance of
a particular type of a device for a frequent diagnosis which is of great significance in view
of the hospitalisation rate and mortality.
•
If the counterfactual method is to be used, it is necessary to ensure a higher quality of data,
i.e. sufficient objective quantitative data to define control groups as well as a suitable area
for use. Economic parameters providing a detailed summary of incomes of entities may
serve as an example, in order to compare the rate of their own funding or funding from other
resources beyond the programme (the aim of a counterfactual assessment would be to assess
the rate of stimulation of development in comparison with other forms of funding); as a
technical example we may use a structure of a type of procedures of a particular department,
change in the catch area of medical facilities, volume of radiation for a particular diagnose,
energy costs per cubic meter, etc. (the aim of the counterfactual would be an exactly
quantifiable assessment of the rate of impact on quality, efficiency and availability in
comparison with entities which have not received support from OPH)
•
Within the topic 3 it is our recommendation to ensure the following activities:
-
In consultations with the EC or relevant general directorates, the form and content of the
Strategic Framework in Healthcare for the period of 2013-2030 should be informally
discussed in relation to the relevant ex-ante conditionality.
-
To focus on representation of an integral strategy containing two interrelated
measures/activities with a common target – systemic effort to increase the efficiency of
104
ABCD
healthcare, while taking into consideration the development and experience from OPH
implementation which should be funded from the Cohesion Policy funds.
-
To further elaborate key systemic measures which are a condition/starting point for
performance of other measures and projects. To consider funding options of preparatory
activities from funds of technical assistance of OP TS (or other sources) which would
strengthen the position of the MOH SR in negotiations with the EC and increase the
preparedness of the healthcare sector for utilization of EU assistance after 2013.
-
Preparation and execution of systemic changes in the healthcare system are
preconditioned by performing an independent analysis of healthcare provision. The
analysis should also involve assessment of performance, age and use of medical
equipment, also using the data of health insurance companies. The respective data may
also be used to define a strategy of increasing the efficiency of healthcare provision. A
part of needs for purchasing new equipment and technology could be funded from funds
of European investment and structural funds as a part of systemic changes. The
performed assessment confirmed the justification of funding and a significant
contribution of OPH to recovery of medical equipment (large devices) which clearly
have a positive impact on quality, availability and efficiency of healthcare provision.
105
ABCD
27. máj 2013
A
List of Abbreviations
Abbreviation
Meaning
ERDF
European Regional Development Fund
EU
European Union
ICT
Information and communication technology
MOH
NHIC
National Health Information Centre
NFC
Non-returnable financial contribution
OPH
Operational Programme Health
HCP
Healthcare provider
HCSA
Health Care Surveillance Authority
STU
Superior Territorial Unit
WHO
World Health Organization
HIC
Health insurance company
HC
Health care
AfNFC
Application for non-returnable financial contribution
106
ABCD
B
List of tables
Table 1: Schedule of activities performed within the Topic 1 ...................................................................................... 10
Table 4: Evaluation team ............................................................................................................................................. 17
Table 5: Summary of applied evaluation methods ....................................................................................................... 18
Table 6: Summary of OPH projects from the point of view of the status of their execution ........................................ 20
Table 7: Summary of OPH projects from the point of view of finalization as per years .............................................. 20
Table 8: Summary of OPH projects from the point of view of drawing funds ............................................................. 21
Table 9: Summary of OPH projects form the point of view of types of expenditures .................................................. 22
