ANTIGUA AND BARBUDA MEDICAL BENEFITS SCHEME MEDICAL BENEFITS SCHEME NATIONAL HEALTH FINANCING UPDATE 6 TH CARIBBEAN CONFERENCE ON HEALTH FINANCING INITIATIVES HEALTH FINANCING INITIATIVES NOVEMBER 2011 PIERRE RICHARDSON DEPUTY CEO
Medical Benefits Scheme Organization Overview Organization Overview Medical Benefits Scheme (MBS) - statutory health services organization i i i • Established under The Medical Benefits Act 1978 E t bli h d d Th M di l B fit A t 1978 • Most recent Act • Most recent Act – The Medical Benefits Act 2010 (effected May 2010) • Most recent Regulations – The Medical Benefits Regulations 2011 (effected May 2011) 2011)
Medical Benefits Scheme Funding Overview Funding Overview 1) Mandatory Employment Remittances - Age 16 to 1) Mandatory Employment Remittances Age 16 to before the Attainment of 60 th Birthday • 3 1 / 2 % Employee Contribution • 3 1 / 2 % Employer Contribution on Employee’s behalf behalf • 5 % Self-Employed Contribution per Salaried Class 5 % S lf E l d C t ib ti S l i d Cl
Medical Benefits Scheme Funding Overview Cont d Funding Overview Cont’d 2) Mandatory Employment Remittances - Age 60 to before the Attainment of 70 th Birthday t f 70 th Bi thd Att i • 2 1 / 2 % Employee & Self-Employed Contribution p y p y 2 3) Voluntary Contributions • 3 1 / 2 % Voluntary Registrant Contribution of Notional Monthly Salary 4) Investments • Maximized Returns from Investments in Securities set out in Authorized Schedule
Medical Benefits Scheme Objective & Services Overview Objective & Services Overview Objective (Management & Prevention of Chronic Disease) To provide financial and other assistance towards the cost of medical services and proactive activities to prevent disease Benefits/Services Provided Refund or Payment for: e u d o y e o : • – Hospitalization – Surgical Care – Laboratory/Investigation Services y g – Doctor’s Fee (if treated for a covered illness) – Overseas Treatment (if not available locally) Pharmaceuticals ( procured and dispensed at MBS distributed • pharmacies)
Medical Benefits Scheme Services Overview Cont d Services Overview Cont’d • Board Sanctioned Benefits – Discretionary and in Collaboration with Statutory & Other Di ti d i C ll b ti ith St t t & Oth Organizations Established to Provide Healthcare in Antigua & Barbuda • Prevention Services (Employee and Public Focus) i i ( l d bli ) – Free Screening for Chronic Diseases (quarterly & planned events - global disease awareness days, annual road show etc.) – Physical Activity & Nutrition Initiatives (challenging walk/run events, school skip rope, aerobics, and healthy recipe competitions) – Education/Therapeutic Lifestyle Choices Programs (cooking demonstrations, nutritional health talks etc.) – Employee Wellness Program (exercise sessions and nutrition classes)
Medical Benefits Scheme Major Operational Results Major Operational Results • Health & Wellness Services – Growth in Successful Marketing & Staging of Prevention Activities Prevention Activities – Increased Public Support & Participation in Activities pp p • Healthcare Services Healthcare Services – Prescription Dispensing & Claims Reimbursement Growth over 2010
Medical Benefits Scheme Major Operational Results Cont’d Major Operational Results Cont d • Compliance Monitoring – Corporate & Self-Employed Active Accounts showed Sequential Increase over Previous Quarters (Active count is affected by erratic fluctuations of reported business (Active count is affected by erratic fluctuations of reported business activity) – Increased Corporate & Self-Employed Registration • Collections Revenue Decreased Despite Intensified Compliance Monitoring & AR Collection Outcomes & Increased Investment Portfolio – Result of Falloff in both Public and Private Sector Contributions
Medical Benefits Scheme New Developments & Progress New Developments & Progress • Implementation of New Act & Regulations – Achieved Agreement on Regulations o To provide high-quality outcomes, demonstrate value & enhance member satisfaction – Seeking Legal Interpretation to Mitigate Perceived Counter Effect of Savings Clause Enshrined in Act g o Clause preserves rights, entitlements, obligations, liabilities & benefits under the former Act – Grappling with Act & Regulations Learning Curve – Tackling Institutionalization & Computerization of New Aspects of g p p Regulations o Self-employed & age 60 to 70 registrations, refunds at the new rates etc.
Medical Benefits Scheme New Developments & Progress Cont d New Developments & Progress Cont’d • Cost Control Challenge – Requested Increase in Hospital Capitation Payment for Members – Lack of Apt Empirical Data to Substantiate Requested Increase Lack of Apt Empirical Data to Substantiate Requested Increase – Pragmatic Increase Granted (methodology to be agreed to ascertain and determine future increases) d d t i f t i ) • Introduction of Queue Management Initiatives and Building of Q g g Two New Pharmacies – To Assure Optimal Access & Member Safety at MBS Pharmacies To Assure Optimal Access & Member Safety at MBS Pharmacies • Issues - Long Waiting Time and Unacceptable Seating/Waiting Areas at Satellite Pharmacies
Medical Benefits Scheme New Developments & Progress Cont’d New Developments & Progress Cont d • Acceptance of Smartcard Personalization Production Solution and Onsite Training on Dedicated Applications for: g pp – Enrolment and Administration of Members and Professionals ( (doctors, labs, pharmacists) , , p ) – Electronic Prescriptions and Claims Management • Completion of New MIS Solution Requirement Specification • Selection of Multi-site Pharmacy Management Software • Execution of Strategy to Commence Re-registration of Execution of Strategy to Commence Re-registration of Members in 2012
Medical Benefits Scheme Plans To Ensure Sustainability Plans To Ensure Sustainability • Commissioning of Inaugural Strategic Plan for MBS to Chart its Course towards the Desired Future State • Finalization of High Performance Workplace Initiative to: – Create an Infrastructure/Framework among Staff to Improve and Sustain Organizational Performance and Productivity – Engender Employee and Customer satisfaction E d E l d C t ti f ti – Enhance the Scheme’s Public Profile and Image • Engendering Appropriate Amendment of MBS Act & Regulations • Enhancing Collections & Ensuring Actuarial Reviews every 3 years h i ll i i i l i or at Shorter Board Sanctioned Intervals - Pursuant to the Act
Medical Benefits Scheme End of Presentation End of Presentation Questions ?
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