The Introduction of The Introduction of National Health National Health
InsuranceInsurance(Universal Health (Universal Health
Care) Care) in in
Saint LuciaSaint Lucia
Prepared by:Emma Hippolyte, Director,
For ISSA meeting - BVIJuly 2005
In March 2005, the Government of Saint In March 2005, the Government of Saint Lucia appointed a Task Force to look into Lucia appointed a Task Force to look into the feasibility of introducing the following the feasibility of introducing the following social programmes in Saint Lucia:social programmes in Saint Lucia:
National Health InsuranceNational Health InsuranceUnemployment InsuranceUnemployment InsurancePension for FarmersPension for Farmers
The Task Force reported to the The Task Force reported to the Cabinet of Ministers on July 11, Cabinet of Ministers on July 11, 20032003..
Current status of healthCurrent status of health
Limited control of secondary and Limited control of secondary and tertiary care servicestertiary care services
Inequitable access to secondary and Inequitable access to secondary and tertiary care servicestertiary care services
Poorly defined agreements and Poorly defined agreements and expectations with health expectations with health professionalsprofessionals
Current status of health (cont.)
Poor communication and frustration Poor communication and frustration between Ministry of Health and between Ministry of Health and health providers and between health providers and between providers and between staff and the providers and between staff and the general publicgeneral public
Poor accountability, limited Poor accountability, limited responsibilityresponsibility
Poor organization and coordinationPoor organization and coordination Pressure from new health Pressure from new health
infrastructure (to be constructed)infrastructure (to be constructed) Poor quality of health care delivered Poor quality of health care delivered
by some providersby some providers The call for improved quality of The call for improved quality of
health care by the public.health care by the public. High migration of nursesHigh migration of nurses
Current Status of Health (cont.)
Methodology (process)Methodology (process)
The Task Force appointed eight (8) The Task Force appointed eight (8) committees to assist in the process of committees to assist in the process of preparing and implementing the preparing and implementing the UHC Programme. These include:UHC Programme. These include:
Registration CommitteeRegistration Committee Human Resource Training and Human Resource Training and
Development CommitteeDevelopment Committee Essential Package of Services Essential Package of Services
CommitteeCommittee
Quality Assurance CommitteeQuality Assurance Committee Health Information and Management Health Information and Management
CommitteeCommittee Legislation CommitteeLegislation Committee Public Education and Marketing Public Education and Marketing
CommitteeCommittee Pharmacy and Therapeutics Pharmacy and Therapeutics
CommitteeCommittee
Methodology (process)…(cont.)Methodology (process)…(cont.)
The Cabinet of Ministers endorsed the The Cabinet of Ministers endorsed the report on August 11, 2003 and mandated report on August 11, 2003 and mandated the NIC to take steps to implement the the NIC to take steps to implement the programme.programme.
Methodology (process)…(cont.)
Prior to preparing the report the Task Prior to preparing the report the Task Force held discussions on the Force held discussions on the features of the programme with key features of the programme with key stakeholders viz:stakeholders viz:
NursesNursesThe Insurance CouncilThe Insurance CouncilThe Trade UnionsThe Trade UnionsEmployers RepresentativesEmployers RepresentativesThe Pharmacy Council.The Pharmacy Council.
Methodology (process)…(cont.)
The Task Force visited the Barbados Drug The Task Force visited the Barbados Drug Service, NIS of Belize and the Antigua Service, NIS of Belize and the Antigua Medical Benefits Scheme.Medical Benefits Scheme.
Methodology (process)…(cont.)
Communications/Public educationCommunications/Public education
During the period, November 2004 During the period, November 2004 and February 2005, a two (2) person and February 2005, a two (2) person team of Ms. Emma Hippolyte and team of Ms. Emma Hippolyte and Dr. Stephen King conducted Dr. Stephen King conducted discussions with communities around discussions with communities around the island. To date the team has met the island. To date the team has met with ten (10) communities. with ten (10) communities.
NIS Belize shared documents on NIS Belize shared documents on their system. their system.
Dr. Figueroa of Belize visited Saint Dr. Figueroa of Belize visited Saint Lucia to share their experience.Lucia to share their experience.
Communications/Public education (cont.)Communications/Public education (cont.)
The public broadly expressed concern The public broadly expressed concern about the quality of care and the equity of about the quality of care and the equity of care in the health delivery system. They care in the health delivery system. They wanted assurance that the UHC system wanted assurance that the UHC system would improve the quality of care.would improve the quality of care.
Communications/Public education (cont.)Communications/Public education (cont.)
A web site A web site www.stluciauhc.orgwww.stluciauhc.org which which encourages persons to send emails encourages persons to send emails with their opinion was established with with their opinion was established with the following features:the following features:
WelcomeWelcomeAbout UHCAbout UHCReportsReports
Communications/Public education (cont.)Communications/Public education (cont.)
FAQFAQCommitteesCommitteesNewsNewsConsultanciesConsultanciesJob opportunitiesJob opportunitiesFormsFormsLinksLinksContact usContact us
Communications/Public education (cont.)Communications/Public education (cont.)