Table 10: Summary of OPH funds ............................................................................................................................... 23
Table 11: Summary of the number of projects within OPH ......................................................................................... 24
Table 12: Ratio indicators of OPH (based on finances) ............................................................................................... 24
Table 13: Ratio indicators of OPH (based on applications for NFC) ........................................................................... 25
Table 14: Financial data on OPH implementation as per regions................................................................................. 27
Table 15: Ratio indicators of OPH Measure 1.1 from regional point of view .............................................................. 28
Table 18: Summary of the numbers and funds of outputs as per Groups and Subgroups for OPH (without 2.2) ........ 33
Table 19: Summary of numbers and funds of outputs as per Groups for the Measure 1.1 ........................................... 34
Table 22: Total contracted NFC divided as per the 'group 5' ....................................................................................... 40
Table 23: Contracted part of NFC spent on equipment divided as per ‘diseases of group 5’ ....................................... 41
Table 24: Causal relations of project outputs ............................................................................................................... 43
Table 25: Contribution of output Groups to Quality, Efficiency and Availability ....................................................... 44
Table 26: Summary of the impact of OPH on the number of devices in SR ................................................................ 49
Table 27: Regional classification of OPH as per the number of projects ..................................................................... 50
Table 28: Regional classification of OPH as per allocated funds ................................................................................. 51
Table 29: Indicative regional EU allocations for 2007-2013........................................................................................ 51
Table 30: Comparison of actual regional allocation vs. indicative regional allocation ................................................ 52
Table 31: Summary of contracted funds taking into account the scope of activity of entities ...................................... 53
Table 32: Morbidity rate of population of SR as per selected causes of hospitalisation and regions (per 100,000
persons) for 2007 ......................................................................................................................................................... 57
Table 33: Mortality rate of population of SR as per selected causes of death and regions (percentage of total mortality
in SR) for 2007............................................................................................................................................................. 58
Table 34: Morbidity rate of population of SR as per selected causes of hospitalisation and regions (per 100,000
persons) for 2011 ......................................................................................................................................................... 58
Table 35: Mortality rate of population of SR as per selected causes of death and regions (percentage of total mortality
in SR) for 2011............................................................................................................................................................. 59
Table 36: Number of hospitalisations as per ‘diseases of group 5’ in the NUTS III regions in 2005........................... 60
Table 37: Number of hospitalisations as per ‘diseases of group 5’ in the NUTS III regions in 2011........................... 61
Table 38: Bed establishments in SR in total ................................................................................................................. 61
Table 39: OPH contribution per one hospitalised patient as per diseases and regions ................................................. 65
Table 40: Summary of the structure of project funding................................................................................................ 76
Table 41: Prognosis of age structure of population ...................................................................................................... 82
