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More and more countries are
following the United States' lead and incorporating case-mix
based payment or budgeting systems
into their healthcare delivery model. Evaluating the impact of changing
national healthcare systems is a difficult task, complicated by political
and cultural issues. New systems must reflect current cultural and political
realities, existing healthcare delivery models and the publics
expectations.
Nimitt Consulting helps governments
around the world with the complicated process
of implementing healthcare reform and communicating with key
stakeholders as they change clinical and financial delivery models. As a
senior technical advisor, Ms. Shah most recently
worked with the Turkish
government through Hacettepe University Hospital and Tepe Technologies
to pilot test the use of coding and classification tools to design a new
payment methodology for all Turkish hospitals.
Key
Services
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Managing
projects and providing technical assistance on all aspects of health
financing reform including implementation of case-mix principles
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Conducting
health policy seminars with government officials
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Providing
technical assistance and training on all aspects of implementing
inpatient financing reform using various tools, including DRGs
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Facilitating
strategic planning sessions and stakeholder meetings
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Developing
and managing programs for USAID and World Bank initiatives related to
health reform, financing, maternal and child health and others
Currently, Ms. Shah is leading a large scale two
year project in the Republic of Moldova to develop, introduce, and pilot
test a Diagnosis-Related Group (DRG) based healthcare financing system.
This project is coordinated through the World Bank and the Ministry of
Health and the National Health Insurance Company in Moldova. Previously,
Ms. Shah served as a senior technical advisor to the Turkish government
through Hacettepe University Hospital and Tepe Technologies to pilot
test the use of new coding and classification tools for use in all
Turkish hospitals. Ms. Shah also served as the project director of a
large scale health reform initiative in Romania where she assisted the
Romanian government to implement a Diagnosis-Related Group (DRG) based
healthcare financing system. Ms. Shah has also worked extensively on
health reform initiatives in a number of other countries, including the
Czech Republic, Hungary, Slovakia and Bulgaria.
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Case Study:
From July 2000 through June 2003, Ms. Shah assisted the Romanian
Ministry of Health and Family, the National Health Insurance House,
the College of Physicians, the Institute for Health Services
Management, and the National Center for Health Statistics through a
USAID and DHHS-funded project to implement a more equitable and
transparent financing mechanism for the country's inpatient hospital
services.
Her efforts included serving as the U.S. project director
managing a team of local Romanian experts organized into functional
teams, including coding, costing, information systems, education,
communication, legislation, working to improve the healthcare
financing system. Her Romanian counterparts included physicians,
economists, public health specialists, and numerous officials from
the various Ministries and governmental agencies.
Twenty-three Romanian hospitals pilot tested the new financing
system. For the first time, their hospital budgets were based on the
number and types of cases discharged according to the DRGs classification system. Previously,
they had been paid according to their inputs (e.g. the number of
beds available), or the number of hospitalization days. Some were
even funded simply based on agreements made with personal contacts
in the government. Under the new financing system, healthcare funds
will "follow the patient", and patient clinical data will be used to
assess outcomes and the quality of services provided.
In November, 2002, the Romanian government approved the creation of
a central institution responsible for implementing and expanding the
case-based financing system (e.g. DRG) to all Romanian hospitals.
Financing for the original 23 pilot hospitals continues to be based
on DRGs. Meanwhile, all other Romanian hospitals are migrating to
this new output-based financing system by beginning to code
diagnosis and procedures consistently, to report their data
electronically, and to build the infrastructure required to support
this new financing system.
The goal to shift all hospitals to the
new output-based financing system
continues. The outcome
will be greater transparency in the healthcare sector, and
decreased inefficiency and corruption. To learn more about the
program, visit www.drg.ro.
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