Disaster, too early for us…

[Assalamualaikum & salam sejahtera]

As title of this post suggest that I will expressed and share on current natural disaster in Yogyakarta. In our academic calendar, block 4.2, module 2 which is proposed on the 5th and 6th week of the block. Merapi eruption has taken place on the 26 October 2010 for the first eruption. It is not stop there, Merapi continue to erupt again with a great energy and damage.

 

Merapi’s Latest Outburst Its Longest So Far
Candra Malik & Fidelis E Satriastanti | November 04, 2010

Yogyakarta. Mount Merapi has broken its own record after erupting nonstop for more than 24 hours, and geologists are now calling this episode the mountain’s worst since the 1870s.

After erupting and spewing heat clouds since Wednesday morning, the mountain unleashed its most extreme volcanic activity yet on Thursday, sending ash seven kilometers into the air.
Geologists said Thursday’s eruption at 5:55 a.m. was five times stronger that the initial eruption on Oct. 26, which lasted only 33 minutes.

Having erupted almost daily for 10 days, Surono, head of the Volcanology and Geological Disaster Mitigation Agency (PVMBG), said this episode was considered Merapi’s worst eruption since the 1870s.

The 1872 eruption, which until now had been considered Merapi’s most violent in recent history, destroyed 13 villages and killed 1,400 people.

Later on Thursday, Surono said the heat clouds were spreading as far as 11.5 kilometers from the crater, dangerously near the edge of the expanded 15-kilometer danger zone, and lava was flowing into the mountain’s rivers.

“The heat clouds are moving more freely since Mount Merapi’s marathon eruptions, destroying houses, trees and anything else in the way,” he said.

“The temperature of the heat clouds is 600 to 800 degrees Celsius. Anyone who does not flee from the disaster zone will not be safe.”
Surono also called on people to keep a safe distance from rivers flowing from the slopes of Mount Merapi.

Heavy rain overnight triggered lahars, mixtures of water and rock debris, that cascaded down the Kuning, Gendol, Woro, Boyong, Krasak and Opak rivers on the slopes of the volcano, destroying a bridge and riverbanks.

“We’re concerned about public safety because there have been lahar flows and this can lead to flooding if they exceed the capacity of those rivers,” Surono said.

Raden Sukhyar, chief of the geology department at the Ministry of Energy and Mineral Resources, said there was still no indication when the eruptions would end.

“We still cannot ensure that the extreme catastrophic events on Thursday will mark a decrease in activity of Mount Merapi,” he said.
“We’re not going to drop its status from the highest alert because we don’t know when the eruptions will end.”
The eruptions have forced the residents of 32 villages within the disaster zone to evacuate.

Central Java’s governor, Bibit Waluyo, said more than 62,000 people from Magelang, Klaten and Boyolali districts had been forced from their homes, while Sri Purnomo, head of Sleman district in Yogyakarta, said his area had more than 22,000 evacuees.

The geologists warned that the dangers posed by the volcano extended beyond the people in the immediate danger zone.

Sukhyar said the volcano had spewed more than 50 million cubic meters of ash, sand and gravel.

“The winds tend to move to the west, taking volcanic ash toward Magelang, but it can spread anywhere depending on the wind direction,” he said.

Transportation Minister Freddy Numberi, speaking in Jakarta, said he had instructed airlines to direct all flights crossing Java to the north or south to avoid Merapi. “We have already prepared alternative routes for all flights,” he said.

“It may cost more and use up more fuel, but safety comes first.”
At least one hajj flight from Solo to Batam is known to have had engine trouble related to volanic ash.

Herry Bakti Gumay, director general of air transportation, said they had issued a warning last week to all airline operators with flights into Yogyakarta and would not withdraw it until conditions returned to normal.

However, the minister said airports in Yogyakarta, Solo and Semarang would remain open.

“If the ash covers the runways, then we will need to close them,” Freddy said.

“But they can be reopened after cleaning, which would take just a few hours.”

Jakarta Globe

 

Extreme damage of the residential area around the Mount Merapi as result of the eruption. Merapi eruption is such a great example of disaster situation. We can see that everyone is in chaos who trying to survive. However, even in very good preparation, there are still many unwanted effect such as morbidity, mortality and psychological trauma.

In order to manage this disaster, the main important sources is human resources and finance. All what we can do is donate some of our effort to share with them. There are many ways to contribute to the disaster management. I did not learn yet about the disaster management in formally, what i can think of is there are many NGO who are conducted the management. If we far away from the disaster site, we can donate our money to support them in order to further continue new life.

