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HEALTH RESOURCES

FEATURE FRANCE BUDGET Currently the total health care expenditure is at 9.4% GDP, among the highest in Europe. Frances budget allocation for health care is about 9.8% of the GNP. The PHI covers roughly 75% of all health expenditures, with services ranging from hospital care, outpatient services, prescription drugs, dental, vision, nursing home care. Remaining expenditures are shared through out-ofpocket expenses and private supplementary insurance. An income ceiling gives lowincome workers free supplemental insurance. All residents are automatically enrolled with MYANMAR BUDGET Total government health expenditure increased from kyats 464.1million in 198889 to kyats 48017.3 million in 2006-2007. HEALTH FACILITIES ( 20072008 ) -TOTAL NUMBER OF GOVERNMENT HOSPITALS =839 -Total hospital beds = 36121. -No. of Primary and Secondary -Health Centers = 86 -No. of Maternal and Child -Health Centers = 348 -No. of Rural Health Centers = 1473 -No. of School Health Teams = 80

BUDGET, MANPOWER,FACILI TIES

an insurance fund based on their occupational status. proprietary hospital sectoraccessible to all insured patients the coexistence of public and proprietary hospitals, half of French NHI expenditures were financed by employer payroll taxes (51.1%) and a general social contribution (34.6%) levied by the French treasury on all earnings, including investment income Remaining sources of financing-included payroll taxes on employees [3.4%], special taxes on automobiles, tobacco and alcohol [3.3%], a specific tax on the pharmaceutical industry [0.8%], and subsidies from the state [4.9%].) HEALTH FACILITIES The private hospital sector in France (both nonprofit and proprietary hospitals)

-No. of Traditional Medicine -Hospitals = 14 -No. of Traditional Medicine Clinics = 237

HEALTH MANPOWER( 20072008) Total No. of Doctors =21725 -Public 8033 - Co-operative & Private 13692 Dental Surgeon 1867 - Public 793 - Co-operative & Private 1074 = = = = =

has 36% of acute beds, including 64% of all surgical beds, 32% of psychiatric beds, and only 21% of medical beds. Hospitals in France are either public (65% of all inpatient beds), private notfor-profit (15% of inpatient beds) or private for-profit (20% of inpatient beds). Private for-profit hospitals mainly deal with minor surgical procedures, whereas public and private not-for-profit hospitals focus more on emergency admission, rehabilitation, long-term care and psychiatric treatment. France has an average of 8.4 hospital beds per 1000 inhabitants, half of which are acute beds,

-NURSES= 22027 -Dental Nurses= 175 -Health Assistants = 1788 -Lady Health Visitors= 3259 -Midwives= 18098 -Health Supervisor (1)= 529 -Health Supervisor (2) =1444 -Traditional Medicine Practitioners = 889

HEALTH MANPOWER France has about 1.6 million health care professionals, accounting for 6.2% of

the working population. In 2002, France had 3.3 physicians and 6.9 nurses per 1000 population, both below the Eur-A averages (Annex. Selected health care resources). There are geographical disparities in the distribution of physicians favouring Paris and southern France and urban relative to rural areas. characterized by large numbers of administrative and clerical personnel.

HEALTH SERVICES
FEATURE FRANCE -Health insurance is compulsory; no one may opt out. Health insurance funds are not permitted to compete by lowering health insurance premiums or attempting to micromanage health care MYANMAR - Ministry of Health is providing comprehensive health services covering promotive, preventive, curative and rehabilitative aspects to raise the health status and prolong the lives of the citizens. NON-ADMITTED PATIENTS-

COMPREHENSIVEN ESS, FREQUENCY, AVAILABILITY

ADMITTED PATIENTS There are budgetary allocations as well as per diem reimbursements. The French indemnity model allows for direct payment by patients to physicians, coinsurance, and balance billing by roughly one third of physicians. ambulatory care is dominated by office-based solo practice, French NHI provides a great degree of patient choice French NHI coverage increases as individual costs rise, there are no deductibles, and pharmaceutical benefits are extensive. NON-ADMITTED PATIENTS For ambulatory care, all health insurance plans operate on the traditional indemnity model reimbursement for services rendered. NHI was extended to all industrial and commercial workers and their families, irrespective of wage levels. French NHI covers services

