Towards a national health insurance system in ... - Detlef Schwefel

Towards a national health insurance system in Yemen – Part 1: Background and assessments 43
Table 20
Estimated total official cost-sharing for selected common medical treatments
Health problem/treatment benefits No. A l-Thawra Sana’a Al Jumhuri Sana’a
Total 88,000
Acute Appendicitis
Simple Appendectomy
Hospital daily allowance in surgery public / private
1
3
40,000
12,000
Total 52,000
25,000/30,000 24
24,000
Uncomplicated delivery
Birth cephalic presentation, episiotomy and joint 1 15,000
5,000 25
Ultrasound
1
1,000
1,200
Immediate attention of the newborn
Hospital daily allowance obstetrics public
1
3
1,000
12,000
2,000
24,000
Total 29,000
32,200
Coronary heart disease
Coronary artery bypass grafts
Hospital daily allowance coronary unit (CU)
Hospital daily allowance medicine
Rx thorax ap and lateral (2 exp.)
Sessions of integral physiological treatment (CU)
Sessions of cardio-respiratory training
Transfusion in operating theatre
Total
1
4
10
1
4
10
2
Ø
Ø
Diaphysiarian o metaphysiarian osteosynthesis
Hospital daily allowance surgery public / private
Sessions of ergometric training
Sessions of motoric re-education
Removal of osteo-synthesis material
Hospital daily allowance surgery public / private
1
10
15
20
1
2
140,00
40,000
15,000 27
20,000
20,000
4,000
100,000
80,000
30,000
40,000
40,000
16,000
Total 239,000 306,000
Sources: Own calculations on the basis of available pricelists (Al-Thawra Hospital 2005, Al-Jumhuri Hospital
2005, Al Saeed Specialised Hospital Taiz 2005) and additional information from providers
With regard to cost-sharing, it is not even clear if all such revenues are declared properly and not
considered to be informal and under-the-table payments for the private use of the staff in public
facilities. This is extremely difficult to investigate because official user fees ar e regularly topped up by
unofficial extra money claimed by health workers for a big array of services and treatments. The
implementation of cost-sharing in public health care facilities has pushed wide open the door of
commercialisation of health care and induced a generalised culture of cash in. For instance, physicians
use to demand one third or even half of the official user fee as extra payment in order to deliver a
certain medical service, nurses and midwives are a little bit more modest but also ask for extra
payment.
0 26
24 Al-Hureiba: 25, 000; German-Yemeni Hospital: 30,000 YR
25 Fee applied in Al-Saba’in Hospital.
26 Operation fee 120,000 plus 20,000 for osteosynthetic material (plate).
27 Physiotherapy not included, has to be hired outside the hospital; estimation 1,000 YR per treatment