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Sumar Program's Universal Coverage: Achievements & New Goals Towards 2020

A presentation by Martín Sabignoso of Argentina's Ministry of Health delivered at the RBF Health Seminar, QOn the Road to Effective Universal Health Coverage: What’s New in Argentina’s Use of Performance Incentives? on June 11, 2015.

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Sumar Program's Universal Coverage: Achievements & New Goals Towards 2020

  1. 1. SUMAR Program’s Universal Coverage: achievements and new goals towards 2020
  2. 2. 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. 4 Introductory Concepts
  3. 3. 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) SUMAR Program’s road to Universal Coverage
  4. 4. +10.5 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 Main figures (april 2015)
  5. 5. SUMAR’s contribution to the three universal coverage axes What do we understand by effective health coverage? Transforming universal coverage into effective coverage Universal coverage 14 million Population: Who is covered? Services: What services are covered? Implicit coverage Explicit coverage (500 services) Financial protection (2% of provincial health budget) Enrollment Access to prioritized services Quality standards Effective Health Coverage
  6. 6.  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  Neonatal care  Treatment of NB in critical condition  Treatment of CHD and congenital malformations  Control of vaccine- preventable diseases  Care of respiratory infections  Diagnosis and treatment of overweight and obesity  Control of vaccine- preventable diseases  Immunoprevention of HPV  Diagnosis and treatment of overweight and obesity  Care of alchohol and other substance consumption  Care of suicide attempt Effective Coverage of Effective Health Interventions Aging 1 year 10 years 20 years Pregnancy Reproductive age Adulthood Birth Childhood Adolescence Ongoing care during the entire lifecycle
  7. 7. Results-Based Financing – Separation of functions NATION Sets a per capita value USD 2.8 PROVINCE Provincial Health Insurance HEALTH PROVIDER Fee for Service (monthly payment) Stewardship Incentives and Autonomy Consensus Autonomy in the use of funds BALANCE External verification External verification Capitation payment based on performance Enrollment (monthly payment) Health outcomes – Tracer indicators (every four months)
  8. 8.  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%)  Development of a surveilance system of the actual growth of children in real time through SUMAR Program  It is essential to reinforce individual followup strategies based on such information. Assessment of the nutritional status of children between 1 and 5 through anthropometric data of SUMAR Program Year Nation Prevalenceofchronicmalnutrition(%)
  9. 9. Outline the right to health Improve equity Improve efficiency Facilitate purchases and payments Tool to guide and articulate efforts Prioritized, brief and revisable contents Evaluation of the population and offer Rigurous and systematic measurement of costs Services linked to quality standards grouped by care lines Participatory and coordinated process Allocation of sufficient resources Pay for performance (as service strategy) Monitoring and evaluation mechanisms Empowerment of health teams Empowerment of the population To expand coverage of covered care lines (emphasis on NCDs) Innovation in pay for performance mechanisms for health providers (emphasis on integrity and equity) To continue strengthening information systems and monitoring skills Institutional framework for the prioritization and definition of HSP Harmonization of HSP with the Social Security Insurances From promises to delivery The Health Service Plan as the backbone for SUMAR Program’s strategy Role of the HSP Definition of HSP Mechanisms for turning HSP into effective access Next Steps
  10. 10. The importance of Autonomy 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 Increases satisfaction 67,2 Index Satisfaction Northern Region “Only satisfied health workers can bring the system towards satisfied patients” Favours the building of new skills “Plan Nacer has changed our way of thinking and doing things, we all became managers” Patricia García, MD.
  11. 11. 6 enablers to develop RBF based on Plan Nacer and Programa SUMAR experience Cooperative leadership Harmonic integration Autonomy New skills Gradual implementation Evaluation CHANGE Towards Universal and Effective Health Coverage
  12. 12. “Monitoring Strategy for Integral coverage” Lic. Humberto Silva National Coordinator of Strategic Planning Area
  13. 13. CORE INDICATORS IN PROGRAMA SUMAR. PDOs: 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 1 2 Proportion of eligible population with effective coverage INDICATOR 1 Proportion of eligible pregnant women receiving prenatal check-ups before the 13th week of pregnancy INDICATOR 2 INDICATOR 3 Proportion of eligible children under 10 years of age receiving complete health check-ups according to protocol Proportion of eligible adolescents between 10 and 19 years of age receiving complete health check-ups according to protocol INDICATOR 4 INDICATOR 5 Proportion of eligible women between 25 and 64 years of age with at least one cervical cancer screening every two years Percentage of provinces achieving the targets of their Annual Performance Agreements INDICATOR 6
  14. 14. December 2012 100% of the population were enrolled but 27% had not reported a health service in the previous year. TRANSFORMING UNIVERSAL COVERAGE INTO EFFECTIVE COVERAGE 60% CAPITATION PAYMENT ENROLLMENT + SERVICE PROVIDED LAST 12 MONTHS ‘Every achievement poses a new challenge.’ Basic EHC BY PROVIDED SERVICE 20% 37.5% APRIL 2015 BASIC EFFECTIVE HEALTH COVERAGE
  15. 15. Indicator 1b: Proportion of eligible men with effective coverage - - - 15% MEASURAMENT PERIOD 2014 GOAL 2014 GOAL 2017 CORE INDICATORS IN PROGRAMA SUMAR. PDOS: Indicator 6: Percentage of provinces achieving the targets of their Annual Performance Agreements 2014 DECEMBER 33% 33% 58% PDOs Indicator 1a: Proportion of eligible population with effective coverage 2014 DECEMBER 35,5% 35% 50% Indicator 2: Proportion of eligible pregnant women receiving prenatal check-ups before the 13th week of pregnancy III Q 2014 (W/A) 29,7% 28% 40% Indicator 3: Proportion of eligible children under 10 years of age receiving complete health check-ups according to protocol III Q 2014 (W/A) 47,2% 32% 60% Indicator 4: Proportion of eligible adolescents between 10 and 19 years of age receiving complete health check-ups according to protocol III Q 2014 (W/A) 18,1% 14% 25% Indicator 5: Proportion of eligible women between 25 and 64 years of age with at least one cervical cancer screening every two years 2014 OCTOBER 9,4% 20% 20%
  16. 16. AGEGROUPS 61% 37% 31%Adolescents 25% Women Basic EHC 35% GOAL PDO 2014 Basic EHC 2014 DECEMBER GOAL NB 2014 60% 39% 17% 37% Basic EHC BY PROVIDED SERVICE 2014 DECEMBER 47% 32% 23% 17% 35% 2014 DECEMBER Basic EHC BY PROVIDED SERVICE 26% Children between 0 -5 Children between 6-9 MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE
  17. 17. Basic EHC Basic EHC by provided service 63% 26% 12% 15% 26% 35% 0% 10% 20% 30% 40% 50% 60% 70% 80% Evolution of the Basic Effective Health Coverage rate vs. Goal December 2013- 2014-2015 For the whole country GOAL 2014 = 35% GOAL 2013 = 20% GOAL 2015 = 40% MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE
  18. 18. MONITORING STRATEGY FOR INTEGRAL COVERAGE 26% 3% 13% Minimum comprehensive health coverage Proper comprehensive health coverage Basic EHC 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) • 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) • High-risk newborn tracking (exit)
  19. 19. SUMAR Program More public health for millions of Argentines

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