The private, for profit, sector is mainly providing ambulatory care existence of traditional medicine along with allopathic medicine. Basic health service is one of the essential components of rural health development scheme. Access to health care for 70% of country population residing in rural areas has been improved through the expansion of health manpower in terms of basic health staffs and voluntary health workers, i.e. community health workers and auxiliary midwives. The outreach services include cataract surgery, reconstructive surgery and general medical and surgical services provided by teams of physicians and surgeons from central, state and divisional hospitals and Eye and ENT hospitals.

ranging from hospital care, outpatient services, prescription drugs (including homeopathic products), thermal cures in spas, nursing home care, cash benefits, and to a lesser extent, dental and vision care. The health system is noted for its high level of freedom for physicians and choice for patients, pluralism in the provision of health services, easy access to health care for most people and, except for some specialties in certain parts of the country, the absence of waiting lists for treatment.

HEALTH POLICIES AND PROGRAMS


FEATURE FRANCE MYANMAR

PROGRAMS OR LAWS RELATED TO HEALTH CARE

Public health policy and practice in France involves many actors and sources of funding, which leads to lack of cohesion among the actors and diluted responsibilities. In March 2003, a new bill was proposed setting out a comprehensive legislative framework for public health policy that developed strategic plans in designated priority areas and established a framework of objectives and targets. the 1999 Universal Health Coverage Act (CMU) has been a major reform. this reform explicitly aims to increase access and, consequently, health care expenditure, for people on low incomes. Decentralization at the regional level has also raised the issue of regional inequalities and some steps have been taken to reduce them, particularly in the hospital sector.

managed by the National Health Committee The National Health Policy was developed with the initiation and guidance of the National Health Committee in 1993. The National Health Policy has placed the Health For All goal as a prime objective using Primary Health Care approach. The National Health Policy is described here under: 1. To raise the level of health of the nation and promote the physical and mental well-being of the people with the objective of achieving HFA goal using the primary health care approach. 2. To follow the guidelines of the population policy formulated in the country. 3. To produce sufficient as well as efficient human resources for health locally in the context of the broad framework of a long-term health development plan.

cost containment policies addressed both the demand side (often by raising co-payments) and the supply side (hospital planning, limitation of the number of medical students, price control). The 1999 CMU Act was passed in spite of the likelihood that it would increase demand for health care, illustrating that the objective of equity has taken precedence over cost containment. CMU should stimulate demand for health care because it lowers financial barriers to access, not only by extending basic coverage to all French residents, but also by exempting those with the least resources from direct payment of costs and giving them free access to complementary VHI ( Voluntary Health Insurance ) MAJOR HEALTH POLICY

4. To strictly abide by the rules and regulations mentioned in the drug laws and byelaws which are promulgated. 5. To augment the role of cooperative, joint ventures, private sector and nongovernmental organisations in delivering health care in view of the changing economic system. 6. To explore and develop an alternative health care financing system. 7. To implement health activities in close collaboration and also in an integrated manner with related ministries. 8. To promulgate new rules and regulations in accordance with the prevailing health and health related conditions as and when necessary. 9. To intensify and expand environmental health activities including prevention and control of air and water pollution. 10. To promote national

DEVELOPMENTS 19901991 EVIN Act (Act 91-32 of 10 January 1991) regulating direct and indirect advertising of alcohol and tobacco, prohibiting smoking in public places and excluding the price of tobacco from the general price index to allow it to increase more freely; restriction of doctors access to Sector 2; introduction of a General Social Contribution (CSG) to strengthen social security financing; Hospital Act setting up regional strategic health plans (SROS) as a tool for planning hospital equipment capacity at the regional level. 1993 Loi Teulade (Act 93-8) concerning relations between health care professions

physical fitness through expansion of sports and physical education activities by encouraging community participation, supporting outstanding athletes and reviving traditional sports. 11. To encourage medical research activities not only on prevailing health problems but also giving due attention to carry out heath system research. 12. To expand health service activities not only to rural areas but also to border regions so as to meet the overall health needs of the country. 13. To foresee any emerging health problems that would pose a threat to the health and well-being of the people so that preventive and curative measures can be initiated. 14. To reinforce the service and research activities of indigenous medicines to international levels and to involve in community health