107
ABCD
27. máj 2013
C
List of graphs
Chart 1: Summary of financial volumes of groups as per Measures ............................................................................ 35
Chart 2: Demand rates of OPH coverage as per regions .............................................................................................. 62
Chart 3: Summary of financial interventions as per ‘diseases of group 5’and individual regions for the whole OPH . 63
Chart 4: Summary of financial interventions as per ‘diseases of group 5’ and individual regions for OP 1.1 ............ 63
Chart 5: Summary of financial interventions as per ‘diseases of group 5’ and individual regions for OP 1.2 ............. 64
Chart 6: Summary of financial interventions as per ‘diseases of group 5’ and individual regions for OP 2.1 ............. 64
Chart 7: OPH contribution per one hospitalised patient as per diseases and regions ................................................... 65
Chart 8: Distribution of the types of equipment as per regions .................................................................................... 66
Chart 9: Distribution of the types of equipment as per regions in pieces ..................................................................... 67
Chart 10: Average price for equipment as per the type of equipment and region ........................................................ 67
Chart 11: Distribution of equipment exceeding the value of €1 million as per regions............................................... 68
108
ABCD
D
Overview of Calls
Regionálna alokácia - vývoj
P. č .
Kód výzvy
1.08 OPZ 2008/1.1/01
3.08 OPZ 2008/1.2/01
1.09 OPZ 2009/1.1/01
5.09 OPZ 2009/1.2/01
Dátum
Dátum
vyhlásenia ukončenia
výzvy
výzvy
PO Opatrenie
22.7.2008
11.9.2008
20.4.2009
29.10.2009
23.10.2008
9.1.2009
22.7.2009
12.3.2010
1
1
1
1
1.1
1.2
1.1
1.2
Alokácia na
výzvu
19 916 351,32
79 665 405,30
2 916 340,33
124 834 720,34
Celková
Počet
Počet
schválená suma zaregistrovaných zazmluvnených
NFP
ŽoNFP
ŽoNFP
NUTS II VÚC
19 896 181,72
12
79 639 914,70
18
2 744 611,23
11
124 833 680,29
26
Národný projekt Národná
transfúzna služba
2.09 OPZ 2009/2.1/01
Národný projekt - VS
3.09 onkologický ústav
4.09 OPZ 2009/2.1/02
1.10 OPZ 2010/2.1/01
4.9.2008
4.9.2008
5.12.2008
15.4.2009
2
2
2.1
2.2
6 638 783,77
7 302 662,15
6 510 766,92
23
7 302 243,75
1
PO
4 230 123,82
37 842 700,00
33 612 576,18
VS
KE
5 562 591,59
29 733 550,00
24 170 958,41
SS
BB
5 628 773,08
34 753 500,00
29 124 726,92
SS
ZA
0,00
23 169 000,00
23 169 000,00
ZS
TN
0,00
27 030 500,00
27 030 500,00
ZS
TT
0,00
7 433 387,00
7 433 387,00
ZS
NR
1 412 934,69
33 112 363,00
31 699 428,31
6 VS
PO
11 860 215,66
33 612 576,18
21 752 360,52
VS
KE
0,00
24 170 958,41
24 170 958,41
SS
BB
5 634 833,07
29 124 726,92
23 489 893,85
SS
ZA
23 968 752,61
23 169 000,00
-799 752,61
ZS
TN
0,00
27 030 500,00
27 030 500,00
ZS
TT
0,00
7 433 387,00
7 433 387,00
ZS
NR
26 180 446,89
31 699 428,31
5 518 981,42
6 VS
PO
794 769,42
21 752 360,52
20 957 591,10
VS
KE
402 057,28
24 170 958,41
23 768 901,13
SS
BB
718 281,35
23 489 893,85
22 771 612,50
SS
ZA
0,00
-799 752,61
-799 752,61
ZS
TN
0,00
27 030 500,00
27 030 500,00
ZS
TT
417 409,50
7 433 387,00
7 015 977,50
ZS
NR
0,00
5 518 981,42
9 VS
PO
25 494 544,73
20 957 591,10
VS
KE
34 707 858,14
23 768 901,13
SS
BB
31 183 980,97
22 771 612,50
SS
ZA
0,00
-799 752,61
-799 752,61
ZS
TN
3 094 000,00
27 030 500,00
23 936 500,00
29.5.2009
18.9.2009
20.1.2010
17.9.2009
11.9.2009
15.1.2010
4.6.2010
2
2
2
2
2.1
2.2
2.1
2.1
15 000 000,00
14 274 901,83
4 308 716,85 projekt zrušený
TT
11 542 454,26
7 015 977,50
-4 526 476,76
10 000 000,00
8 200 000,00
9 227 513,35
4 854 659,74
n/a
27
30
1.11 OPZ 2011/2.1/01
2.11 OPZ 2011/2.1/02
26.2.2010
26.4.2011
30.5.2011
7.7.2010
26.7.2011
14.10.2011
2
2
2
2.1
2.1
2.1
8 000 000,00
5 700 000,00
3 740 839,30
6 259 160,70
5 675 706,97
3 581 883,66
29
34
25
52 293 726,92
66 163 315,31
45 923 318,93
22 690 141,24
39 982 868,42
44 726 492,23
21 971 859,89
39 565 458,92
-4 536 953,63
-8 412 368,47
ZS
NR
0,00
5 518 981,42
PO
1 335 393,28
8 231 606,00
6 896 212,72
VS
KE
0,00
7 908 797,00
7 908 797,00
5 518 981,42
SS
BB
0,00
6 790 602,00
6 790 602,00
SS
ZA
2 789 671,78
7 067 770,00
4 278 098,22
ZS
TN
0,00
6 112 392,00
6 112 392,00
ZS
TT
0,00
5 730 368,00
5 730 368,00
ZS
NR
1 399 992,34
7 258 466,00
5 858 473,66
PO
1 034 434,00
6 896 212,72
-9 212 121,08
24 929 004,66
14 805 009,72
11 068 700,22
17 701 233,66
5 861 778,72
VS
KE
993 868,00
7 908 797,00
6 914 929,00
SS
BB
853 010,00
6 790 602,00
5 937 592,00
SS
ZA
887 826,00
4 278 098,22
