SUMAR Program s Universal Coverage: achievements and new goals towards 2020

Transcription

1 SUMAR Program s Universal Coverage: achievements and new goals towards 2020

2 4 Introductory Concepts 1. Argentina is a federal country where provincial governments are responsible for the provision of healthcare. 2. Plan NACER is a national program that provides health coverage for pregnant women and children up to 5 years of age without formal insurance. 3. Programa SUMAR is the expansion of Plan NACER including new population groups. 4. This Results Based Financing (RBF) aims to transform the existing free universal coverage into effective coverage.

3 SUMAR Program s road to Universal Coverage Plan Nacer in the Provinces in the North (700,000 people) Plan Nacer nationwide Coverage of Congenital heart disease treatment Incorporation of children, teenagers and women up to 64 years of age Incorporation of adult men (14 million people)

4 Main figures (april 2015) MILLION BENEFICIARIES +500 HEALTH SERVICES COVERED +7,300 HEALTH PROVIDERS UNDER AGREEMENT USD400 MILLION INVESTED 100 MILLION HEALTH SERVICES BILLED & PAID +800 PROFESSIONALS IN 25 MULTIDISCIPLINARY TEAMS

5 Transforming universal coverage into effective coverage SUMAR s contribution to the three universal coverage axes What do we understand by effective health coverage? Effective Health Coverage Financial protection (2% of provincial health budget) Enrollment Access to prioritized services Quality standards Universal coverage 14 million Population: Who is covered? Implicit coverage Explicit coverage (500 services) Services: What services are covered?

6 Effective Coverage of Effective Health Interventions Prevention, diagnosis and beginning of treatment of breast, cervical and colorectal cancer NCD research, identification of risk level and follow-up Care of low and high-risk pregnancy Care of childbirth and its complications in safe Maternities Health promotion and risk prevention actions Family planning Care of alchohol and other substance consumption Care of suicide attempt Pregnancy Aging Adulthood Reproductive age Birth Ongoing care during the entire lifecycle 20 years 1 year Childhood Adolescence 10 years Neonatal care Treatment of NB in critical condition Treatment of CHD and congenital malformations Control of vaccinepreventable diseases Care of respiratory infections Diagnosis and treatment of overweight and obesity Control of vaccinepreventable diseases Immunoprevention of HPV Diagnosis and treatment of overweight and obesity Care of alchohol and other substance consumption Care of suicide attempt

7 Results-Based Financing Separation of functions Capitation payment based on performance Enrollment (monthly payment) NATION PROVINCE HEALTH PROVIDER Sets a per capita value USD 2.8 Health outcomes Tracer indicators (every four months) Provincial Health Insurance Fee for Service (monthly payment) Autonomy in the use of funds External verification External verification Stewardship BALANCE Incentives and Autonomy Consensus

8 Prevalence ofchronic malnutrition (% ) Assessment of the nutritional status of children between 1 and 5 through anthropometric data of SUMAR Program Over 13 million health checkups from over 1,4 million children under 5 years of age in more than 6,500 health facilities nationwide (2005 to 2013) Prevalence of stunting (chronic malnutrition) decreased by 45% (from 20.6% to 11.3%) Nation Development of a surveilance system of the actual growth of children in real time through SUMAR Program Year It is essential to reinforce individual followup strategies based on such information.

9 From promises to delivery The Health Service Plan as the backbone for SUMAR Program s strategy Role of the HSP Outline the right to health Definition of HSP Prioritized, brief and revisable contents Mechanisms for turning HSP into effective access Allocation of sufficient resources Next Steps To expand coverage of covered care lines (emphasis on NCDs) Improve equity Evaluation of the population and offer Pay for performance (as service strategy) Innovation in pay for performance mechanisms for health providers (emphasis on integrity and equity) Improve efficiency Facilitate purchases and payments Rigurous and systematic measurement of costs Services linked to quality standards grouped by care lines Monitoring and evaluation mechanisms Empowerment of health teams To continue strengthening information systems and monitoring skills Institutional framework for the prioritization and definition of HSP Tool to guide and articulate efforts Participatory and coordinated process Empowerment of the population Harmonization of HSP with the Social Security Insurances

10 The importance of Autonomy Favours the building of new skills Plan Nacer has changed our way of thinking and doing things, we all became managers Patricia García, MD. Increases satisfaction 67,2 Index Satisfaction Northern Region Only satisfied health workers can bring the system towards satisfied patients Encourages creativity At Christmas, a health center of La Pampa draws bicycles (purchased with Plan Nacer funds) for all those children whose vaccines and checkups are up to date and a health center of Entre Ríos hired a taekwondo coach for adolescents

