Universal Health Coverage in Aruba
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- Darrell Sharp
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1 Universal Health Coverage in Aruba 15 years AZV: what s going on? Lex de Jong, Chief Medical Officer lex.de.jong@uoazv.aw November 4, 2014` 1
2 Talking Points Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 2
3 Topics Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 3
4 Values, principles and characteristics: historical context Before AZV After AZV Pretty good infrastructure of medical resources, services and providers Segmented and fragmented system of health plans and health insurers Risk selection by private insurers and limited access for specific (high risk) groups Different coverage by the different health plans Most plans based on reimbursement and out-of-pocket expenditures Expansion of providers and medical services/treatments covered Pooling of all health plans under one single health plan with a single payer Equal access for all (legal) citizens; no riskselection Equal comprehensive coverage for all (legal) citizens In kind delivery of services; no reimbursement, no copayments or deductibles 4
5 Values, principles and characteristics Before AZV After AZV High administrative and operational costs (9%) Poor Governance structure Incomparable data because of incomplete and inconsistent data collection High growth rate of yearly expenditures (avg. 7%) Declining life expectancy Lower administrative and operational cost (5%) Improved Governance structure Central and uniform database to sustain policymaking From 2010: moderate growth rate of yearly expenditures Increased life expectancy 5
6 Values, principles and characteristics Main Characteristics of universal health coverage Mandatory: every legal citizen is mandatory enrolled and legally obliged to contribute by paying a premium Equal coverage in scope and quality of health benefits Insureds are entitled to in kind delivery of services; no reimbursement, no (or very limited) copayments or deductibles Based on solidarity No risk-adjustment or cream skimming based on income, sex, age, geographical area or medical history By contributing in line with one s ability to pay or financial capacity 6
7 Topics Values, principles and characteristics 1 Which health benefits to include? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 7
8 The health benefits to include The health benefits will have to reflect the scope and quality of existing medical providers and services The defining of the health benefits: what is usual and common in the profession Preventive services - Cure - Care Based on the coverage of the larger health plans before introduction of AZV 8
9 The health benefits of the AZV Family physicians (gatekeeper) Medical specialists Hospital services Prescription drugs Laboratory services Prosthetic and medical devices Pregnancy-related services (midwives) Physical therapy Dental care Ambulance services Overseas services 9
10 Topics Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 10
11 Funding 1 Fiscal contribution 2 (Pay-roll) premium : Health Tax (dedicated sales tax) and co-payments? 11
12 Financial Outlook 2013 (x mln. florin) Total Revenues Fiscal Contribution Premium (incl. other revenues) Total Expenditures Health Services Operational Costs Highlights 2013 Lower premium revenues: 0,6% lower compared to 2012 Moderate growth of total expenditures: 0,4% Moderate growth of expenditures health services Operational costs decreased by 1,5% Average cost per insured decreased by 1,2% Number of insurees increased by 1.4% Average inflation : 2.0% % growth 3,1% 2.9% 0.4% 12
13 % fiscal contribution Total Revenues Funding Share of premium & fiscal contribution in total revenues premium fiscal contribution % fiscal contribution
14 Health Care Expenditures CIJFERS HOH EN IMSAN CORRIGEREN VOOR DIALYSE ( en 3.6, HM 2013 voor 4.0). x mln. AWG Hospital care (incl 2/3 of dialysis) Pharmaceuticals + bandages Medical referrals abroad Diagnostic Laboratory tests Non-hospital employed medical specialists Primary care physicians (Family doctors) Instituto Medico San Nicolas + dialysis entity Dental Physical therapy Hearing aides, prostheses, ortheses, etc Midwives Non-urgent medical transport Total health care expenditures
15 Health Care Expenditures as a percentage of GDP Expenditures (cure & care) as percentage of GDP Aruba, Curacao and The Netherlands % of GDP Aruba Curacao The Netherlands 15
