A right step towards inclusive health

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The inclusion in the fund of clinical conditions like Parkinson and Alzhaimer, normally neglected, is really encouraging.

A special fund worth 50 million NRS will be created within the Department of Health Services and a list of hospitals all over the country have been included for the treatment of people eligible under the fund.

This can be a real breakthrough but a lot will depend on how the fund will be rolled out and administered. Theoretically a wide range of hospitals will be involved but the “devil” will be in the details of implementation. The directive mentions the establishment of a committee that will be in charge of deciding who can get what. This aspect is worrisome.

Moreover it is not clear if the committee will be established only at central or also at district level. 

The discretionality it will maintain while deciding about the financial disbursement for each single patient is also a matter of concern.

Ideally once criteria are set nationwide or regionally (considering the great socio-economic disparities among different region of the country), the health providers should be in a position to decide on eligibility and therefore reject the request with full justification or offer the prescribed services.

This would imply a sort of reimbursement system based on a national database that can register and take into account the fund’s spending patterns and the percentage per conditions. Moreover clear timing should be set in order to speed up and mainstream the process.

The directive needs to be reinforced with a stronger management and oversight structure. Hard to imagine how the fund will work if the case by case decision making is centralized.

The arrival of national ID Card or similar provisions to better identify those living below the line are also indispensible requisites to make this fund a successful partial milestone towards an integrated health system.

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