and health insurance funds including, in particular, the setting of ceilings for growth in health care expenditure, the introduction of practice guidelines (RMOs), the establishment of a basis for the coding of procedures and diagnoses and the creation of regional unions of self-employed doctors (URML), with the intention that they should participate in analysing the health care system and its components, monitor the quality of treatment and participate in public health action; Agreement of 21 October 1993 bringing the Loi Teulade into force: ceilings for expenditure growth, setting out RMOs and implementation of their negative phrasing; Act on the Medical Safety of Blood Transfusions and Medicines (Act 93-5 of 4 January 1993) creating the

care activities. 15. To strengthen collaboration with other countries for national health development. The Ministry of Health is systematically developing Health Plans, aiming towards Health for All Goal. Myanmar Health Vision 2030-a long-term (30 years) health development plan to meet any future health challenges Health Legislation Legal provision for the interest of health of the people is accomplished through enacting the following health related laws: Public Health Law (1972)- It is concerned with protection of peoples health by controlling the quality and cleanliness of food, drugs, environmental sanitation, epidemic diseases and regulation of private clinics.

Blood Agency and the Medicines Agency; last increase, to date, in patients contributions to the costs of health care. 1994 creation of the French Institute for Transplants (Act 94-43 of 18 January 1994); Framework Agreement of 24 January between the government and the pharmaceutical industry, envisaging a revision of prices if consumption volume exceeds a fixed level. 1996 Constitutional Act (96-138 of 22 February 1996) introducing annual legislation on social security funding, estimating the receipts of social security bodies for the year to come and setting a growth target (ceiling) for total health care expenditure

Dental and Oral Medicine Council Law (1989) -Provides basis for licensing and regulation in relation to practices of dental and oral medicine. Describes structure, duties and powers of oral medical council in dealing with regulatory measures. Law relating to the Nurse and Midwife (1990) -Provides basis for registration, licensing and regulation of nursing and midwifery practices and describes organization, duties and powers of the nurse and midwife council. Myanmar Maternal and Child Welfare Association Law (1990) Describes structure, objectives, membership and formation,duties and powers of Central Council and its Executive Committee. National Drug Law (1992) Enacted to ensure access by the people safe and efficacious

by the health insurance funds; the Act also approved the governments policy directions in health and social security. 1997 1998 Social Security Funding Act: replacement of almost all earnings-related health insurance contributions with the CSG at the rate of 5.1% of earned income; the government divides up the total financial budget for hospitals between the regions with the aim of reducing regional inequalities; signing for the first time of an agreement on targets and management between the government and the health insurance funds, covering three years; scheme for early retirement of self-employed doctors. 1998 Act reinforcing medical

drugs. Describes requirement for licensing in relation to manufacturing, storage, distribution and sale of drugs. It also includes provisions on formation and authorization of Myanmar Food and Drug Board of Authority. Narcotic Drugs and Psychotropic Substances Law (1993) - Related to control of drug abuse and describes measures to be taken against those breaking the law. Enacted to prevent danger of narcotic and psychotropic substances and to implement the provisions of United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. Prevention and Control of Communicable Diseases Law (1995) - Describes functions and responsibilities of health personnel and citizens in relation to prevention and control of communicable diseases. It also

safety, with the creation of the Institute for Monitoring Public Health, the French Agency for the Medical Safety of Food Products, and the French Agency for the Medical Safety of Health Products; 1999 Social Security Funding Act introduces payment of a penalty contribution by pharmaceutical companies, based on their turnover, in the event of pharmaceutical expenditure in excess of ceilings set. 1999 introduction of pharmacists rights to substitute generic for brand drugs; introduction of a reference to health care networks in the Social Security Code; clauses in the General Practitioners Agreement from 1998 concerning

describes measures to be taken in relation to environmental sanitation, reporting and control of outbreaks of epidemics and penalties for those failing to comply. The law also authorizes the Ministry of Health to issue rules and procedures when necessary with approval of the government. Eye Donation Law (1996) Enacted to give extensive treatment to persons suffering from eye diseases who may regain sight by corneal transplantation. Describes establishment of National Eye Bank Committee and its functions and duties, and measures to be taken in the process of donation and transplantation. Traditional Drug Law (1996)- Concerned with labeling, licensing and advertisement of traditional drugs to promote traditional medicine and drugs. It also