16 Health Care Expenditures per capita Expenditures (cure) per capita Aruba, Curacao and The Netherlands per capita in AWG ,421 3,677 florins florins 4,852 florins 0.00 Aruba Curacao The Netherlands 16
17 Topics Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 17
18 Sustainability and cost control Main mechanisms of cost control Starting point: procurement based on transparency of prices and quality Capitation (family doctors) Fee-for-service with annual budget caps (medical specialists) Lumpsum (hospital) Public Tender (medical devices) Hospital: Case payment (DRG Canadian Case Mix Groups) Authorization in advance for selected treatments or services Guidelines and protocols for selected treatments and diagnostic tests Bonus/malus payments for selected providers based on performance indicators Recurrent statistical information for selected providers to benchmark their practice with their peers Pharmaceuticals o Fixed fee per line prescription for operational costs of the pharmacies o Penetration of generics by Best Aruban Pricelist o MoU between minister of Health and importers about price reduction for brand names and generics Co-payments for selected services 18
19 Sustainability and cost control: current policy explained Q+ Q0 Q0 Q- Q- Q++ Policy 19
20 Sustainability and cost control: significant results Farmaceuticals (BAP policy on generics) Laboratories (budget, court case in appeal) Specific results due to AZV policy on quality focus Diabetic Care (Wednesday) Care for the elderly (Wednesday) Physical Therapy (Thursday) Complex medical referrals (Thursday and November 24 & 25) 20
21 Topics Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 21
22 Some other requirements for succesful implementation Political commitment and leadership Legal framework with a phased implementation road Involvement of all stakeholders, keeping in mind that there will never be complete consensus Payment agreements with providers which are capped IT investments 22
23 Topics Values, principles and characteristics 1 Which health benefits? 2 Funding and expenditures 3 Sustainability and cost-control 4 Other important requirements for implementation 5 Future developments 6 23
24 Future developments Medical challenges: Increase in NCD s Transparancy and Quality: DRG implementation Financial changes: Co payments, sin tax? Interregional cooperation: medical referrals, farmaceuticals, prevention 24
25 Thank you for listening 25
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplan.memorialhermann.org or by calling 1-888-594-0671.
Important Questions Answers Why this Matters:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type: PPO This is only a summary. If you want more detail about your coverage and costs, you
CommunityCare : 1CCS CommunityCare Silver Coverage Period: 01/01/2014 -
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2018 Summary of Benefits
January 1 December 31, 2018 2018 Summary of Benefits Kaiser Permanente Medicare Advantage (HMO) for Federal Members High, Standard, and High Deductible Health Plan Options MA0001579-51-17 About this Summary
Is there an out of pocket limit on my expenses? Even though you pay these expenses, they don t count toward the out-ofpocket
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplan.memorialhermann.org or by calling 1-877-988-1918.
Some of the services this plan doesn t cover are listed on pages 5. See your policy Yes. doesn t cover?
Molina Healthcare of Florida, Inc.: Molina Silver 100 Plan Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family
2019 Summary of Benefits Medicare Advantage Plans with Part D Prescription Drug Coverage. BlueMedicare Choice (Regional PPO) R
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COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948
PLAN YEAR 2018 COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948 POWERED BY compassrosebenefits.com 1 WELCOME WE ARE HERE TO HELP YOU SOLVE THE COMPLEXITIES OF INSURANCE PLAN HIGHLIGHTS COMPASS
Benefits Summary Direct HMO / HMO For Groups with 2-50 Eligible Employees (Eff. 10/01/10, Pending NYS Dept. of Insurance Approval)
Copayment Options 1 Inpatient Copayment Primary (PCP) Copayment Specialist Copayment ER Copayment Option 12 copayment* copayment 1 $50 copayment 1 $150 copayment *Per admission/maximum per calendar year
FirstMedicare Direct Healthy State HMO Prime (HMO) 2018 Summary of Benefits
Healthy State HMO Prime (HMO) 2018 Summary of Benefits This is a summary of drug and health services covered January 1, 2018-December 31, 2018 by the FirstMedicare Direct. The benefit information provided