How To Improve Health Care In Turkies And Caicos Islands

Transcription

1 THE NATIONAL HEALTH INSURANCE PLAN TURKS & CAICOS ISLANDS Presented by Zaneta Burton

2 QUICK FACTS TURKS & CAICOS Total Population approx. 30,000 Turks & Caicos Islanders 34% of total Population Expatriate Population 66% of total Population The Turks and Caicos Labor Force: 12,000 Persons Physical Facts : 40 Islands 2.5 times the size of Washington DC 230 miles of Beaches Front Third largest coral reef system in the world

3 THE TURKS & CAICOS ISLANDS

4 TURKS & CAICOS ISLANDS HEALTHCARE SYSTEM Ministry of Health NHIB Preferred Provider Interhealth Canada Private Sector & Int l Donors Contract Providers TCI and Int l

5 OBJECTIVE & SCOPE OF NHIP Comprehensive benefits package through a strict Preferred Provider network. Domestically, the Preferred Provider is Interhealth Canada All services offered by Interhealth Canada are available to NHIP beneficiaries, for a $10 copayment (co-payments for a single event or chronic condition are capped at 5 per year). The prescription drug formulary includes approximately 1,000 drugs. NHIB reimburses 50% of the cost of drugs, up to a maximum out-of-pocket of $25. Beneficiaries may choose to utilize the services of a private doctor, NHIB pays a $35 indemnity per medically necessary visit. In the event that Interhealth Canada cannot manage a condition domestically, the beneficiary is referred to NHIB for Overseas Treatment. NHIP coverage does not extend to medical events incurred outside of Turks and Caicos Islands (all overseas treatment must be referred by the Preferred Provider and approved by NHIB)

6 SCOPE OF NHIP FUNDING Total Members 28,179 Contributors 17,795 Dependents 10,384 Total Contributions collected $19.6 million Employer/Employee share 5.0% (Qualifying Compensations Up To $7,800 per month) Self-employed pay $250/month (no income disclosure), or $150 or $50 with income disclosure Pensioners pay 2.5% of pension benefits exceeding $2,000/month TCIG fund Overseas Treatment Aboard Programme - $12 mil Transfer of Employment Injury reserves from NIB- $612,000 TCIG pays actuarial transfers to cover wards of the State

7 OPERATIONAL RESULTS SUCCESSES Improvement in the Healthcare Facilities Improved diagnostic capabilities Entire insured population have access to affordable quality health care More health services offered locally Oncology coming soon Decreased need to send overseas for minor treatment NHIP has successfully reduced the treatment abroad cost from $36 million for 10,000 Turks & Caicos Islanders in 2008 to just over $9 million for over 30,000 beneficiaries.

8 NEW DEVELOPMENTS

9 OPERATIONAL RESULTS- SETBACKS High cost of Health Care Total annual cost of health care of TCI is approximately $61.5 million, broken down as follows: Infrastructure Costs $20 million is paid to Interhealth Canada Limited (ICL) for infrastructure and equipment Clinical costs $24 million is paid to ICL for Clinical Services. This represents the operational costs of the hospitals, and includes $3.4 million in electricity costs $12 million paid to NHIP for Overseas Treatment Costs, Wards of the State, pharmaceutical program and payments to local private primary care practitioners. $5.5 million spent on the Government Primary Health Care programs, including emergency services, and services for mental health and long-term care.

10 OPERATIONAL RESULTS- SETBACKS NHIB Revenue fiscal Year 2010/11 - $32 Million Contribution Collected $19 million $13million from the TCIG NHIB Expenditure fiscal year 2010/11-$36 Million Payments to ICL accounted for some $24 million or 63.1% of NHIP expenditure. Overseas Medical Expenses accounted for $9,040 million or 23.3% of NHIP expenditure.,pharmacy/ Local practitioners $3 million) This combined amount represents 87.4% of the total NHIB expenditure. NHIB Experience a shortfall of $4 million The financial situation is exacerbated by the increased number of Wards of the State, those individuals who are unemployed, on long term disability, prisoners or pensioners. This is a direct reflection of the depressed economy. Decreasing population

