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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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