3 390 272,22
ZS
TN
767 893,00
6 112 392,00
5 344 499,00
ZS
TT
719 899,00
5 730 368,00
5 010 469,00
ZS
NR
911 872,00
8 VS
PO
2 919 639,75
5 861 778,72
2 942 138,97
VS
KE
0,00
6 914 929,00
6 914 929,00
SS
BB
1 699 270,02
5 937 592,00
4 238 321,98
SS
ZA
1 607 551,62
3 390 272,22
1 782 720,60
5 858 473,66
4 946 601,66
ZS
TN
0,00
5 344 499,00
5 344 499,00
ZS
TT
3 379 072,65
5 010 469,00
1 631 396,35
ZS
NR
2 452 819,26
4 946 601,66
2 493 782,40
VS
PO
0,00
2 942 138,97
12 776 707,72
9 327 864,22
15 301 569,66
9 857 067,97
6 021 042,58
9 469 677,75
2 942 138,97
VS
KE
0,00
6 914 929,00
6 914 929,00
SS
BB
0,00
4 238 321,98
4 238 321,98
SS
ZA
0,00
1 782 720,60
1 782 720,60
ZS
TN
0,00
5 344 499,00
5 344 499,00
ZS
TT
0,00
1 631 396,35
1 631 396,35
2 493 782,40
ZS
NR
0,00
2 493 782,40
4 VS
PO
2 105 945,93
2 942 138,97
836 193,04
VS
KE
1 855 516,19
6 914 929,00
5 059 412,81
SS
BB
1 944 176,41
4 238 321,98
2 294 145,57
SS
ZA
0,00
1 782 720,60
1 782 720,60
ZS
TN
0,00
5 344 499,00
5 344 499,00
ZS
TT
0,00
1 631 396,35
1 631 396,35
ZS
NR
1 866 337,94
2 493 782,40
627 444,46
4 VS
PO
0,00
836 193,04
836 193,04
VS
1.10 OPZ 2010/2.1/02
57 783 534,59
1
32
n/a
5 518 981,42
Zostatok
alokácie podľa
NUTS II
-10 938 957,01 -15 475 910,64
4 VS
VS
29.5.2009
Zostatok
alokácie
5 VS
ZS
2.08 OPZ 2008/2.1/01
Regionálna
alokácia podľa PM
Zazmluvnená
OPZ
alokácia - ERDF
KE
0,00
5 059 412,81
5 059 412,81
SS
BB
1 554 325,48
2 294 145,57
739 820,09
SS
ZA
1 662 511,66
1 782 720,60
120 208,94
ZS
TN
0,00
5 344 499,00
5 344 499,00
ZS
TT
877 818,69
1 631 396,35
753 577,66
ZS
NR
0,00
627 444,46
627 444,46
10 VS
PO
3 915 043,55
836 193,04
-3 078 850,51
VS
KE
347 334,78
5 059 412,81
4 712 078,03
SS
BB
406 629,64
739 820,09
333 190,45
SS
ZA
0,00
120 208,94
120 208,94
ZS
TN
0,00
5 344 499,00
5 344 499,00
ZS
TT
0,00
753 577,66
753 577,66
ZS
NR
0,00
627 444,46
627 444,46
5 VS
PO
0,00
-3 078 850,51
-3 078 850,51
VS
KE
1 189 711,06
4 712 078,03
3 522 366,97
SS
BB
0,00
333 190,45
333 190,45
SS
ZA
1 067 397,91
120 208,94
-947 188,97
4 351 975,70
ZS
TN
992 523,30
5 344 499,00
ZS
TT
1 073 648,58
753 577,66
ZS
NR
583 950,00
627 444,46
43 494,46
5 VS
PO
1 485 647,12
-3 078 850,51
-4 564 497,63
VS
KE
0,00
3 522 366,97
3 522 366,97
SS
BB
1 652 149,65
333 190,45
-1 318 959,20
9 857 067,97
6 021 042,58
9 469 677,75
5 895 605,85
4 076 866,17
7 603 339,81
5 895 605,85
860 029,03
6 725 521,12
1 633 227,52
453 399,39
6 725 521,12
443 516,46
-613 998,52
-320 070,92
SS
ZA
0,00
-947 188,97
-947 188,97
ZS
TN
0,00
4 351 975,70
4 351 975,70
ZS
TT
0,00
-320 070,92
-320 070,92
ZS
NR
0,00
43 494,46
43 494,46
4 075 399,24
-1 042 130,66
-2 266 148,17
4 075 399,24
109
ABCD
27. máj 2013
E
A complete list of Groups and Subgroups with their efects and
possible proofs
Výstupové skupiny
Nové diagnostické
Výstupy podskupina
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Bronchoskopy
Gastroskopy a duodenoskopy
Kolonoskopy, sigmoidoskopy a rektoskopy
ECHO - Prístroje ultrazvukové diagnostické
USG - Prístroje ultrazvukové diagnostické
Efekty
■Zvýšenie kapacity
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Presnosť diagnostiky
■Nové typy výkonov
■Redukcia čakacej doby
■Skrátenie doby diagnostiky
■Zrýchlenie diagnostiky a liečby
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
Vyhodnotenie / Dôkaz / Poklad
■Výkaz ambulantných výkonov a počtu hospitalizovaných per prístroj
■Trvanie výkonu
■Rehospitalizácie
■Výkaz ambulantných výkonov
■Rehospitalizovanosť
■Výkaz počtu nových výkonov a ich identifikovanie - poisťovňou pridaný výkon?
■?
■Skrátenie doby hospitalizácie/výkaz hospitalizácií
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Menej žiarenia
■Menej žiarenia
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Menej žiarenia
■Menej žiarenia
■Nové metodiky
■Ekonomizácia prevádzky
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Trvanie výkonu
■?
-
p
p
p
na
na
na
Kvalitu Efektívn Dostup
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Prístroje pre magnetickú rezonanciu
Prístroje pre sním., reproduk. a záznam bioelektrickýc
Prístroje pre vyšetrovanie dýchacích ciest
Prístroje RTG diagnostické
Zariadenie pre zvláštne vyšetrovanie (angiografiu)
Mamografy
Mamografy
Mamografy
Mamografy
Mamografy
Mamografy
Mamografy
Mamografy
Mamografy
Tomografy počítačové (CT)
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Denzitometer
Laboratórna technika
Zariadenie pre vyhodnocovanie RTG obrazu
Iné nové diagnostické prístroje
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Trvanie výkonu
■Výkaz počtu nových výkonov a ich identifikovanie - poisťovňou pridaný
■?