11 6 enablers to develop RBF based on Plan Nacer and Programa SUMAR experience Cooperative leadership Harmonic integration Autonomy New skills CHANGE Towards Universal and Effective Health Coverage Gradual implementation Evaluation

12 Monitoring Strategy for Integral coverage Lic. Humberto Silva National Coordinator of Strategic Planning Area

13 CORE INDICATORS IN PROGRAMA SUMAR. PDOs: 1 2 INCREASE IN THE UTILIZATION AND QUALITY OF THE KEY HEALTH SERVICES FOR THE ELIGIBLE TARGET POPULATION: IMPROVEMENT OF INSTITUTIONAL MANAGEMENT BY STRENGTHENING RESULTS-BASED INCENTIVES IN PARTICIPATING PROVINCES AND AMONG AUTHORIZED PROVIDERS INDICATOR 1 Proportion of eligible population with effective coverage INDICATOR 2 INDICATOR 3 Proportion of eligible pregnant women receiving prenatal check-ups before the 13th week of pregnancy Proportion of eligible children under 10 years of age receiving complete health check-ups according to protocol INDICATOR 4 INDICATOR 5 Proportion of eligible adolescents between 10 and 19 years of age receiving complete health check-ups according to protocol Proportion of eligible women between 25 and 64 years of age with at least one cervical cancer screening every two years INDICATOR 6 Percentage of provinces achieving the targets of their Annual Performance Agreements

14 TRANSFORMING UNIVERSAL COVERAGE INTO EFFECTIVE COVERAGE Every achievement poses a new challenge. December % of the population were enrolled but 27% had not reported a health service in the previous year. BASIC EFFECTIVE HEALTH COVERAGE 60% CAPITATION PAYMENT ENROLLMENT + SERVICE PROVIDED LAST 12 MONTHS 37.5% APRIL % Basic EHC BY PROVIDED SERVICE

15 CORE INDICATORS IN PROGRAMA SUMAR. PDOS: PDOs MEASURAMENT PERIOD 2014 GOAL 2014 GOAL 2017 Indicator 1a: Proportion of eligible population with effective coverage 2014 DECEMBER 35,5% 35% 50% Indicator 1b: Proportion of eligible men with effective coverage % Indicator 2: Proportion of eligible pregnant women receiving prenatal check-ups before the 13th week of pregnancy Indicator 3: Proportion of eligible children under 10 years of age receiving complete health check-ups according to protocol Indicator 4: Proportion of eligible adolescents between 10 and 19 years of age receiving complete health check-ups according to protocol Indicator 5: Proportion of eligible women between 25 and 64 years of age with at least one cervical cancer screening every two years Indicator 6: Percentage of provinces achieving the targets of their Annual Performance Agreements III Q 2014 (W/A) 29,7% 28% 40% III Q 2014 (W/A) 47,2% 32% 60% III Q 2014 (W/A) 18,1% 14% 25% 2014 OCTOBER 9,4% 20% 20% 2014 DECEMBER 33% 33% 58%

16 AGE GROUPS MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE 35% GOAL PDO 2014 Basic EHC 2014 DECEMBER Basic EHC BY PROVIDED SERVICE 2014 DECEMBER GOAL NB % Children between % 60% 37% Children between % 39% Basic EHC 35% 2014 DECEMBER 26% Basic EHC BY PROVIDED SERVICE 31% Adolescents 25% Women 23% 17% 17% 37%

17 MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE 80% 70% Evolution of the Basic Effective Health Coverage rate vs. Goal December For the whole country 63% 60% 50% 40% 30% 20% GOAL 2013 = 20% 26% GOAL 2014 = 35% GOAL 2015 = 40% 35% 26% 10% 0% 12% 15% Basic EHC Basic EHC by provided service

18 MONITORING STRATEGY FOR INTEGRAL COVERAGE Children Under Age 1 Secondary Prevention Preterm care (500 to 1500 g) Care of preterm infants (500 to 1500 g) during the first days of life with requirement of ARM or CPAP Care of preterm infants (500 to 1500 g) during the first days of life without requirement of ARM or CPAP High-risk newborn tracking (admission) High-risk newborn tracking (exit) Basic EHC 26% Minimum comprehensive health coverage Care of preterm infants with requirement of ARM o CPAP Care of preterm infants without requirement of ARM o CPAP High-risk newborn tracking (admission) 13% High-risk newborn tracking (exit) Proper comprehensive health coverage 3%

19 SUMAR Program More public health for millions of Argentines