Universal Health Insurance: Tuberculosis

Dr. David Chavarri Venegas Technical Officer

ESN PCT Sao Paulo April 29, 2013

Content:

• Indicators of tuberculosis in Peru

• Legal framework of Universal Health Insurance

• Financial coverage of TB

• Challenges

Tuberculosis in Perú 2012

• Population: 30’135,875 hab.

• Population density: 23 hab. x km2

• Three geographic regions

• 25 political regions

• Growth PBI 2011: 6,7%

• World Bank: Medium High income

• Poverty: 27,8%

• 5th place americas impact on region.

• 1st place MDR TB on the Americas

• Morbidity TB: 32,145

• New cases TB: 28,217

• New cases TBpFP: 17,870

• Lima and Callao: 51% cases TB sensibity, 77% MDR TB and 89% XDR TB

Equator Colombia

Brazil

Bo

livia

Pacific Ocean

LORETO

128.1

UCAYALI 148.0

PUNO

26.7

CUSCO

46.1

JUNIN

54.0

AREQUIPA

56.0

MADRE DE DIOS

154.3

LIMA

120.0

PIURA

25.9

ICA

87.4

ANCASH

68.4

AYACUCHO

32.3

SAN MARTIN

71.3

PASCO

31.3

HUANUCO

51.8

AMAZONAS

32.3

CAJAMARCA

7.9

TACNA

128.6

LA LIBERTAD

63.6

APURIMAC

19.3

HUANCAVELICA

18.4

MOQUEGUA

80.6

LAMBAYEQUE

53.0

TUMBES

49.5

CALLAO

113.9

TASA DE INCIDENCIA

POR CUARTILES

DEPARTAMENTOS MINSA 2012

7.9 - 32.3

32.4 - 63.6

63.7 - 87.4

87.5 - 154.3

Trends in the form of TB according to resistance-

Peru 1990 - 2012

Operational inform MINSA/ others institutions Date: March 18, 2013 / AMHE/JECC

198.1

106.7

1

84

44

1,216

0

200

400

600

800

1,000

1,200

1,400

0.0

50.0

100.0

150.0

200.0

250.0

300.0

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

N M

DR

TB

ca

ses

TB m

orb

idit

y /

N X

DR

TB

cas

es

Años

Tasa de Morbilidad XDR MDR

Legal framework of Universal Health Insurance

BUDGETING FOR RESULTS

Ministerial Resolution Nº 178-2011/MINSA

Operational Definitions and Criteria of Programming: 11

Sub Products

Law Nº 29344: Framework Law of Universal Health Insurance (UHI) - 2009

Article 3º: The universal health insurance is a process to ensure that all persons residing in the national territory provided health insurance that allows you to access a range of health benefits of preventive, promotional, recuperative and rehabilitation, under proper conditions efficiency, equity, timeliness, quality and dignity, on the basis of Universal Insurance Essential Plan (PEAS)

Subsidized:

SIS, INPE

Semi contributory:

SIS, FFAA, PNP

Contributory: EsSalud, EPS, SISOL, Others

P E A S

T B

UHI

Plan Health Insurance Essential and Tuberculosis

2. Pulmonary tuberculosis, A15.0, A15.7, A15.9, A16.0. 3. Extrapulmonary tuberculosis: A15.6, A16.3, A16.4, A16.5, A16.8, A17, A18, A19, I32.0, K67.3. 4. Tuberculosis with Complications, J47, J93. 5. MDR TB, A15.8

Total Population has some kind of Insurance, 2005 al 2011

Insurance types

Public Providers*

Ministries/Local Governments

Entities % of the total notified % total cases

Ministry of Health/Local Governments

DISAS , DIRESAS,GERESAS, Hospitales.

26,800 81.95

Ministry of Labor Social Insurance 5,056 15.46

Ministry of Interior Police Insurance 60 0.18

Ministry of Defense Military Insurance 4 0.01

Ministry of Justice Correctional System 780 2.39

Municipality OTHERS (Municipalities, public

hospitals, other public insurance) 3 0.01

Total cases 32,703 100%

Institutions that notify TB cases - 2011

Operational Inform ESNPCT, years 2009-2011

Financial Coverage of TB

INSTITUTIONAL DEVELOPMENT OPENING BUDGET (PIA) TUBERCULOSIS

PRODUCTS ONLY FINANCIAL YEAR 2011-2013. PERÚ

64,016,110

88,556,36292,151,997

0.00

50,000,000.00

100,000,000.00

150,000,000.00

200,000,000.00

250,000,000.00

2011 2012 2013

PIA

100,000,000

50,000,000

$

Fuente: Power Play del 18-10-12/MEF

4%

BUDGETING FOR RESULTS

Fuente: Consulta Amigable_MEF: 15.01.2013

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

PIM2011GOBIERNONACIONAL

PIM2011GOBIERNOREGIONAL

PIM2012GOBIERNONACIONAL

PIM2012GOBIERNOREGIONAL

3043965 PERSONA QUE ACCEDE AL EESS Y RECIBETRATAMIENTO OPORTUNO PARA TUBERCULOSISESQUEMAS 1, 2, NO MULTIDROGO RESISTENTE Y