■Trvanie výkonu
■?
■Trvanie výkonu
■?
■Parametre prístroja per pacient vs. starý stroj
■Dĺžka zákroku
■Trvanie výkonu
■?
■Trvanie výkonu
■?
■Trvanie výkonu
■?
■Dĺžka zákroku
X
výkon?
X
X
X
X
X
X
X
výkon?
X
X
X
X
X
X
X
výkon?
X
X
X
X
X
X
X
výkon?
X
X
X
X
X
X
X
výkon?
výkon?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
■Výkaz laboratórnych výkonov
■Výkaz laboratórnych výkonov
■Náklady na priestor, pracovnú silu, energie a spotrebný materiál
■Trvanie výkonu
■?
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
110
ABCD
Nové operačné
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
■Bezpečnosť výkonu
Lasery zdravotnícke
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
Endoskopy chirurgické (laparoskopy, arthroskopy)
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
Iné nové operačné prístroje
■Kvalita výkonu
■Kvalita výkonu
■Nové metodiky
Zlepšenie stavu
Ostatné vybavenie operačných sál
■Kvalita výkonu
■Kvalita výkonu
■Zvýšenie štandardu sterility
Rekonštrukcia operačných sál
■Kvalita výkonu
■Kvalita výkonu
Nové terapeutické
Prístroje RTG terapeutické
■Kvalita výsledku
■Menej žiarenia
■Menej žiarenia
■Menej žiarenia
Lineárne urýchľovače
■Menej žiarenia
■Menej žiarenia
■Menej žiarenia
Litotriptory
■Nové metodiky
Litotriptory
Litotriptory
■Subjektívna kvalita
Prístroje svetlo-, teplo-, vodoliečebné
■Nové metodiky
Simulačný nácvik chôdze u pacientov s poškodením m ■Nové metodiky
Simulačný nácvik chôdze u pacientov s poškodením m ■Kvalita výsledku
Simulačný nácvik chôdze u pacientov s poškodením m ■Subjektívna kvalita
Iné nové terapeutické prístroje
■Nové metodiky
Zlepšenie stavu
Nové prístroje centrálneho príjmu
■Kvalita výkonu
Zlepšenie stavu
Nové prístroje intenzívnych oddelení (OAIM a JIS)
■Zvýšenie hygienického štandardu
■Kvalita výkonu
Resuscitačné a intenzivistické lôžka
■Kvalita výkonu
Iné zariadenie
Funkčné zariadenie pre operatívny chod
Nábytok
Nábytok
Stavebná
Rekonštrukcia budovy – energie
■Ekonomizácia prevádzky
Rekonštrukcia budovy – funkčnosť
■Kvalita výkonu
■Kvalita výkonu
■Zlepšenie vnútornej logistiky
Rekonštrukcia budovy – bezbariérovosť
■Dostupnosť pre hendikepovaných
Stavebné rozšírenie Vytvorenie nového priestoru pre poskytovanie ZS
Vytvorenie nového priestoru pre poskytovanie ZS
■Nový poskytovateľ
IKT
PACS
PACS
Software
■Kvalita výkonu
Software
Software
■Zlepšenie vnútornej komunikácie
PC a príslušenstvo
■Kvalita výkonu
■Zlepšenie vnútornej komunikácie
■Trvanie výkonu
■Interná evidencia výkonov v rámci operacií
■Interná evidencia výkonov v rámci operacií
■Počet úmrtí na operačnom stole
■Trvanie výkonu
■Trvanie výkonu
■Trvanie výkonu
■Trvanie výkonu
■Redukcia nozokomiálnych infekcii
■Trvanie výkonu
■Počet ožiarení per pacient per diagnóza vs. staré zariadenie
■ Interná čakacích listín vs. pred zavedením prístroja
■Počet nežiadúcich účinkov vs. staré zariadenie
■Dĺžka zákroku
■Počet nežiadúcich účinkov vs. staré zariadenie
■Dĺžka zákroku
■Interná evidencia výkonov
■Zlepšenie funkčného stavu pacientov vs. predtým
■Dotazník pacientom
