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Mapping Clinical Pathways

Transforming Tunisia’s Clinical Cost Structures

Currently financed by out of-pocket payment, (the subsidisation of the National Health Insurance Fund based on billing and the State subsidisation),the billing and fee structures of Tunisia’s healthcare facilities do not reflect the reality of the costs, resulting in a negative impact on the financial situation of public facilities and services.

The Challenge

The Tunisian Ministry of Health (MOH) recognised the issues surrounding their billing structures and, launched a pivotal project to implement a medico-economic informational system, to change the future operational running.

  • Combat the current issues on budgeting Tunisian health care facilities
  • Address the billing and fee structures
  • Set up a medico-economic informational system to calculate the real costs and accurate fees

Agencia’s Action

Agencia entered a bilateral project with both the British Embassy and the Tunisian Ministry of Health to train key staff groups on the new systems. Agencia assembled a team of experts who were qualified to address two main areas:

Medical Component:

Introducing the ICD 10

Agencia delivered training on the International Statistical Classification of Diseases and Related Health Problems from the World Health Organisation (WHO).

The Methodology of Coding

Agencia taught staff groups not only what to code, but the main and secondary diagnosis, along with the correct procedures to follow at each stage.

DRG and CPT Procedures

This was a case of presenting the importance of The Diagnosis Related Group (DRG) – a statistical system of classifying any inpatient stay into groups for the purposes of payment and medicare reimbursement. Additionally, informing and educating the groups about Current Procedural Terminology (CPT) – a medical code set which is used to report medical, surgical and diagnostic procedures and services – was equally as important.

Coded Medical Data, Indicators and Dashboard

Further training was provided on the use of the software and operating systems, in order to gain familiarity and valuable experience for the users.

Methodology to Analyse Data and make Strategic Decisions

It is crucial to be able to effectively use the data to make important decisions at a central level. To do this, Agencia educated the teams on how to manage the contracts at different levels between the Tunisian MOH and the Head Manager of the health care facilities.

Economic Component:

Presentations reinforcing the different methods for integrating economic and medical data, in order to calculate the cost per process and per DRG, were executed.

On top of this, additional training was provided for methods surrounding the cost weight, and how to develop the national scale of cost and its use in financing the health system.

Finally, methodology for analysing data at a central level to enable strategic decision making was carried out.

The Results

Following the training that Agencia delivered, there have already been a number of improvements.

  • Improved intelligence-led decisions about where resources should be apportioned
  • Helped strengthen the business case for the state to invest in better services for patients
  • A model that can be rolled out to other countries in the region

“We are excited to have expanded our Healthcare work into North Africa. This is a key opportunity to help the Ministry of Health improve its services to patients, and we are delighted to have been able to support this. This work follows on from us previously having been invited to join Rt Hon The Lord Mayor of the City of London, Alderman Fiona Woolf CBE, in a visit to Tunisia. Agencia was invited to present on judicial reform, and share Agencia’s expertise in this area with attending delegates.”

Agencia Managing Director, Helen Gibson

Company/Organisation

Ministry of Health, Tunisia

Date

March 2017

Location

Tunisia

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