MULTIDROGO RESISTENTE

19,197,911 12,533,394 18,999,162 20,179,659

3043964 DIAGNOSTICO DE CASOS DE TUBERCULOSIS 13,809,671 12,668,833 23,404,862 40,558,928

3043972 PERSONA QUE ACCEDE AL EESS Y RECIBETRATAMIENTO OPORTUNO PARA TUBERCULOSIS

EXTREMADAMENTE DROGO RESISTENTE (XDR)1,051,039 2,203,538 9,023,178 4,288,989

3043962 DESPISTAJE DE TUBERCULOSIS ENSINTOMATICOS RESPIRATORIOS

2,117,952 13,393,072 15,474,265 18,111,323

$

827,325

7,882,679 7,421,548 4,895,857

1,675,386 3,524,679 860,757 410,562

15,843,331 9,142,524 4,948,763 5,394,403

7,074,736 6,044,635 5,231,669

40,000,000 30,000,000 20,000,000 10,000,000

BUDGET ALLOCATED FOR SCREENING, DIAGNOSIS AND TREATMENT NATIONWIDE

(2011-2012)

BUDGETING FOR RESULTS

Increase 409%

Increase 109%

7,499,184

Person accessing the health facility and receive prompt treatment for tuberculosis schemes 1 and 2, no multidrug-resistant and multidrug-resistant

TB screening for respiratory symptomatic

Person accessing the health facility and receive prompt treatment for extremely druggie resistant tuberculosis (XDR)

Diagnosis of tuberculosis cases

Sensitive TB MDR TB XDR TB

Characteristics Duration of treatment

6 months 18 - 24 months 24 months or +

Cost 40 USD 4000 USD 70000 USD

Costs of anti-tuberculosis treatment

Oficio Circular N° 008-2012-

SIS/J (18.04.2012) SIS y TB:

Official Circular N° 008-2012-SIS/J (April 18, 2012)

I. Tuberculosis in any of its forms is funded clinics Integrated Health System (SIS), for all our insureds of the scheme / subsidized component in both pilot areas Universal Health Insurance (AUS), as in areas governed by Supreme Decree No. 004-2007-SIS.

II. In patients diagnosed with tuberculosis, the only features that are not funded through the SIS, are those that already have other funding

sources, such as the following features that are funded by the National Health Strategy for Prevention and Tuberculosis Control:

Detection of respiratory symptomatic

Diagnosis: Diagnostic Tests, bacilloscopies, crop and sensitivity test. Treatment: Medication management and strategic anti tuberculosis drugs.

Politic commitment: local and sectoral budget: Alliance "Lima breathes life together against tuberculosis”,

September 11, 2011

• Ministry of Health • Ministry of Housing, Construction

and Sanitation • Ministry of Development and

Social Inclusion • Ministry of Women and

Vulnerable Populations • Ministry of Education • Ministry of Labor and

Employment Promotion • Production Ministry. • Metropolitan Municipality of Lima • Municipality of La Victoria • Municipality of El Agustino.

Multisectoral model focused on People Affected by Tuberculosis: Component Biomedical and Social

Determinants

quick sensitivity test

Tto sensible,

MDR /XDR

Control and monitoring /

Complications / RAFAS / Surgical

EESS: Hospitals

PAT / social determinants

M.

Pro

du

ctio

n

M. L

abo

ur

M. H

ou

sin

g

MIN

DES

/MID

IS

M. J

ust

ice

M.

Edu

cati

on

SIS/ IAFAS

TB screening

Regions / local government

PpR

PpR

PpR

SIS/ IAFAS

INS

MINSA / EsSalud / OTHERS SUBSECTORS INTERSECTORAL / INTERGOVERNMENTAL

ACMS

1. Expand insurance coverage.

2. Increase participation Multisectoral, Intergovernmental and local.

3. Strengthen addresing the social determinants of tuberculosis.

4. Approval of the law of tuberculosis.

5. Strengthen and closing gaps in human resources.

6. Expand the network of laboratories at national level.

CHALLENGES

Thank you for your attention

www.tuberculosis.minsa.gob.pe