■Dotazník personálu
■Dĺžka hospitalizácie
■Dĺžka hospitalizácie
■Náklady na energie pred a po
■Trvanie výkonu
■Trvanie výkonu
■Výkaz výkonov
■Výkaz výkonov / hospitalizácií
■Nové oddelenia
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
111
ABCD
27. máj 2013
F
Additional views
F.1
Zazmluvnená oprávnená suma nákladu NFP podľa typu v EUR
Prioritná os 1
Typ nákladu
Prioritná os 1 spolu
Prioritná os 2
Prioritná os 2 spolu
Celkovo za OPZ
Opatrenie
1.1
%
Opatrenie
1.2
%
EUR
%
Opatrenie
2.1
%
Opatrenie
2.2
%
EUR
%
EUR
%
8 676
0,04%
34 442
0,02%
43 118
0,02%
91 358
0,18%
5 950
0,08%
97 308
0,17%
140 425
0,05%
637003 Propagácia, reklama a
inzercia
637004 Všeobecné služby
1 441
0,01%
11 124
0,01%
12 565
0,01%
155
0,00%
5 010
0,07%
5 165
0,01%
17 729
0,01%
176 426
0,78%
288 402
0,14%
464 828
0,20%
492 136
0,99%
0
0,00%
492 136
0,87%
956 964
0,34%
711003 Nákup softvéru
0
0,00%
5 054
0,00%
5 054
0,00%
8 599
0,02%
0
0,00%
8 599
0,02%
13 653
0,00%
711004 Nákup licencií
0
0,00%
1 368
0,00%
1 368
0,00%
18 001
0,04%
0
0,00%
18 001
0,03%
19 369
0,01%
0,78%
281 980
0,14%
458 406
0,20%
464 224
0,94%
0
0,00%
464 224
0,82%
922 630
0,33%
0,00%
0
0,00%
0
0,00%
1 312
0,00%
0
0,00%
1 312
0,00%
1 312
0,00%
44,25%
34,44%
Nákup IKT
713002 Nákup výpočtovej
176 426
techniky
713003 Nákup
0
telekomunikačnej techniky
Nákup zdravotníckych
18 108 875
prístrojov spolu
713004 Nákup prevádzkových
8 228 429
strojov, prístrojov, zariadení
713005 Nákup špeciálnych
9 880 446
strojov, prístrojov, zariadení
714005 Nákup špeciálnych
0
automobilov
Stavby a ich úpravy spolu
717001 Realizácia nových
stavieb
717002 Rekonštrukcia a
modernizácia stavieb
717003 Prístavby, nadstavby,
stavebné úpravy
80,31%
78 301 794
38,32%
96 410 670
42,50%
23 324 699
47,05%
5 807 773
80,03%
29 132 471
51,26%
125 543
141
36,49%
64 332 824
31,49%
72 561 254
31,98%
20 107 066
40,56%
5 037 374
69,41%
25 144 439
44,24%
97 705 693
43,82%
13 968 970
6,84%
23 849 416
10,51%
3 217 633
6,49%
0
0,00%
3 217 633
5,66%
27 067 049
9,54%
0,00%
0
0,00%
0
0,00%
0
0,00%
770 399
10,62%
770 399
1,36%
770 399
0,27%
4 253 924
18,86%
125 678
457
61,51%
129 932
381
57,27%
25 669 762
51,78%
1 438 683
19,82%
27 108 445
47,70%
157 040
826
55,35%
0
0,00%
56 575 532
27,69%
56 575 532
24,94%
0
0,00%
0
0,00%
0
0,00%
56 575 532
19,94%
4 253 924
18,86%
42 163 608
20,64%
46 417 532
20,46%
22 573 446
45,53%
1 438 683
19,82%
24 012 129
42,25%
70 429 661
24,83%
0
0,00%
26 939 317
13,19%
26 939 317
11,87%
3 096 316
6,25%
0
0,00%
3 096 316
5,45%
30 035 633
10,59%
F.2
Percentuálne členenie potreby a pokrytia
Pomery dopytu a pokrytia OPZ per kraje - podla hospitalizacii
60,0%
50,0%
40,0%
30,0%
20,0%
10,0%
0,0%
PO
BB
KE
Intervencia OPZ - Ochorenia obehovej sústavy
NR
TN
TT
Potreba - Ochorenia obehovej sústavy
Intervencia OPZ - Nádorové ochorenia
Potreba - Nádorové ochorenia
Intervencia OPZ - Choroby dýchacej sústavy
Potreba - Ochorenia dýchacej sústavy
Intervencia OPZ - Vonkajšie príčiny ochorení a úmrtí
Potreba - Vonkajšie príčiny ochorení a úmrtí
Intervencia OPZ - Choroby tráviaceho systému