Here are some:

 

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Just for fun!!!

[Assalamualaikum & salam sejahtera]

[Doctor & Patient]

[Doctor]

[Hospital Director, Government]

 

[Doctor]

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Provider Payment System in Asia

[assalamualaikum & salam sejahtera]

Provider Payment System is one of the system that play a very important role in the health system. This sub-system in a complex system closely related to the main sources of input such as money, human resources. As this is one of the important criteria in health system, I would to share information on the provider payment system in Asia.

 

Basically, Health system in Asia are mostly derived from the British model of health system which is predominantly publicly financed and provided care. Thus, in the last two decades, most countries already move towards to large and growing private sector, both in terms of financing and provision care. Today’s, there are 3 broad group that classify the Asia countries.

The first group is made up of countries which have kept the original payment methods from the colonial times. This model named as The Beveridge Model, named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax  payments, just like the police force or the public library. Hospital are paid by the national budget allocation (tax), and physicians employed in the government hospital paid by salary while those who are employed in the private hospital are paid by fee-for-service method. Both public and private sector are independently managed in the country. This system applied in India, Malaysia, Sri Lanka, and probably Pakistan and Bangladesh.

The second group consist of countries that have implemented some degree of social health insurance. This reformation have adopted health financing systems which are closer to the Bismarck model. Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of  the unification of Germany in the 19th century. This system using insurance system which usually financed jointly by employers and employees through payroll education, thus its providing health care would look familiar to Americans. Small-scale employer-based insurance schemes have gradually grown into universal coverage without the development of a substantial tax-financed delivery system. The countries that apply this system include Japan, Korea, and Philippines.

The remaining group of Asian countries appear to be moving from the British model with public sector delivery and financing of care toward one based on the social insurance. This reformation as result of broader economic transitions. Incomes of citizens grew greatly from few decades ago, thus result in transition of public health services to private health services due to less satisfied of existing public services. Indonesia, Thailand and Vietnam is some of the countries in the Asia that apply this system. Limitation of the central government financial support reduces the improvement of the public health services that would have satisfied the public, and therefore social insurance was seen as a way to mobilize resources and offer universal coverage to citizens.

References:

1. Wang, Hong, Mark McEuen, Lucy Mize, Cindi Cisek, and Andrew Barraclough. February 2009. Private Sector Health in Indonesia: A Desk Review. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc.

2. PHNP Resources. Health Care Systems - Four Basic Models

 

What do you think?

[assalamualaikum & salam sejahtera]

Total expenditures on health as percentage of Gross Domestic Product (GDP) and Life expectancy at birth (in years), 2006.

Sources: Wang, Hong, Mark McEuen, Lucy Mize, Cindi Cisek, and Andrew Barraclough. February 2009. Private Sector Health in Indonesia: A Desk Review. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc.

Total expenditure referring to national budget that being allocate every years to the health sector. The national budget has been allocate depending to the gross domestic product. As a simple measurement, proportion of expenditure to the health and GDP can be used as universal indicator on percentage of national budget allocate to the health regardless the amount. Total expenditure is one the input of the health system.

As we can interpret the figure, Indonesia has been spent the lowest percentage of GDP to the health sector as well as Philippines and Thailand. Micronesia and Tango has spent the most percentage of GDP to the health sector. These variations happen because there are variation in health system in each country. So, health system is one of the influencing criteria to the Total Expenditure on Health and percentage of GDP in country.

Life expectancy at birth (in years) is a simple measure of the health outcomes. If the expenditure is input, the services (management) is the process, thus, the outcome can I say as a indicator of the effectiveness in the process, in this case is management. But why life expectancy at birth being use as an indicator? What the reason?

Life expectancy at birth used because it is as general indicator of the health access outcomes. If the low life expectancy, there might have a bad health access, bad health services as health is major determination of life expectancy. Good health comes from the good healthy lifestyle but on the other hands, good health can be derived from the good health services. this is the reason why life expectancy being used as indicator of the health.

Back to the graph, we can see that Malaysia has highest life expectancy at birth which is 75 years old. Where as Indonesia has the lowest life expectancy among other country in the study. Other countries is scattered in the middle.

Indonesia, Malaysia, Thailand and Philippines has total expenditure on health relatives similar in number which is around 3-4% of GDP. But the health outcomes can be different so much.

So, here is the conclusion. What do you think?

*Leave a comment on this. Your comment, I highly appreciated.

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Salary… Salary… Salary…

[assalamualaikum & salam sejahtera]

Today’s topic is about salary.. As I mention on the previous post that the only motivation to the doctor is the reward or salary. What it is mean by salary? How they are paid? How much the doctors are paid?