The UHC productThe UHC product
Hospital based services including inpatient Hospital based services including inpatient and outpatient care, diagnostic services, pre-and outpatient care, diagnostic services, pre-hospital and hospital emergency care and hospital and hospital emergency care and inpatient pharmacy services.inpatient pharmacy services.Mental health services including substance Mental health services including substance
abuse rehabilitationabuse rehabilitationOutpatient pharmaceuticalsOutpatient pharmaceuticalsOverseas careOverseas care
Community services (in the second phase)Community services (in the second phase) Local service developmentLocal service development Limited package in all areasLimited package in all areas The joint purchasing of drugs and medical supplies The joint purchasing of drugs and medical supplies
by public and private providersby public and private providers Financing mechanism:Financing mechanism:
Flat tax: health and environmental levy on Flat tax: health and environmental levy on imports (excluding food and clothing) to gross imports (excluding food and clothing) to gross approximately XCD30m annually.approximately XCD30m annually.
The UHC product (cont.)The UHC product (cont.)
Execution/AdministrationExecution/Administration
Four consultancies are in progress:-Four consultancies are in progress:-
Risk Management and Quality Risk Management and Quality Assurance AssessmentAssurance Assessment
Human ResourceHuman Resource Legislative ReviewLegislative Review Health Information and Management Health Information and Management
System (HIMS)System (HIMS)
Risk Management and Quality Assurance Assessment
Objective:Objective: To assess the status of the five To assess the status of the five
providers and to present a road map providers and to present a road map for international accreditation.for international accreditation.
To improve the quality of health To improve the quality of health service in the country.service in the country.
Execution/AdministrationExecution/Administration (cont.) (cont.)
Human resourceHuman resource
The consulting firm of Odyssey The consulting firm of Odyssey Consulting was appointed in August Consulting was appointed in August 2004 to prepare a Human Resource 2004 to prepare a Human Resource and Training Strategic plan for the and Training Strategic plan for the entire health sector.entire health sector.
Execution/AdministrationExecution/Administration (cont.) (cont.)
Legislative reviewLegislative review
A legislative draftsman was appointed A legislative draftsman was appointed in October 2004 to review existing in October 2004 to review existing legislation and to make legislation and to make recommendations.recommendations.
Execution/AdministrationExecution/Administration (cont.) (cont.)
Determine the most cost effective Determine the most cost effective design, implementation and support for design, implementation and support for an integrated system health an integrated system health information system that is capable of information system that is capable of responding to the requirements of the responding to the requirements of the health sector. health sector.
Health Information and Health Information and Management System (HIMS)Management System (HIMS)
To ensure a seamless flow of information To ensure a seamless flow of information between primary care and secondary carebetween primary care and secondary care
The protection of data from unauthorised The protection of data from unauthorised useuse
The use of a single identification card or The use of a single identification card or more than one card.more than one card.
THE CHALLENGESTHE CHALLENGES
Governance: ProvidersGovernance: Providers
The task force identified the The task force identified the rectification of the governance of rectification of the governance of Victoria Hospital as a crucial pre-Victoria Hospital as a crucial pre-requisite for improvement to quality requisite for improvement to quality care.care.
Governance – UHCGovernance – UHC
Governance of UHC has been an issue of Governance of UHC has been an issue of intense discussion.intense discussion.
Propose an amended NIC Board.Propose an amended NIC Board.
The challenges that we are currently The challenges that we are currently working on follows:working on follows:
The amendments to the current NIC The amendments to the current NIC Structure to accommodate the UHC.Structure to accommodate the UHC.Identifying the right skills set to get the Identifying the right skills set to get the job done.job done.Socio Economic Impact Assessment Socio Economic Impact Assessment now underway – to be completed in June now underway – to be completed in June 2005.2005.
Governance – UHC (cont.)Governance – UHC (cont.)
Implementing the change Implementing the change processes at the provider level.processes at the provider level.
Managing public expectation – Managing public expectation – they want immediate solutions.they want immediate solutions.
Governance – UHC (Cont.)Governance – UHC (Cont.)
Other outputs/OutcomesOther outputs/Outcomes
Registration Committee:Registration Committee:
A report on method of registration has been A report on method of registration has been received from the Committee. This received from the Committee. This however has to fit into the work of the however has to fit into the work of the HIMS Committee.HIMS Committee.
Essential Package of Services Committee:Essential Package of Services Committee:The Committee has developed a Draft The Committee has developed a Draft Essential Package of Services – This was Essential Package of Services – This was sent to the Saint Lucia Dental and Medical sent to the Saint Lucia Dental and Medical Association and the Nurses Association for Association and the Nurses Association for their comments. Thereafter to the Insurance their comments. Thereafter to the Insurance Council for their consideration and Council for their consideration and amendments of their private Health amendments of their private Health Insurance Plans.Insurance Plans.
Other outputs/Outcomes (cont.)Other outputs/Outcomes (cont.)
Pharmacy and Therapeutics CommitteePharmacy and Therapeutics Committee
This Committee has developed a Drug This Committee has developed a Drug formulary for the country. This will be formulary for the country. This will be circulated to the Saint Lucia Dental and circulated to the Saint Lucia Dental and Medical Association, the Saint Lucia Medical Association, the Saint Lucia Nurses Association and the Pharmacy Nurses Association and the Pharmacy Association.Association.
Other outputs/Outcomes (cont.)Other outputs/Outcomes (cont.)
The Work Continues…The Work Continues…
Thank YouThank You