penalties in cases of failure to take account of RMOs are declared illegal (Decree of the Council of State of 10 November); announcement by CNAMTS of a policy plan for quality health care for all aimed at a substantial reduction of statutory health insurance costs: definition of a basket of care and adjustment of reimbursement rates in light of medical effectiveness; the government rejects these provisions, which were much disputed, but debate continues on the plans provisions and, in particular, on the basket of care; 2000 Social Security Funding Act: restriction of the areas of expenditure managed by CNAMTS, defining a allocated expenditure target covering treatment in private practice, excluding pharmaceutical costs; ONDAM

aims to enable public to consume genuine quality, safe and efficacious drugs. The law also deals with registration and control of traditional drugs and formation of Board of Authority and its functions. National Food Law (1997) Enacted to enable public to consume food of genuine quality, free from danger, to prevent public from consuming food that may cause danger or are injurious to health, to supervise production of controlled food systematically and to control and regulate the production, import, export, storage, distribution and sale of food systematically. The law also describes formation of Board of Authority and its functions and duties. Myanmar Medical Council Law (2000) Enacted to enable public to enjoy qualified and effective health care assistance, to maintain and upgrade the

growth rate set at 2.4 %. 2002 Act on Patients Rights and Quality of Care (4 March 2002): enhancement of the collective and individual rights of patients (including improved access to medical records), development of continuing education for health care professionals and evaluation of professional practices, compensation of patients for accidents occurring without any fault on the part of the health care professionals involved; 2003 the Ordinance for the simplification of hospital and other medical facilities planning merges in a single tool (the regional strategic plan) the strategic planning of hospital facilities and activities; previously, this was managed

qualification and standard of the health care assistance of medical practitioner, to enable studying and learning of the medical science of a high standard abreast of the times, to enable a continuous study of the development of the medical practitioners, to maintain and promote the dignity of the practitioners, to supervise the abiding and observing in conformity with the moral conduct and ethics of the medical practitioners. The law describes the formation, duties and powers of the Myanmar Medical Council and the rights of the members and that of executive committee, registration certificate of medical practitioners, medical practitioner license, duties and rights of registered medical practitioners and the medical practitioner license holders. Traditional Medicine Council aw (2000) Enacted to protect public health by

using several tools; the Ordinance also decentralizes almost all types of authorization for hospital activities, facilities and other medical equipment to the regional hospital agency; presentation of the Public Health Bill to parliament (to be passed in 2004); creation of the High Council for the future of health insurance to propose solutions for the modernization of health insurance; 2004 Social Security Funding Act details the implementation of payment per case for hospitals. Act of 9 August 2004 on the public health policy, which introduces five major fiveyear programmes and regional public health policy management. The five programmes for 2004-2008 are: The cancer plan, The plan to combat violence, abuse, risk behaviour and addictive behaviour, The plan to curb the impact of environmental factors on health, The plan to improve the quality of life of

applying any type of traditional medicine by the traditional medical practitioners. Blood and Blood Products Law (2003) - Enacted to ensure availability of safe blood and blood products by the public. Body Organ Donation Law (2004) -Enacted to enable saving the life of the person who is required to undergo body organ transplant by application of body organ transplant extensively, The Control of Smoking and Consumption of Tobacco Product Law (2006) Enacted to convince the public that smoking and consumption of tobacco product can adversely affect health, to make them refrain from the use, to protect the public by creating tobacco smoke free environment.

patients with chronic illnesses, The plan to improve treatment and care for patients with rare diseases. The 2012 Hospital Plan endowed with 10 billion euros is to enable the launching of new investments with three priorities: the strengthening of complementarity between hospitals located in one territory, the upgrading of security standards, and the computerization of the hospital system.

