universal health insurance tuberculosis - who.int · i. tuberculosis in any of its forms is funded...
TRANSCRIPT
Universal Health Insurance: Tuberculosis
Dr. David Chavarri Venegas Technical Officer
ESN PCT Sao Paulo April 29, 2013
Content:
• Indicators of tuberculosis in Peru
• Legal framework of Universal Health Insurance
• Financial coverage of TB
• Challenges
Tuberculosis in Perú 2012
• Population: 30’135,875 hab.
• Population density: 23 hab. x km2
• Three geographic regions
• 25 political regions
• Growth PBI 2011: 6,7%
• World Bank: Medium High income
• Poverty: 27,8%
• 5th place americas impact on region.
• 1st place MDR TB on the Americas
• Morbidity TB: 32,145
• New cases TB: 28,217
• New cases TBpFP: 17,870
• Lima and Callao: 51% cases TB sensibity, 77% MDR TB and 89% XDR TB
Equator Colombia
Brazil
Bo
livia
Pacific Ocean
LORETO
128.1
UCAYALI 148.0
PUNO
26.7
CUSCO
46.1
JUNIN
54.0
AREQUIPA
56.0
MADRE DE DIOS
154.3
LIMA
120.0
PIURA
25.9
ICA
87.4
ANCASH
68.4
AYACUCHO
32.3
SAN MARTIN
71.3
PASCO
31.3
HUANUCO
51.8
AMAZONAS
32.3
CAJAMARCA
7.9
TACNA
128.6
LA LIBERTAD
63.6
APURIMAC
19.3
HUANCAVELICA
18.4
MOQUEGUA
80.6
LAMBAYEQUE
53.0
TUMBES
49.5
CALLAO
113.9
TASA DE INCIDENCIA
POR CUARTILES
DEPARTAMENTOS MINSA 2012
7.9 - 32.3
32.4 - 63.6
63.7 - 87.4
87.5 - 154.3
Trends in the form of TB according to resistance-
Peru 1990 - 2012
Operational inform MINSA/ others institutions Date: March 18, 2013 / AMHE/JECC
198.1
106.7
1
84
44
1,216
0
200
400
600
800
1,000
1,200
1,400
0.0
50.0
100.0
150.0
200.0
250.0
300.0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
N M
DR
TB
ca
ses
TB m
orb
idit
y /
N X
DR
TB
cas
es
Años
Tasa de Morbilidad XDR MDR
BUDGETING FOR RESULTS
Ministerial Resolution Nº 178-2011/MINSA
Operational Definitions and Criteria of Programming: 11
Sub Products
Law Nº 29344: Framework Law of Universal Health Insurance (UHI) - 2009
Article 3º: The universal health insurance is a process to ensure that all persons residing in the national territory provided health insurance that allows you to access a range of health benefits of preventive, promotional, recuperative and rehabilitation, under proper conditions efficiency, equity, timeliness, quality and dignity, on the basis of Universal Insurance Essential Plan (PEAS)
Subsidized:
SIS, INPE
Semi contributory:
SIS, FFAA, PNP
Contributory: EsSalud, EPS, SISOL, Others
P E A S
T B
UHI
Plan Health Insurance Essential and Tuberculosis
2. Pulmonary tuberculosis, A15.0, A15.7, A15.9, A16.0. 3. Extrapulmonary tuberculosis: A15.6, A16.3, A16.4, A16.5, A16.8, A17, A18, A19, I32.0, K67.3. 4. Tuberculosis with Complications, J47, J93. 5. MDR TB, A15.8
Public Providers*
Ministries/Local Governments
Entities % of the total notified % total cases
Ministry of Health/Local Governments
DISAS , DIRESAS,GERESAS, Hospitales.
