Technical Brief: Strategic Purchasing Approaches for the Tuberculosis Hospital System in Ukraine

Resource Type: Technical Brief
Authors: Olga Zues, Alexandr Katsaga, Sara Feinstein, Barton Smith, and Sarah Dominis
Published: September 2018

Resource Description:

The Health Finance and Governance Project (HFG), funded by the United States Agency for International Development-funded (USAID), worked closely with national and regional partners to develop strategic purchasing approaches for TB hospitals in the country and introduce operating systems for strategic purchasing for TB hospitals. The key operating systems include a cost accounting system; discharged patient system; hospital performance monitoring system; and simulation module for hospital optimization.

HFG developed online tools for each system and provided training and mentoring to participating health departments and hospital staff on using each system. In sum, all 28 TB hospitals across HFG’s pilot regions of Poltava oblast, Odesa oblast, Lviv oblast, and Kyiv City completed a cost accounting analysis for 2015–16. Each participating hospital uploaded discharged patient data for every patient hospitalized since 2015, totaling over 34,000 cases to date.
Using data from both the cost accounting and discharged patient systems, HFG worked in concert with country partners to develop a Hospital Performance Monitoring System to analyze TB hospital performance, with the objective of supporting TB decision-makers in making evidence-based decisions on TB hospital optimization. The system provides data analysis across three blocks: oblast/city level; TB hospital level; and cross-regional level. Health departments and hospitals use it to see information across nine types of indicators, including hospitalization structure by International Classification of Disease (ICD)-10 diagnosis; average length of stay (ALOS); admission structure by diagnostic method and drug sensitivity category; cost by type of case; and provider productivity. HFG also designed a simulation module for TB hospital optimization to enable health departments and hospitals to model changes in types of patients, length of stay, or other variables, and see the resulting impact on bed use and cost.

HFG also contributed to the policy dialogue and case-based system design to support introduction of the new payment systems for TB hospitals on the national level. The systems will be piloted beginning in 2019.
As HFG comes to a close, the four operational systems are institutionalized in the four pilot regions and the framework is in place to support national rollout. Continued support by regional, country, and international stakeholders for strategic purchasing will be key to improving resource use and achieving substantive improvements in TB outcomes moving forward.

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