1st question: what is salary?

Salary~synonym: wages/pay/income/earning - money that employees receive for doing their job, especially professional employees or people working in an office, usually paid every month

*These are all words for money that a person earns or receives for their work.

- income ~ money that a person receives for their work, or from investments or business: people on low incomes

- wage/wages ~ money that employees get for doing their job, usually paid every week: a weekly wage of £200

- pay ~ money that employees earn for doing th

eir job: The job offers good rates of pay

- salary ~ money that employees earn for doing their job, usually paid every month

- earnings ~ money that a person earns from their work: a rise in average earnings for factory workers

In other word, salary is one of the important aspect in the health system. What ever it is, the money is matters.

2nd question: How they are paid?

During recent years the question of how to provide the most cost-effective health care services has been of increasing interest to health care managers, health insurers, providers, patients, and governments. Provider payment systems have been central to this discussion. These mechanisms are defined as the way money is distributed from the government, insurance company, or other stakeholder to a health care provider. Different payment systems generate different incentives for efficiency, quality, and utilization of health care facilities, and these incentives may vary according to whether one is a provider, patient or payer.

When we are talking a

bout payment mechanism, there are four main actor who play a role in this. They are health care facilities (hospital), health care providers (doctors), patients, and the insurers/payers. This payment mechanism has a big, complex interaction between these 4 main actors. Each actors has their own goals in this payment mechanism.

Health care facility wants to deliver the services in cost effective. Health care provider wants to deliver the services that expand their incomes. Patient who insured does not has any problems of receiving the services because they are paid by the insurer. The problems will be on the provider and insurer. While for out-of-pocket patient, they seek health care to obtain services to cure their illness. But unfortunately, they do not know the quality of the services. Misleading measurement sometimes being used which is curative rate. The insurer/payers have goal of minimizing pay for the services or demand a certain quality of the services.

In defining a provider payment method, it is important to specify when payment rates are actually set. When the payment rate for a package of health care services is negotiated and agreed upon before the treatment takes place, it is referred to as prospective payment. Prospectively set payment rates—including case-based and per capita-based payment—increase the incentive for efficiency because the health provider faces higher financial risk.

When the payment rate is selected during or after the service has been rendered, it is referred to as retrospective payment, or sometimes as cost-based reimbursement and is well known for being cost enhancing rather than cost reducing. Fee-for-service is a typical form of retrospective reimbursement. Although prices for each service may be set in advance, providers are not limited by a predetermined agreement on the types and number of services rendered.

Here are the example of payment mechanism:

Payment Method	Unit of Services	Retrospective /Prospective	Main Incentive Created [Note: Quality assurance mechanisms should accompany each payment system method]
Line Item Budget	Functional Budget Categories	Either	Little flexibility in resource use, cost control of total costs, poor incentives to improve productivity, sometimes results in rationing
Global Budget	Health Facility	Prospective	Spending artificially set rather than through market forces, not always linked to performance indicators, cost-shifting possible if global budget covers limited services, rationing may occur
Capitation	Per person to a health care provider who acts as stakeholder	Prospective	Incentives to undersupply, strong incentives to improve efficiency that may cause providers to sacrifice quality, rationing may occur, improves continuity of care
Case-based Payment	Per case or episode	Prospective	Incentives to reduce services per case but increase number of cases (if per case rate is above marginal costs), incentives to improve efficiency per caser
Per Diem	Per day	Prospective	Incentives to reduce services per day but increase length of stay (if per diem rate is above marginal costs)
Fee-for-Service	Per unit of service	Retrospective	Incentives to increase units of service

Table 1: Six Payment Systems and Main Incentives Created

Sources: Maceira, Daniel. August 1998. Provider Payment Mechanisms in Health Care: Incentives, Outcomes, and Organizational Impact in Developing Countries. Major Applied Research 2, Working Paper 2. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.

So, at the end, which payment system you are dreams for? Today’s payment system getting complex and more complex as they will continue to evolve to obtain best method of payment mechanism. The traditional system is evolve to modern system which everyone are looking for the best for themselves.

Hope, this several information on payment mechanism can express an understanding on physicians payment mechanism from various point of view.

References:

1. Maceira, Daniel. August 1998. Provider Payment Mechanisms in Health Care: Incentives, Outcomes, and Organizational Impact in Developing Countries. Major Applied Research 2, Working Paper 2. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.

2. John Caroll. December 2007. How Doctors Are Paid Now, And Why It Has to Change. MANAGED CARE. ©MediMedia USA

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