ANTIGUA AND BARBUDA MEDICAL BENEFITS SCHEME MEDICAL BENEFITS - - PowerPoint PPT Presentation

ANTIGUA AND BARBUDA MEDICAL BENEFITS SCHEME MEDICAL BENEFITS SCHEME

NATIONAL HEALTH FINANCING UPDATE

6TH 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 i i i services organization E t bli h d d Th M di l B fit A t 1978

• Established under The Medical Benefits Act 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 60th Birthday

• 3 1/2 % Employee Contribution
• 3 1/2 % Employer Contribution on Employee’s

behalf behalf 5 % S lf E l d C t ib ti S l i d Cl

• 5 % Self-Employed Contribution per Salaried Class

Medical Benefits Scheme Funding Overview Cont’d Funding Overview Cont d

2) Mandatory Employment Remittances - Age 60 to before the Att i t f 70th Bi thd Attainment of 70th Birthday

• 2 1/2 % Employee & Self-Employed Contribution

2

p y p y 3) Voluntary Contributions

• 3 1/2 % Voluntary Registrant Contribution of Notional

Monthly Salary 4) Investments

• Maximized Returns from Investments in Securities set
• ut 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

• :

– 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

Di ti d i C ll b ti ith St t t & Oth – Discretionary and in Collaboration with Statutory & Other Organizations Established to Provide Healthcare in Antigua & Barbuda

i i ( l d bli )

• Prevention Services (Employee and Public Focus)

– 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

• 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

• 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

• 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 d d t i f t i ) and determine future increases)

• 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 E d E l d C t ti f ti – Engender Employee and Customer satisfaction – Enhance the Scheme’s Public Profile and Image

• Engendering Appropriate Amendment of MBS Act & Regulations

h i ll i i i l i

• Enhancing Collections & Ensuring Actuarial Reviews every 3 years
• r at Shorter Board Sanctioned Intervals - Pursuant to the Act

Medical Benefits Scheme End of Presentation End of Presentation

Questions ?