Develop strategies to reduce inefficiencies and inadequacies in health service
provision bearing in mind the country’s limited financial resources.
Discuss public and private sector activities in health sector financing and outline the
proposed roles and interaction among these sectors.
Outline approaches for developing the finance component of the health system
| Issues |
Recommendations |
Strategies |
| How will health services be financed? |
Decide on policies for an optimal balance
between the sources of finance eg. Government contributions , User fees , National Health
Insurance , Private insurance , consider co-payments to reduce abuse and continue
collaboration between NHI and NIS |
Assess capital needs and recurrent cost of
services Ascertain the cost of health service. Implement financial reform in the health
sector
· cost recovery – User
charges that reflect the cost of providing public health care
· cost containment –
tighter controls over budgets and supplies
· cost sharing –
greater reliance on private and social insurance as well as private institutions .
|
| How should health funds be allocated for the
provision of health care services? |
Identify priority areas for financing Determine
Governments contribution to NHI |
Conduct a health needs assessment Allocate
appropriate funds to :
1. Improve primary facilities so as to reduce the burden on Hospitals
2. Management of inefficiencies
NHI- will pay hospital bills and reimburse clients (NHI should not be saddled with
excessive debt especially during the early stages of its operation). |
| How can the Ministry of Health reduce
inefficiencies?
|
Reorganize financing systems
Determine the impact that financing and efficiency measures will have on expectations
of improved quality of health service provision.
Increase mechanisms to ensure accountability |
Separate service provision from administration
Tie budgets to desired outputs and outcomes
Develop ratios between Health Reform and desired outputs.
Establish review teams which comprise trained professionals to monitor and evaluate the
activities of the health institutions
Develop recording systems to monitor expenditure
Allocate finance to cost effective operations
Decentralization
Utilize more sophisticated and accurate Information systems
Institute management structures closer to commercial management |
| How should health providers and
institutions be compensated for services? |
Determine appropriate means of compensation
for health providers and institution. |
Capitation – for a stated list of
benefits. This method requires a culture of quality and strong regulatory mechanisms. Fixed
or group payments for certain items of health care
Fee for service – This method must be properly controlled
Implement reward systems |
|
What should be the role of the Government of Saint Lucia in the provision of health
care services? |
The Government of Saint Lucia should clearly define its role in the provision of health
care services and that of other major stakeholders financial and otherwise. |
Sharing of delivery of health care services
and finance between private and public sector
Determine total financial requirements of health care services.
Create policy guidelines which clearly stipulates the roles of all major players in the
development and provision of health care services.
|
| How should the finance component of the health
system be organized? |
Encourage collaboration between the public and
private sector.
The finance component should address the need for equitable health coverage for the
poor and the indigent |
Decentralization of health services to health
regions in order to provide greater autonomy to manage budgets and operate as statutory
institutions Develop National Health Insurance as the major financial component of the
health system for public sector funding |
| How can we promote wellness as
opposed to sickness? |
Develop a comprehensive health
promotion and preventative programme. |
Increase emphasis on health
promotion and preventative health care services-
· Include poverty concerns
in the financing of preventative services for adults and children eg. user fees at health
centers
· Inclusion of the wider
society in the design, planning and implementation of preventative health care programs
eg. Schools and NGO’s.
|
| The relationship between capital and recurrent
expenditure |
The need to examine carefully the relationship
between capital expenditure and recurrent cost. |
Conduct optional appraisals i.e. include
capital and recurrent cost implications in all financial estimates and project reports |
| The escalating cost of health service
provision
Government ‘s increasing inability to provide health care services at a standard
required by the public. |
Develop a financial strategy to fund the
health system. This strategy must provide special consideration for vulnerable groups.
Greater private sector involvement
Greater collaboration between public and private sector activities in the provision of
health services. |
Establish a National Insurance Scheme Make
use of earmarked taxes in the provision of certain services
Institute user fees for the use of government institutions by private health
professionals.
Monitor and evaluate expenditure patterns in health institutions
Greater regulation for public and private sector activities eg. fees charged, types of
services provided, activities of hospital personnel. |
