27 questions about the equality health bwindi scheme
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27 questions about the eQuality Health Bwindi scheme. Bwindi Community Hospital December 2009. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
27 questions about the eQuality Health Bwindi
schemeBwindi Community Hospital December 2009
Introduction
Bwindi Community Hospital is about to start working together with International Medical Foundation (IMF) to start a health scheme for the people of Kayonza, Mpungu and Kanyantorogo sub-counties of Kanungu District, Uganda
The scheme will benefit an estimated 60,000 people
Bwindi Community Hospital
Located in Kanungu District, Uganda Church of Uganda Hospital. Private-not-for-profit Highly donor-dependent (largely small
donations, with a few larger partners) 120 staff, including 5 doctors 200 village health promoters working with the
Hospital – one in each village Annual Report and more information is online at
www.BwindiHospital.com
Bwindi Community Hospital
Vision: “A healthy and productive community, free
from preventable disease and with excellent health services accessible to all”
Bwindi Community Hospital
Services:Outpatients, dental and eyesAdult inpatients and diagnosticsSurgeryChild HealthCommunity Health & BatwaHIV/AIDS & TBSexual and Reproductive Health
Kanungu District
South West Uganda95% of households are subsistence
farmers10 hours from KampalaHilly terrain with lots of rain and muddy
roads
1. What is the eQuality scheme?
At the moment patients pay a fee for service at Bwindi Community Hospital. So if someone is admitted with pneumonia they pay an admission charge and a charge for drugs
With a health scheme people pay in advance for care. And they pay a flat fee – the same amount for everyone. When they need to come to Hospital they don’t have to pay for drugs or care. They have already paid in advance.
2. What are the advantages of a Health Scheme?
Fee for service Health schemeHow much to pay?
Unpredictable amounts
Fixed annual payment
When to pay? Pay when sick Pay when wellIf you don’t have money?
May go into debt for large amount
No large debt
Responsibility Hospital taking responsibility
Community responsibility
Power Passive recipients of care
Powerful consumer body
2. What are the advantages of a Health Scheme?(2)It provides a sustainable source of income
to the Hospital from the community
3. Who are IMF?
International Medical Foundation is part of International Medical Group, which also runs International Hospital, Kampala
IMG have experience of delivering quality health care, and also own the health insurance organisations IAA and Microcare
This scheme has been given the name eQuality Health Bwindi
eQuality, the Hospital and the Community
Community
Pay annual subscription for all Bataka members to…
eQuality Health Bwindi
Contract with and pay monthly payments to…
Provide services to…
Bwindi Community Hospital
International Medical Foundation
Financial support and performance management
4. eQuality? Why?
‘Quality’ because Bwindi Community Hospital and IMF have entered into a partnership to ensure quality health services
‘Equality’ because all people are given an equal opportunity to join the scheme at a price that is affordable to all
The ‘e’ in eQuality shows that we are using modern electronic technology to collect information and measure the impact of the scheme
5. Who pays who?
The community make payments to eQuality Health Bwindi
Bwindi Community Hospital (BCH) provides services to patients
eQuality Health Bwindi pays BCH according to the delivery of quality standards. Payment is per capita – the Hospital gets a fixed amount per person per year (estimated at UGX 12,000)
6. How much will membership cost families to buy?
Everyone aged 5 or over will pay UGX 6,000 ($3) a year to join the scheme
They will make these payments through their Bataka groups (burial societies) who are used to collecting and saving money
The Bataka has collect money from families and will make the payment to eQuality Health Bwindi for all members at the same time
Children under 5 years will have their premium paid as part of the Child Health Access Project (CHAP), so will not be included in this at the moment
7. CHAP?
This is the project being funded by the Eurochange Charity.
This project was initially for one year, but we are negotiating extending it to three years, and possibly even beyond
It pays the costs of care for about 8000 children under the age of 5 in Kayonza and Mpungu
8. What will membership of the scheme entitle a person to?
Members can able to access most emergency and routine outpatient and inpatient health care at Bwindi Community Hospital including admission to the Hospital, investigations, drugs, eye care, dental services and specialist clinics
Care provided on outreach and at Byumba Health Centre II is covered
Some operations that can be performed in Bwindi (like hernia repair) will be covered
9. Will there be any other charges
Yes, there will be a small charge each time someone uses the service of UGX 1000 (UGX 500 for Batwa and children under 5).
10. Why?To encourage people to only use the
service when they are sick
11. So – antibiotics, multivitamins, x-rays and blood tests for all?
No, it will be very important that the Hospital only gives people medicines that they absolutely need, and keeps investigations to a minimum.