Potreba - Ochorenia tráviacej sústavy
Intervencia OPZ - Iné choroby
Potreba - Iné choroby
112
ZA
ABCD
F.3
Percentuálne členenie potreby a pokrytia
Pomery dopytu a pokrytia OPZ per kraje - podla hospitalizacii tie su delene na celu SR a intervecie su
delene na cele OPZ = sucet percent vsetkych dychacich per kraj je 100% penazi OPZ co slo na dychacie
40,0%
F.4
35,0%
30,0%
25,0%
20,0%
15,0%
10,0%
5,0%
0,0%
PO
BB
KE
NR
TN
TT
Intervencia OPZ - Ochorenia obehovej sústavy
Potreba - Ochorenia obehovej sústavy
Intervencia OPZ - Nádorové ochorenia
Potreba - Nádorové ochorenia
Intervencia OPZ - Choroby dýchacej sústavy
Potreba - Ochorenia dýchacej sústavy
Intervencia OPZ - Vonkajšie príčiny ochorení a úmrtí
Potreba - Vonkajšie príčiny ochorení a úmrtí
Intervencia OPZ - Choroby tráviaceho systému
Potreba - Ochorenia tráviacej sústavy
Intervencia OPZ - Iné choroby
Potreba - Iné choroby
ZA
Measure 1.1
V
koľkých
projekto
ch
Skupina / Podskupina
Nové diagnostické prístroje
Bronchoskopy
Denzitometer
Mamografy
Prístroje pre sním., reproduk. a záznam bioelektrických veličin
Nové operačné prístroje
Nové terapeutické prístroje
Hyperbarická komora
Litotriptory
Simulačný nácvik chôdze u pacientov s poškodením miechy s
Zlepšenie stavu centrálneho príjmu
Zlepšenie stavu intenzívnych oddelení (OAIM a JIS)
Zlepšenie stavu operačných sál
17
2
1
1
7
1
1
1
3
3
2
1
6
1
3
1
1
4
2
Spolu
koľko
kusov/
krát
Spolu koľko
kusov/ krát
v ukončených
projektoch
V akej ∑
hodnote EUR
% podiel z
celkových
vynaložený
ch
prostriedk
ov NFP
103
3
1
3
65
10
8
8
5
136
135
1
17
1
13
2
1
274
243
31
138
10 083 295,00 €
797 915,00 €
169 932,00 €
439 391,00 €
664 515,00 €
402 098,00 €
509 371,00 €
320 000,00 €
6 780 074,00 €
520 010,00 €
403 831,00 €
116 179,00 €
3 649 429,00 €
240 781,00 €
163 886,00 €
2 800 550,00 €
444 212,00 €
1 942 564,00 €
1 280 225,00 €
43,91%
3,48%
0,74%
1,91%
0,00%
2,89%
0,00%
1,75%
0,00%
0,00%
0,00%
0,00%
2,22%
0,00%
1,39%
0,00%
29,53%
2,26%
0,00%
1,76%
0,00%
0,51%
15,89%
1,05%
0,71%
12,20%
0,00%
0,00%
0,00%
1,93%
0,00%
0,00%
8,46%
0,00%
0,00%
5,58%
75
2
1
2
53
10
2
1
4
8
7
1
18
1
15
1
1
274
86
113
ABCD
27. máj 2013
V
koľkých
projekto
ch
Iné zariadenie
Nábytok
Stavebná rekonštrukcia
Stavebné rozšírenie priestorov
IKT
PACS
Software
Spolu
2
5
3
2
5
2
3
2
2
44
Spolu
koľko
kusov/
krát
Spolu koľko
kusov/ krát
v ukončených
projektoch
V akej ∑
hodnote EUR
% podiel z
celkových
vynaložený
ch
prostriedk
ov NFP
138
1730
1564
166
11
6
5
4
4
2413
1 280 225,00 €
1 051 589,00 €
571 617,00 €
479 973,00 €
4 255 858,00 €
1 258 886,00 €
2 996 972,00 €
178 085,00 €
178 085,00 €
22 961 055,00 €
5,58%
0,00%
4,58%
2,49%
2,09%
18,54%
5,48%
13,05%
0,00%
0,00%
0,00%
0,78%
0,78%
0,00%
0,00%
100,00%
Spolu koľko
kusov/ krát
v ukončených
projektoch
V akej ∑
hodnote EUR
% podiel z
celkových
vynaložený
ch
prostriedk
ov NFP
93
3
3
65
2
1
8
3
8
139
2
135
1
1
15
13
2
65
65
381
373
8
138
138
13 114 247,00 €
159 163,00 €
434 628,00 €
3 604 820,00 €
605 000,00 €
1 718 717,00 €
3 387 891,00 €
1 230 460,00 €
1 973 567,00 €
