NATIONAL HEALTH INSURANCEBELIZE

Caribbean Conference on Health Financing Initiatives

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Initiatives

BERMUDA, 22nd to 24th November, 2011

OUTLINE

• PRESENT COVERAGE

• CHALLENGES

• CHANGES MADE

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• CHANGES MADE

• OTHER ACHIEVEMENTS

• FUTURE DIRECTION

PRESENT COVERAGE�Population Covered:

�South Side Belize District: 46,755 Registered members.

�Southern Region: 46,932 Registered members

�Network of 9 Primary Care Provider clinics

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�Network of 9 Primary Care Provider clinics (includes specialized PCP elderly), a list of approved pharmacy , laboratory and diagnostic centers, hospitals (Southern Region) and ophthalmology providers;

�Nutrition Program in the Southern Region

CHALLENGES

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Challenges

Problem Policy Options Proposal

1. Introduce adjustments to contract such as benchmarks, which are

evidence based; weights will be higher for those benchmarks

relating to pharmacy and laboratory referrals. Analysis of patient

loads by PCP will also be done to see distribution of Chronic

patients; random sample of files will be reviewed to assess

prescription practices. All pharmacy and laboratory items will be

reviewed for price changes. No pharmacy outlets allowed. Co-

payments to be re-instituted

Skyrocketing

expenditures of

pharmaceuticals

and labs

1.Adjustments to contracts

in terms of benchmarks

(reduce pharmacy and lab,

increase weights, review

prices, etc)

2.Reduction in participating

outlets.

3. Introduce Protocols for

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payments to be re-instituted

2. Redistribution of pharmacies per PCP based on geographic

location; inclusion of MOH pharmacy and tendering for additional

pharmacy to cover BHP; Mercy clinic will be advertised for support

service provision as well. Contracts will only be signed up to June

of 2011 so that all these can be put in place by then.

3. Introduce Protocols for

ARI and UTI.

4. Medical record audits.

5. Locking of pharmacies

6. Capping of Laboratory

Expenditures

7. Inclusion of MOH with

lower prices.

$3.30

$4.26

$3.00

$4.00

$5.00

$6.00

Lab PMPM

pharmacy

Trend in Per Member Per Month Expenditure, 2006 to 2010, South Side area Belize City, based on total Registered Members (Bze $)

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$1.02 $1.06 $1.22

$1.96

$3.30

$1.62 $1.92

$2.15

$2.63

$0.00

$1.00

$2.00

$3.00

2006 2007 2008 2009 2010

pharmacy PMPM

PCPS54%

Imaging 9%

Laboratory11%

Ophthalmology0%

Hospitals7%

Southside payments for Providers & Services 2008

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54%

Pharmacy19%

Southside Payments

0%

PCPS49%Imaging

8%

Laboratory15%

Ophthalmology1%

Hospitals6%

Southside payment for Providers & Services 2009

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Pharmacy21%

BMA

MRHC

BHP

LIMITATION ON THIS:

PATIENTS FIXED TO SPECIFIC

PHARMACIES TO HAVE

PRESCRIPTIONS DISPENSED AND MAY

CAUSE PUBLIC BACKLASH

TENDERING FOR TWO “NEW”

PHARMACY PROVIDERS

MOH PHARMACY CAN BE WITHIN

Brodies

CDS

MOH

1st Choice

PROPOSAL FOR CONFIGURATION

Pharmacy PCP

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BHP

BFLA

MERCY

CLINIC

MOH PHARMACY CAN BE WITHIN

PCP; PRICES will BE LOWER SINCE

PURCHASING COST IS MUCH LOWER.goodcare

BHPBMA

MOH

ACHIEVEMENTS

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KPIs Belize City PCPs 2010

Indicators

Target Bonus BFLA 2009 BFLA 2010 BMA 2009BMA 2010

BHP 2009

BHP 2010MRPC 2009

MRPC 2010

At least 90 percent of the GPs and nurses have received training on protocols in the last year (Chronic Disease Management Protocols)