The scheme will fail if over-prescribing and over-investigation happen.
One of the quality standards of the scheme is to reduce unnecessary prescribing
Sometimes people will come to the Hospital and will leave with no medicines, if medicines are not deemed necessary
12. Is there anything not included?
Yes, there are some exemptions: Maternity care and HIV care are provided for
under other schemes within the Hospital, so are not covered under this one
Operations not provided in Bwindi and referral costs are not covered
Expensive drugs like rabies vaccination are not covered
Cosmetic dental work is not covered
13. How do I join? Individuals and families cannot join – you can
only join as part of a group. More than 95% of people in the area are
members of Bataka groups. When the Bataka pays the annual payment for all of its members they can all join
The Bataka head will bring payment to the eQuality office in Bwindi
We should already have your details including your fingerprint. We will just stamp your green book to confirm that you are a member
14. Can someone pay in instalments?Groups can decide for themselves how to
collect payments
15. If a person is not covered will they still get care?
They will still get health care, but their bill is likely to be very large. Our bills will be for the actual cost of care
For example, the average admission to adult ward including drugs and the cost of staff actually costs the Hospital about UGX 150,000 We will charge all of this to uninsured people
Except in the case of life-threatening emergencies, payment will be before seeing a doctor or clinical officer for un-covered people
16. Will staff of BCH have to buy membership for their families?
Staff and their family members who are not part of a Bataka group will have to form a group for payment, as will other people who work in the Bwindi area
We think that staff who are already part of a Bataka group should show leadership and make payments through their Bataka, otherwise it may seem unfair.
Staff will be able to get a refund from the Hospital for the payments that they make for themselves and their immediate families
17. If I pay and don’t use the Hospital, will I get a refund?No. Some people will incur costs of more
than UGX 200,000 and some people will not incur any costs.
This is known as ‘pooling risk’ – the risk of payment is shared among the whole community
18. Will UGX 10,000 per person per year cover all of the costs?
No. Even if 30,000 people join the scheme then they will contribute
30,000 x 6,000 = 180 million per year
The OPD, Surgery and Adult wards in the Hospital will cost more than UGX 500 million to run this year, and we expect them to cost more next year
19. So where will the rest of the money come from?
GrantsGovernmentDonations
20. Who will run eQuality in Bwindi?There will be an eQuality office at the
Hospital with one employeeThis person will collect money on behalf of
the scheme, and will make payments to the Hospital.
This person will also monitor the quality of the Hospital
21. Quality of the Hospital?
Availability of doctors and clinical officersAvailability of drugsPatient satisfactionAccess to care for the poorestWaiting times for operations
All of these things and others will be measured, and the Hospital will only be paid if it is providing high quality care
22. How will the data be captured?
Bwindi Community Hospital already has a population database containing demographic and health information about every person and family in the area
When people join the scheme their membership will be reflected on this system
Fingerprint recognition will be used to confirm identity
22. How will the data be captured? (2)
Every someone uses the Hospital their disease and their treatment will be recorded
GPS coordinates will be used to monitor uptake of the scheme and use of the Hospital
Poverty measurements including income, water and sanitation and food security have already been made
Household data will be updated through an annual household survey
23. Will International Hospital be making a lot of profit from this?No, this will cost them money at the start
(they will make a loss that they will have to raise money for).
The aim is that in the long-term this scheme breaks even (neither make a profit or a loss)
24. So why are International Medical Foundation making an effort to work with Bwindi?
Because they share our vision of:A healthy and productive community, free from preventable disease, and with excellent health services accessible to all
Because they want to learn from this scheme and try to replicate it elsewhere
25. When does all this start?
By the end of December all people in 4 parishes of Kayonza will be registered onto the population database
Children under 5 are already using the scheme
Bataka groups can start paying premiums in January 2010 and using the scheme in February 2010
26. What else needs to happen? The Hospital needs to continue the
computerisation project in OPD and other areas to record usage of the services
James Twebaze is leading a sensitisation programme, starting with local leaders
The Hospital will change its billing system – and increase prices for people who choose not to join the scheme
Prices will remain low for Parishes that we have not yet registered onto the database and until one month after they have registered
27. And the community?
Bataka leaders need to learn all about this scheme and share information
The CAO, LC V and LC III leaders are supporters of this scheme
Groups, not individuals, will make payments to the eQuality scheme. And the groups will be responsible for collection of money
We will begin marketing with posters and leaflets in December
Any more questions?