9 627 742,00 €
436 759,00 €
8 503 265,00 €
571 454,00 €
116 263,00 €
11 350 416,00 €
66 935,00 €
11 283 481,00 €
621 448,00 €
11 191 179,00 €
15 331 583,00 €
7 884 730,00 €
6,46%
0,08%
0,00%
0,21%
0,00%
1,77%
0,00%
0,00%
0,30%
0,85%
0,00%
0,00%
1,67%
0,61%
0,97%
0,00%
0,00%
4,74%
0,22%
4,19%
0,28%
0,06%
5,59%
0,00%
0,03%
5,55%
0,00%
0,00%
0,00%
0,00%
0,31%
0,00%
5,51%
0,00%
0,00%
7,55%
3,88%
86
238
72
166
5
2
3
2
2
706
Zdroj dát: MZSR, Aktuálnosť dát: 30.6.2012, EUR – Zazmluvnené NFP
F.5
Measure 1.2
V
koľkých
projekto
ch
Bronchoskopy
Denzitometer
Mamografy
Litotriptory
25
3
2
4
1
1
7
1
6
13
3
7
2
1
3
1
2
2
2
13
7
4
Spolu
koľko
kusov/
krát
57
3
2
25
1
1
11
1
13
210
3
202
4
1
3
1
2
87
87
1182
408
273
114
ABCD
V
koľkých
projekto
ch
Iné zariadenie
Nábytok
IKT
PACS
Software
Spolu
3
12
11
1
31
7
9
15
9
9
8
2
2
4
123
Spolu
koľko
kusov/
krát
Spolu koľko
kusov/ krát
v ukončených
projektoch
V akej ∑
hodnote EUR
% podiel z
celkových
vynaložený
ch
prostriedk
ov NFP
0
1730
1564
166
56
6
5
45
4
4
105
4
0
101
2726
7 446 853,00 €
12 588 257,00 €
12 529 432,00 €
58 825,00 €
44 938 688,00 €
7 928 988,00 €
37 009 700,00 €
0,00 €
83 996 443,00 €
83 996 443,00 €
377 193,00 €
87 100,00 €
6 422,00 €
283 671,00 €
203 137 197,00 €
3,67%
6,20%
6,17%
0,03%
22,12%
3,90%
18,22%
0,00%
41,35%
41,35%
0,19%
0,04%
0,00%
0,14%
100,00%
135
2856
2808
48
83
7
9
67
9
9
133
2
0
131
5028
F.6
Measure 2.1
V
koľkých
projekto
ch
Bronchoskopy
Denzitometer
Mamografy
Litotriptory
94
1
2
4
7
30
7
1
6
1
1
2
11
4
15
1
1
14
1
13
5
1
1
1
2
1
1
Spolu
koľko
kusov/
krát
Spolu koľko
kusov/ krát
v ukončených
projektoch
565
1
2
5
12
471
13
4
6
1
3
2
12
4
25
3
1
91
1
90
21
1
1
1
18
1
1
110
3
1
3
0
65
1
10
2
1
0
8
3
8
0
5
137
2
135
13
13
0
0
0
138
138
V akej ∑
hodnote
EUR
19 696 227 €
21 134 €
204 363 €
620 265 €
1 195 802 €
6 217 972 €
459 915 €
345 000 €
1 346 473 €
1 726 084 €
431 777 €
86 599 €
1 970 707 €
1 824 077 €
2 657 138 €
236 120 €
352 800 €
1 892 995 €
49 482 €
1 843 512 €
1 123 998 €
1 800 €
474 009 €
404 283 €
243 906 €
30 400 €
30 400 €
% podiel z
celkových
vynaloženýc
h
prostriedkov
NFP
42,20%
0,05%
0,44%
1,33%
2,56%
13,32%
0,99%
0,74%
2,89%
3,70%
0,93%
0,19%
4,22%
3,91%
5,69%
0,51%
0,76%
4,06%
0,11%
3,95%
0,00%
0,00%
2,41%
0,00%
0,00%
0,00%
1,02%
0,87%
0,52%
0,00%
0,00%
0,00%
0,00%
0,00%
0,00%
0,07%
0,07%
115
ABCD
27. máj 2013
V
koľkých
projekto
ch
Iné zariadenie
Nábytok
IKT
PACS
Software
Spolu
20
20
82
31
20
31
10
10
26
3
2
21
252
Spolu
koľko
kusov/
krát
Spolu koľko
kusov/ krát
v ukončených
projektoch
428
428
117
31
20
66
10
10
183
3
0
180
1416
116
1564
1564
56
6
5
45
4
4
105
4
0
101
2116
V akej ∑
hodnote
EUR
2 228 645 €
2 228 645 €
16 511 320 €
10 168 850 €
6 342 470 €
0€
4 780 734 €
4 780 734 €
404 778 €
99 581 €
24 588 €
280 610 €
46 669 097 €
% podiel z
celkových
vynaloženýc
h
prostriedkov
NFP
0,00%
4,78%
4,78%
0,00%
35,38%
21,79%
13,59%
0,00%
10,24%
10,24%
0,87%
0,21%
0,05%
0,60%
100,00%

Operational Programme Health Evaluation of Impacts

Transcription

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