11 OPERATIONAL RESULTS- SETBACKS Health Challenge Public Discussion Paper Between the two funding sources (NHIP and TCIG), there are currently insufficient funds to fund the delivery of health care as mandated by NHIP benefits regulations, TCIG/ICL Hospital contract obligations and Primary Health Care and Public Health needs. Inadequate funding of Primary Health Care to implement effective health promotion and disease prevention and control programmes which should reduce morbidity and mortality and thus a concomitant reduction in expenditure on secondary and tertiary care services in the medium and long term. Possible ineffective drug procurement and distribution programme that may be too costly to the purchaser and the end user alike. This is an area that requires careful assessment and review by an independent team with expertise in this area. A continued requirement for secondary and tertiary health care services relative to our ability to afford them. These costs can be difficult to plan for completely. High cost for medical treatment overseas continues to threaten the sustainability of the programme due to an open door, no limit policy as required by current legislation

12 OPERATIONAL RESULTS- SETBACKS Poor health information systems which resulted in inadequate data and information for effective evidence based decision making. Development of the new hospitals and establishment of the National Health Insurance Board with high end information technology services in 2010 helped to address some of the information gap challenges, but major challenges still remain. Complete and unrestricted funding of healthcare for Migrant workers due to Lack of Migrant health policy Unlimited funding and duration thereof for medical care overseas for persons who are not permanently resident in the TCI Unlimited funding of dependents regardless of the number of dependents

13 STRATEGIC PLANS TO ADDRESS CHALLENGES Reduce Cost Review of the ICL contract by both ICL and the TCIG to see if there is any room to modify or renegotiate the contract to reflect the current economic situation. The goal would be to reduce the cost of clinical services provided by adjusting the clinical cost formula. There could also be a cap on the provision of primary care services from the hospital. This will reduce the cost of providing primary care in a hospital setting under a contract. Reduce the range of services that are funded by NHIP/TCIG. Limit the range of people whose care is fully funded by the state. Under the existing Legislative frame work, migrant workers can register one day and receive coverage the same day. These individuals may only be resident in the TCI for relatively short periods of time, and in the case of the domestic workers, and laborers, are only making minimal payments for coverage of themselves and their dependents. A two tier policy differentiating long term residents and short term residents with different benefit packages might be an option. Cap or limit NHIP benefits. The NHIP regulations already outline which services are offered to its members on a limited basis or totally excluded. However, one of the greatest risks to the sustainability of the NHIP fund is the open ended and unlimited nature of its treatment abroad policy. Medical treatment overseas is available to all members without a cap, deductible, or duration.

14 STRATEGIC PLANS TO ADDRESS CHALLENGES NHIB could fund the delivery of TCIG primary health care programmes by several methods: Support the current TCIG clinics by adequately funding the operational cost i.e. staff, supplies, infrastructure up-keep. Paying TCIG for services provided to NHIP beneficiaries and TCIG continue to fund primary health care, Support private sectors primary care providers by increasing the funding of private sector delivery of primary care services from $35 per visit based on actuarial assessment. The NHIP should consider developing a drug programme. A system should be developed whereby there is more robust competitive tendering and the NHIP pays for the provision of drugs to all its beneficiaries through all participating pharmacies, including those that may be operated by NHIP. The pharmaceutical procurement process is fragmented and we may not be getting value for money as we are not maximizing on benefits of competitive tendering and bulk procurement. A central clearing/ordering agency controlled by TCIG/NHIP might allow for bulk ordering.

15 STRATEGIC PLANS TO ADDRESS CHALLENGES Increase Revenue All beneficiaries contribute to the plan. Currently only those who are employed contribute. There are approximately 11,000 dependents being supported by 15,000 (???) contributors Increase the contribution rate to a higher percentage. Establish a minimum contribution rate of $25 per month. Increase co-payments for services provided. Allow voluntary contributions by long-term residents currently not eligible, retired person and winter visitors. These could be for a full benefits package or a local treatment only package. Apply sin tax to tobacco, alcohol and high sugar content products which is specifically allocated to the healthcare budget. Increase revenue by encouraging health tourism. Immigration Introduce an immigration migration policy. This should be restricted only to first world countries and other Overseas Territories. This would increase the tax base and lessen the burden on the small population. There are social and cultural issues associated with

16 THANK YOU