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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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the introduction of national health insurance universal health care in saint lucia

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

Prepared by:

Emma Hippolyte, Director,

For ISSA meeting - BVI

July 2005

slide2
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
current status of health
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
current status of health cont
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
current status of health cont1
CurrentStatus 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
methodology process
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
methodology process cont
Methodology (process)…(cont.)
  • Quality Assurance Committee
  • Health Information and Management Committee
  • Legislation Committee
  • Public Education and Marketing Committee
  • Pharmacy and Therapeutics Committee
methodology process cont1
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.
methodology process cont2
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.
methodology process cont3
Methodology (process)…(cont.)
  • The Task Force visited the Barbados Drug Service, NIS of Belize and the Antigua Medical Benefits Scheme.
communications public education
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.
communications public education cont
Communications/Public education (cont.)
  • NIS Belize shared documents on their system.
  • Dr. Figueroa of Belize visited Saint Lucia to share their experience.
communications public education cont1
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.

communications public education cont2
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
communications public education cont3
Communications/Public education (cont.)
  • FAQ
  • Committees
  • News
  • Consultancies
  • Job opportunities
  • Forms
  • Links
  • Contact us
the uhc product
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
the uhc product cont
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.
execution administration
Execution/Administration

Four consultancies are in progress:-

  • Risk Management and Quality Assurance Assessment
  • Human Resource
  • Legislative Review
  • Health Information and Management System (HIMS)
risk management and quality assurance assessment
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.
human resource
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.

legislative review
Legislative review

Execution/Administration (cont.)

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

slide23

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.

slide24

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.
governance providers
Governance: Providers

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

governance uhc
Governance – UHC

Governance of UHC has been an issue of intense discussion.

Propose an amended NIC Board.

governance uhc cont
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.
governance uhc cont1
Governance – UHC (Cont.)
  • Implementing the change processes at the provider level.
  • Managing public expectation – they want immediate solutions.
other outputs outcomes
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.

other outputs outcomes cont
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.

other outputs outcomes cont1
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.