The Introduction of National Health Insurance (Universal Health Care) in Saint Lucia

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The Introduction of National Health
Insurance(Universal Health Care) in Saint Lucia
Prepared by Emma Hippolyte, Director, For ISSA
meeting - BVI July 2005
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• In March 2005, the Government of Saint Lucia
  appointed a Task Force to look into the
  feasibility of introducing the following social
  programmes in Saint Lucia
• National Health Insurance
• Unemployment Insurance
• Pension for Farmers

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• The Task Force reported to the Cabinet of
  Ministers on July 11, 2003.

4
Current status of health

• Limited control of secondary and tertiary care
  services
• Inequitable access to secondary and tertiary care
  services
• Poorly defined agreements and expectations with
  health professionals

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Current status of health (cont.)

• Poor communication and frustration between
  Ministry of Health and health providers and
  between providers and between staff and the
  general public
• Poor accountability, limited responsibility

6
Current Status of Health (cont.)

• Poor organization and coordination
• Pressure from new health infrastructure (to be
  constructed)
• Poor quality of health care delivered by some
  providers
• The call for improved quality of health care by
  the public.
• High migration of nurses

7
Methodology (process)

• The Task Force appointed eight (8) committees to
  assist in the process of preparing and
  implementing the UHC Programme. These include
• Registration Committee
• Human Resource Training and Development Committee
• Essential Package of Services Committee

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Methodology (process)(cont.)

• Quality Assurance Committee
• Health Information and Management Committee
• Legislation Committee
• Public Education and Marketing Committee
• Pharmacy and Therapeutics Committee

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Methodology (process)(cont.)

• The Cabinet of Ministers endorsed the report on
  August 11, 2003 and mandated the NIC to take
  steps to implement the programme.

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Methodology (process)(cont.)

• Prior to preparing the report the Task Force held
  discussions on the features of the programme with
  key stakeholders viz
• Nurses
• The Insurance Council
• The Trade Unions
• Employers Representatives
• The Pharmacy Council.

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Methodology (process)(cont.)

• The Task Force visited the Barbados Drug Service,
  NIS of Belize and the Antigua Medical Benefits
  Scheme.

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Communications/Public education

• During the period, November 2004 and February
  2005, a two (2) person team of Ms. Emma Hippolyte
  and Dr. Stephen King conducted discussions with
  communities around the island. To date the team
  has met with ten (10) communities.

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Communications/Public education (cont.)

• NIS Belize shared documents on their system.
• Dr. Figueroa of Belize visited Saint Lucia to
  share their experience.

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Communications/Public education (cont.)

• The public broadly expressed concern about the
  quality of care and the equity of care in the
  health delivery system. They wanted assurance
  that the UHC system would improve the quality of
  care.

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Communications/Public education (cont.)

• A web site www.stluciauhc.org which encourages
  persons to send emails with their opinion was
  established with the following features
• Welcome
• About UHC
• Reports

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Communications/Public education (cont.)

• FAQ
• Committees
• News
• Consultancies
• Job opportunities
• Forms
• Links
• Contact us

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The UHC product

• Hospital based services including inpatient and
  outpatient care, diagnostic services,
  pre-hospital and hospital emergency care and
  inpatient pharmacy services.
• Mental health services including substance abuse
  rehabilitation
• Outpatient pharmaceuticals
• Overseas care

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The UHC product (cont.)

• Community services (in the second phase)
• Local service development
• Limited package in all areas
• The joint purchasing of drugs and medical
  supplies by public and private providers
• Financing mechanism
• Flat tax health and environmental levy on
  imports (excluding food and clothing) to gross
  approximately XCD30m annually.

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Execution/Administration

• Four consultancies are in progress-
• Risk Management and Quality Assurance Assessment
• Human Resource
• Legislative Review
• Health Information and Management System (HIMS)

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Risk Management and Quality Assurance Assessment
Execution/Administration (cont.)

• Objective
• To assess the status of the five providers and to
  present a road map for international
  accreditation.
• To improve the quality of health service in the
  country.

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Human resource
Execution/Administration (cont.)

• The consulting firm of Odyssey Consulting was
  appointed in August 2004 to prepare a Human
  Resource and Training Strategic plan for the
  entire health sector.

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Legislative review
Execution/Administration (cont.)

• A legislative draftsman was appointed in October
  2004 to review existing legislation and to make
  recommendations.

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Health Information and Management System (HIMS)

• Determine the most cost effective design,
  implementation and support for an integrated
  system health information system that is capable
  of responding to the requirements of the health
  sector.

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THE CHALLENGES

• To ensure a seamless flow of information between
  primary care and secondary care
• The protection of data from unauthorised use
• The use of a single identification card or more
  than one card.

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Governance Providers

• The task force identified the rectification of
  the governance of Victoria Hospital as a crucial
  pre-requisite for improvement to quality care.

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Governance UHC

• Governance of UHC has been an issue of intense
  discussion.
• Propose an amended NIC Board.

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Governance UHC (cont.)

• The challenges that we are currently working on
  follows
• The amendments to the current NIC Structure to
  accommodate the UHC.
• Identifying the right skills set to get the job
  done.
• Socio Economic Impact Assessment now underway
  to be completed in June 2005.

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Governance UHC (Cont.)

• Implementing the change processes at the provider
  level.
• Managing public expectation they want immediate
  solutions.

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Other outputs/Outcomes

• Registration Committee
• A report on method of registration has been
  received from the Committee. This however has to
  fit into the work of the HIMS Committee.

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Other outputs/Outcomes (cont.)

• Essential Package of Services Committee
• The Committee has developed a Draft Essential
  Package of Services This was sent to the Saint
  Lucia Dental and Medical Association and the
  Nurses Association for their comments.
  Thereafter to the Insurance Council for their
  consideration and amendments of their private
  Health Insurance Plans.

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Other outputs/Outcomes (cont.)

• Pharmacy and Therapeutics Committee
• This Committee has developed a Drug formulary for
  the country. This will be circulated to the
  Saint Lucia Dental and Medical Association, the
  Saint Lucia Nurses Association and the Pharmacy
  Association.

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• The Work Continues
• Thank You