90% 5% 5% 5% 5% 5% 5% 5% 5% 5%

Percentage of clinical records with incorporated forms and complete information

85% 15% 15% 0% 15% 15% 15% 15% 15% 15%

System for suggestions/complaints in place Yes 5% 5% 5% 5% 5% 5% 5% 5% 5%

ACHIEVEMENTS

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System for suggestions/complaints in place Yes 5% 5% 5% 5% 5% 5% 5% 5% 5%

Percentage of complaints resolved within 2 weeks 80% 5% 5% 5% 5% 5% 5% 5% 5% 5%

At least 90 percent of PCP patients expressed full satisfaction with regard to services received from the PCP

90% 15% 15% 0% 15% 0% 15% 0% 15% 0%

Percentage of women aged 19-64 who had a Pap smear test in the last two years

50% 10% 0% 0% 0% 10% 0% 0% 0% 5%

Percentage of pregnant women with 1 prenatal care visits during the first trimester

50% 10% 0% 0% 0% 10% 10% 10% 10% 10%

Percentage of high-risk pregnancy cases with at least 7 prenatal care visits during their pregnancy period

80% 10% 10% 10% 10% 10% 10% 10% 10% 10%

Percentage of men ages over 50yrs of age who had PSA test a during the last 2 years

50% 10% 10% 10% 10% 10% 10% 10% 10% 5%

Compliance with Medical Protocols implementation (Diabetes, Hypertension and Asthma) 80% 15% 15% 0% 15% 0% 0% 0% 15% 15%

TOTAL SCORE 100% 80% 35% 80% 70% 75% 60% 90% 75%

KPIs BFLA BMA BHP MRHC

50% of Women aged 19-64 who

had a Pap Smear Test done in the

last two years

1242/3049

40.73%

1465/3496

41.7%

765/2950

25.73%

961/3201

30%

50% of all pregnant women who

had first booking for prenatal care 100/197 76/124 112/155 88/130

KPI RESULTS SOUTH SIDE TO JUNE 2011

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during the first trimester of

gestation

100/197

50.76%

76/124

61.29%

112/155

72.25%

88/130

67.69%

80% of all high-risk deliveries

who had at least 7 prenatal

care visits during their

pregnancy period

61/ 90

67.7%

20/21

95.23%

20/33

60.60%

21/25

84%

50% of all men ages over 50yrs of

age who had PSA Test done in

the last two years

232/424

54.77%

392/772

50%

414/543

76%

306/765

40%

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OTHER

• FACILITY EVALUATION EVERY 6 MONTHS

• CHANGE IN APPROACH TO MEDICAL AUDITS FOR CHRONIC DISEASES

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AUDITS FOR CHRONIC DISEASES

• PHARMACY AUDITS

• FINALIZE THE OBSTETRIC PROTOCOLS.

• AUDIT OF OBSTETRIC PROTOCOLS

BUILDING BLOCKS

Compliance with Medical Protocols implementation

(Diabetes, Hypertension and Asthma)80%

15% Protocol Audits by NHI

Block 1: Standardization and

KPI

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Block 1: Standardization and

Organization of Medical Records

Block 2: Proper Classification

of and Treatment of DM,HTN,

Asthma

Block 3: Evidence of Control of NCD

Implementation and monitoring of Action

Plan of NCD

Block 4: Determination of Target Organ

Damage and proper Action /Intervention

SCHEDULE OF AUDITS

• Phase 1: June to December 2011

– BLOCK 1 & 2

• Phase 2: Jan 2012- December 2012

– BLOCK 3&4

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– BLOCK 3&4

• Phase 3: December 2013

– Complete Annual Audit

FUTURE PLANS

• APPLY CAP TO PHARMACY AND IMAGING SERVICES

• GERIATRIC SPECIALTY TO UPGRADE

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• GERIATRIC SPECIALTY TO UPGRADE STANDARDS OF MERCY CLINIC.

• Advocacy for Extension of coverage and financing of Scheme.

THANK YOU

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