Health Care Waste Management (HCWM)

Financing of the Future HCWM System

Ohrid,Ana Petrovska

Present Tariffs• Tariff paid for collection of HCW in the Skopje area is:

MKD 56 (0,9 Euro) per kg excl. VAT (18%).• Tariff paid for delivery of HCW at the gate at Drisla

Landfill is: MKD 45 (0,75 Euro) per kg excl. VAT (18%).• Tariff paid for collection of yellow HCW boxes (25 litres)

from private General Practitioners and ambulatories, etc. in the Skopje area, is: MKD 385 (6,4 Euro) per box (3 kg), or 128 MKD per kg. (2,0 Euro) excl. VAT (18%).

• Tariff paid for collection of yellow HCW boxes (25 litres) from private General Practitioners and ambulatories in Kumanovo MKD 130 (2,1 Euro) per kg excl. VAT (18%), to be paid to the Kumanovo Health Centre, which is organizing collection and transport to the "Drisla" landfill

• Transparency of setting the tariffs is not sufficient

Sources of Financing

• Major investments in a new HCWM system can not be made based on funds from the Health Insurance Fund, due to its accumulated debts.

• Financing directly from the state budget via MoH is considered, in combination with:– Contributions from MEPP on specific environmental

programmes, – Soft loans based on Government guarantees,– International grants, etc

Future Tariffs

• Future tariff for HCWM should incorporate the following costs:– The costs of establishing and maintaining proper storage

facilities at general hospitals and health centres, – Costs for purchase, maintenance and operation of a sufficient

number of small vans or trucks to be used in the primary collection service,

– Other internal costs such as investments in small plastic containers on wheels, receptacles, etc. and use of consumables in the form of plastic bags, sharps boxes, etc.

– Costs for the investments in the establishment of the final treatment facilities (e.g. three regionally based autoclaves) and associated operation & maintenance costs

Responsibilities for Setting of Tariffs

• According to the Law on Waste the Operator of the disposal facility is in charge of setting the tariff

• The MEPP shall approve the tariff, taking care for the inclusion of all costs

• Tariff paid by the generator shall cover the full costs for the operation of the (regional) HCWM Systems

• Small generators shall pay to the regional centers also a margin for the “internal” collection

Financing of the Regional HCWM Systems

• Preparation of annual budgets on all costs related to the operation and maintenance of the regional system;

• Determination of corresponding tariffs to be paid by medical waste generators being serviced by the system, and assuring approval of such tariffs;

• Daily accounting/bookkeeping, and based hereon issuing of invoices at regular intervals to the medical waste generators being serviced by the system and assure that invoices are being paid;

• Financing of regional offices and staff management;• Reporting of all relevant financial, technical and

environmental aspects to the owners of the medical waste management system and to the responsible authorities (MoH and MoEPP).