COMPARISON OF HEALTH CARE SYSTEM

FEATURE HEALTH INSURANCE COVERAGE

FRANCE ( PHI ) UNIVERSAL -the core of the system is PHI ( public health insurance) - originally based on occupational status, the program evolved to include every French citizen. -universal health insurance coverage was established on the basis of residence in France (99.9% coverage). -Mandated public plans, private supplementary plans (87% of pop. purchases) -Public and private providers, govt reimbursement, public plans -statutory health insurance system has three main schemes. The general scheme covers about 84% of the population (employees in commerce and industry and their families). The agricultural scheme covers farmers and their families (7.2% of the population). The scheme for self-employed people covers 5% of the population. 70 PERCENT -

MYANMAR

FINANCING

TAXES Portion of salaries proportional to income Low income population receive health care funded by the government -Payroll tax (13% of income from employer, 0.75% employee), income taxation (5.5%) -The PHI is financed by a combination of employer and employee contributions. -Employers pay equivalent of 13.1% of employee's salary to the national health insurance program. Employees pay 0.75% of salary. Income taxes also helps provide universal coverage for retirees, unemployed, disabled and the poor. Most people (87%) also have supplemental insurance from private for-profit insurers, which they purchase or is often paid for by an employer. -PHYSICIAN FINANCING

MIX OF PUBLIC AND PRIVATE SYSTEM - financed by government and private households -hospital trust funds -community cost-sharing system -social support is provided by medical social workers - financial support is provided by NGOs and other individual donors.

REIMBURSEMENT

GLOBAL BUDGET TO

CONSUMER OUT-OFPOCKET PRICE

-Mainly private fee for service, salaried in public hospitals -HOSPITAL FINANCING -Rates set by government -fee-for-service private practice for ambulatory care and public hospitals for acute institutional care, among which patients are free to navigate and be reimbursed under NHI. -Physicians in private practice (and in proprietary hospitals) are paid directly by patients on the basis of a national fee schedule. -Patients are then reimbursed by their local health insurance funds -Proprietary hospitals are reimbursed on a negotiated per diem basis (with supplementary fees for specific services) public hospitals (including private nonprofit hospitals working in partnership with them) are paid on the basis of annual global budgets negotiated every year between hospitals, regional agencies, and the Ministry of Health. POSITIVE -the co-payments for many

HOSPITALS; SALARIES AND CAPITATION PAYMENTS TO PHYSICIANS

POSITIVE BUT GENERALLY SMALL

PRODUCTION

PHYSICIAN CHOICE

services are relatively high. -About 87% of the population opts to pay for supplemental insurance premiums, which range from national to occupation-based plans. -patients are exempted from both when (1) expenditures exceed approximately $100, (2) hospital stays exceed 30 days, (3) patients suffer from serious, debilitating, or chronic illness, or (4) patient income is below a minimum ceiling, thereby qualifying them for free supplementary coverage. PRIVATE -France demonstrates that it is possible to achieve universal coverage without a single-payer system or the exclusion of private insurance. UNLIMITED -patients have free choice of physician. -patients have an extraordinary degree of choice among providers.

PUBLIC

RELATIVELY LIMITED

REFERENCES: http://www.itup.org/Reports/Fresh%20Thinking/France.pdf http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447687 http://itup.org/Reports/Fresh%20Thinking/International%20Table.pdf http://www.npr.org/news/specials/healthcare/healthcare_profiles.html http://www.who.int/bulletin/archives/78(6)770.pdf http://www.euro.who.int/document/e83126.pdf http://www.codebluenow.org/vital-signs/Health%20System%20Comparison%20Charts%205.30.2008.pdf http://www.moh.gov.mm/file/Myanmar%20Health%20Care%20System.pdf http://www.whomyanmar.org/LinkFiles/Health_in_Myanmar_2008_04_policyplan.pdf http://www.whomyanmar.org/EN/Section6_146.htm http://www.searo.who.int/EN/Section313/Section1522_10908.htm http://www.euro.who.int/document/e83126.pdf

RESEARCH PROJECT
(Comparative Analysis of Health Resources, Services and Policies of Two Countries)
Submitted to: Dr. Cuison Submitted by:

LUMBRES, JOHN PAUL B. MARTINEZ, TON EDRIC LO, RICHMOND ELEAZAR FELIX, JUSTIN ALEXIS NERI, MARTIN JAREN MERCADER, JUAN MIGUEL BSN II-3 MAY 11,2009