26,800 81.95
Ministry of Labor Social Insurance 5,056 15.46
Ministry of Interior Police Insurance 60 0.18
Ministry of Defense Military Insurance 4 0.01
Ministry of Justice Correctional System 780 2.39
Municipality OTHERS (Municipalities, public
hospitals, other public insurance) 3 0.01
Total cases 32,703 100%
Institutions that notify TB cases - 2011
Operational Inform ESNPCT, years 2009-2011
INSTITUTIONAL DEVELOPMENT OPENING BUDGET (PIA) TUBERCULOSIS
PRODUCTS ONLY FINANCIAL YEAR 2011-2013. PERÚ
64,016,110
88,556,36292,151,997
0.00
50,000,000.00
100,000,000.00
150,000,000.00
200,000,000.00
250,000,000.00
2011 2012 2013
PIA
100,000,000
50,000,000
$
Fuente: Power Play del 18-10-12/MEF
4%
BUDGETING FOR RESULTS
Fuente: Consulta Amigable_MEF: 15.01.2013
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
80,000,000
90,000,000
PIM2011GOBIERNONACIONAL
PIM2011GOBIERNOREGIONAL
PIM2012GOBIERNONACIONAL
PIM2012GOBIERNOREGIONAL
3043965 PERSONA QUE ACCEDE AL EESS Y RECIBETRATAMIENTO OPORTUNO PARA TUBERCULOSISESQUEMAS 1, 2, NO MULTIDROGO RESISTENTE Y
MULTIDROGO RESISTENTE
19,197,911 12,533,394 18,999,162 20,179,659
3043964 DIAGNOSTICO DE CASOS DE TUBERCULOSIS 13,809,671 12,668,833 23,404,862 40,558,928
3043972 PERSONA QUE ACCEDE AL EESS Y RECIBETRATAMIENTO OPORTUNO PARA TUBERCULOSIS
EXTREMADAMENTE DROGO RESISTENTE (XDR)1,051,039 2,203,538 9,023,178 4,288,989
3043962 DESPISTAJE DE TUBERCULOSIS ENSINTOMATICOS RESPIRATORIOS
2,117,952 13,393,072 15,474,265 18,111,323
$
827,325
7,882,679 7,421,548 4,895,857
1,675,386 3,524,679 860,757 410,562
15,843,331 9,142,524 4,948,763 5,394,403
7,074,736 6,044,635 5,231,669
40,000,000 30,000,000 20,000,000 10,000,000
BUDGET ALLOCATED FOR SCREENING, DIAGNOSIS AND TREATMENT NATIONWIDE
(2011-2012)
BUDGETING FOR RESULTS
Increase 409%
Increase 109%
7,499,184
Person accessing the health facility and receive prompt treatment for tuberculosis schemes 1 and 2, no multidrug-resistant and multidrug-resistant
TB screening for respiratory symptomatic
Person accessing the health facility and receive prompt treatment for extremely druggie resistant tuberculosis (XDR)
Diagnosis of tuberculosis cases
Sensitive TB MDR TB XDR TB
Characteristics Duration of treatment
6 months 18 - 24 months 24 months or +
Cost 40 USD 4000 USD 70000 USD
Costs of anti-tuberculosis treatment
Oficio Circular N° 008-2012-
SIS/J (18.04.2012) SIS y TB:
Official Circular N° 008-2012-SIS/J (April 18, 2012)
I. Tuberculosis in any of its forms is funded clinics Integrated Health System (SIS), for all our insureds of the scheme / subsidized component in both pilot areas Universal Health Insurance (AUS), as in areas governed by Supreme Decree No. 004-2007-SIS.
II. In patients diagnosed with tuberculosis, the only features that are not funded through the SIS, are those that already have other funding
sources, such as the following features that are funded by the National Health Strategy for Prevention and Tuberculosis Control:
Detection of respiratory symptomatic
Diagnosis: Diagnostic Tests, bacilloscopies, crop and sensitivity test. Treatment: Medication management and strategic anti tuberculosis drugs.
Politic commitment: local and sectoral budget: Alliance "Lima breathes life together against tuberculosis”,
September 11, 2011
• Ministry of Health • Ministry of Housing, Construction
and Sanitation • Ministry of Development and
Social Inclusion • Ministry of Women and
Vulnerable Populations • Ministry of Education • Ministry of Labor and
Employment Promotion • Production Ministry. • Metropolitan Municipality of Lima • Municipality of La Victoria • Municipality of El Agustino.
Multisectoral model focused on People Affected by Tuberculosis: Component Biomedical and Social
Determinants
quick sensitivity test
Tto sensible,
MDR /XDR
Control and monitoring /
Complications / RAFAS / Surgical
EESS: Hospitals
PAT / social determinants
M.
Pro
du
ctio
n
M. L
abo
ur
M. H
ou
sin
g
MIN
DES
/MID
IS
M. J
ust
ice
M.
Edu
cati
on
SIS/ IAFAS
TB screening
Regions / local government
PpR
PpR
PpR
SIS/ IAFAS
INS
MINSA / EsSalud / OTHERS SUBSECTORS INTERSECTORAL / INTERGOVERNMENTAL
ACMS
1. Expand insurance coverage.
2. Increase participation Multisectoral, Intergovernmental and local.
3. Strengthen addresing the social determinants of tuberculosis.
4. Approval of the law of tuberculosis.
5. Strengthen and closing gaps in human resources.
6. Expand the network of laboratories at national level.
CHALLENGES