Financing and audit: mechanisms characteristic for the Republic of Moldova

Lilia Gantea, deputy head, Policies Budget and Finance Department, Ministry of Health

June 27th 2011

Sources of financing:

National public budget means, Contributions of international organisations,

donations and grants.

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National public budget (NPB)

Consolidated totality of: State budget; State Social Insurance Budget (BASS); Compulsory Health Insurance Funds

(FAOAM); Budgets of territorial administrative units

(TAU).

National public budget (NPB) State budget- NPB component managing the public financial

resources dedicated to the implementation of economic, social and other Government strategies and objectives.

BASS - NPB component managing the state social insurance contributions and other public financial resources dedicated to the state public social insurance system.

FAOAM – NPB component managing the the compulsory health insurance premiums and other public financial resources dedicated to the compulsory health insurance system.

TAU Budgets- NPB component managing public financial resources dedicated to the implementation of purposes and functions attributed, according to the law, to local public authorities, especially for the social, economical and cultural needs of the population for the development of the subordinated territory.

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Dynamic of total expenses for health protection and their percentage of the GDP

The burden of the state budget in the financing of The burden of the state budget in the financing of the healthcare systemthe healthcare system

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Sources of financing for the protection of Sources of financing for the protection of health, 2010health, 2010

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Sources of financing for health expenses,2010

Financial agents: 1. Public sector: Central public authorities (Ministry of Health, Ministry of Justice, Ministry of

Defense, Ministry of Labour, Social Protection and Family, Ministry of Education, Ministry of Youth and Sports, etc.)

National Health Insurance Company (CNAM) National Office of Social Insurance (CNAS) Local public authorities

2. Private sector: Economic agents Non-profit organisations Households

3. International sector: Bilateral international organisations Multilateral international organisations

Service providers:

Medico-sanitary institutions Mass-media (Television, Radio, Printed press) Education institutions Non-profit organisations Other providers

Medico-sanitary institutions

I. Public medico-sanitary institutions financed from the state budget:

National Centre of Public Health, AIDS Center, regional AIDS laboratories of municipal and district health centers, (HIV/AIDS epidemiological surveillance, laboratory diagnostic, and prevention activities)

Blood Transfusion Centres (blood safety), National Healthg Management Centre (monitoring and evaluation

activities of the National Program);

Medico-sanitary institutionsII. Public medico-sanitary institutions which are part of the

compulsory health insurance system:

Family Doctors’ Centers (measures to promote health and prevent HIV/AIDS/STI transmission, early detection health services);

Voluntary counselling and testing centres from the consultative sections of the hospital type PMSI (voluntary counselling and testing services of the disease)

PMSI Toma Ciorba Clinical Infectious Disease Hospital (pre-treatement and ARV treatment surveillance);

PMSI Republican Dermato-Venerologic Dispensary (STI pre-treatment surveillance and treatment);

PMSI Republican Narcologic Dispensary (IDU Harm Reduction Program activities, including methadone substitution treatment);

PMSI Scientific Research Institute in the field of Mother and Child Health Protection (activities to prevent vertical HIV transmission);

III. non-governmental institutions providing services from public funds like home healthcare, palliative healthcare provided in hospice conditions

Legal and normative acts: Law nr.847 of 24.05.1996 on the budget system and budget process; Government Decision nr.82 of 24.01.2006 on the creation of the mid-

term expense framework and the budget project; Healthcare law nr. 411 of  28.03.1995; Law nr.1585 of 27.02.1998 on compulsory health insurance; Law nr.1593 of  26.12.2002 on the size, mode and terms of paying

compulsory health insurance premiums; Annual state budget laws; Annual laws on compulsory health insurance funds; The unique program of compulsory health insurance approved

through Government Decision nr.1387 of December 10th, 2007; Normative acts of the Ministry of Finance, Ministry of Health, CNAM

Stages of the annual budget planning cycle:

1. Government policy priorities

2. Preliminary macrofiscal prognoses

3. CCTM concept document

4. Sectorial expense strategies

5. Actualised expense analysis and limits

6. Documents on CCTM prognoses

7. Annual directives on budget planning

8. Creating budget proposals/projects

9. Analysis and discussions based on budget projects

10. Examination and apporval of budget projects by Government/TAU

Executive Authorities

11. Approval of budgets by Parliament/TAU deliberative and representative authorities

Methods of payment in the compulsory health insurance system : per capita - in pre-hospital healthcare, primary healthcare adjusted by

age risk, according to the following groups : ages 0 to 4—11 months 29 days; ages 5 to 49—11 months 29 days; over 50 ani.

per capita, global budget – in specialised ambulatory healthcare per case treated, global budget – in hospital healthcare per service- for high performance medical service per visit – for home based healthcare per bed-day- for palliative healthcare provided in hospice conditions initiation per Harm Reduction Program (estimation of HRP costs based on the

service pack provided to beneficiaries) – for the facilitations of actions to start HRP financing from NPB resources and launching the process of NGO social contracting

Flow of financial means :

Financial means transfered by the PMSI to the CNAM, represent the payment for healthcare services provided and are not divided on expense elements (chapters).

Healthcare institutions working based on the self-financing principle plan their economico-financial in a way in which they could insure the achievement of statutory purposes and their further development, coordinating the income and expense estimate with the Founder and the CNAM.

Payment of medical services is made monthly in the limit of available financial means, until the 15th of the respective moth, advance payment of up to 80% of 1/12 of the annual contractual sum and quarterly after presenting the integral payment invoices of ¼ of the annual contractual sum, with the exclusion of the paid advance quantum.

Flow and management of financial means:

The global budget payment means, divided into expense elements (chapters) is used for providing healthcare services, including for HIV/AIDS/STI patients, in public medico-sanitary institutions that are financed from the state budget.

The funding of public health care institutions financed from the state budget is based on plans of financing, which include distribution of monthly financial allocations according to the economic classification.

Legislation appliable to the activity of public medico-sanitary institutions Law on accounting nr.113-XVI of April 27th,

2007; Government Decision nr.710 din 23.09.1994 on

the Republic of Moldova State program of transition to the world system of accounting and statistics;

Other norms and regulations issued by the Ministry of Finance.

Reporting Quarterly and annually based on forms approved by the National

Bureau of Statistic, Ministry of Finance, Ministry of Health and the National Health Insurance Company.

Public medico-sanitary institutions financed from the state budget present financial reports and balances to the Ministry of Health that furtherly generalises them and presents them to the Ministry of Finance.

Public medico-sanitary institutions that are part of the compulsory health insurance system present financial reports and balances to the National Bureau of Statistics, and the reports approved through order nr. 448/111-A of June 23rd, 2010 to the Ministry of Health and the CNAM.

Reporting of expenses per 2010-according to National Health Accounts

Auditing

internal audit, carried by internal auditors of institutions; external audit:

Republic of Moldova Court of Accounts, supreme auditing institution of the country,

Independent audit company (firm) both national and international;

Centre for Combating Economic Crimes and Corruption;

Financial Control and Revision Service of the Ministry of Finance;

Evaluation and control department of the National Health Insurance Company