News and updates, april-october,fy2013
Board of Directors
Advancing Towards Legalizing MiCare Presence in Manila
The FSM Assistant Attorney, Mr. Joses Gallen
accompanied by the MiCare Administrator, Nena S.
Nena met with a Makati based law firm last October
14, 2013 to discuss the possibility of extending legal as-
FSM National Government
sistance to MiCare. There is a need to register in the
Philippines as a foreign entity the representative Office
of MiCare Main Office to perform non-profit medical
referral coordination hence the meeting with this law
(Chuuk seat stil vacant)
FSM Assistant AG, Joses Gallen discusses MiCare
presence in Manila with Attorney Gerry Paras and
The outcome of the discussions and understand-
ing between the two parties led to the eventual execution of a retainer agreement between
the lead Attorney, Mr. Paras and the MiCare Administrator.
Based on the agreement, the following documents will be furnished by MiCare: (1) A
MiCare Manila Office to Resolution Adopted by the MiCare Board of Directors approving the establishment of a Rep-
resentative Office in the Philippines; (2) Copy of the MiCare Law in lieu of the Charter of
Corporation; and (3) Copy of the MiCare Regulations.
Unaudited Net Assets
Pi cks Up in FY13
Based on the commitment by the law firm, they will assist MiCare to register and file
all the necessary documents with the appropriate agencies within the Philippine Government. (
Continue on page 7)
Referral to Guam in
2013 Fun Walk Winners,
McDonald Marcus won the overal
page 15. More photos on
Male and 18 Years and under age
Unified Bil ing System is
categories at 19.13 minutes.
negotiation with CMC
Administrative Budget Approved at 8% of Projected Revenue
Diseases Tops Causes of
The projected revenue for
the new fiscal year2014, is about
$6.3 million based on the prelimi-
nary listing of membership enroll-
Clinical Diagnosis in
ment. The Management and staff
requested and was approved by the
Board of Directors, 8% of projected
SPC: Pacific HIV Gets
revenue or about $505,000 for Ad-
ministrative Budget as shown in the breakd
By law, the annual administrative budget s
hould not ex ceed 10% of the projected
revenue in each fiscal year.
Personnel budget makes up about 71% of the Administrative budget, followed by the
Contractual services at 16%. Major activities under the contractual include the Medical
Claim Audit, Pharmacy Audit and the Actuarial Survey.
Bits and Pieces!!
3. Actuarial Survey is Scheduled for
1. MiCare Manila Office on the Verge of
The FSM laws require that MiCare perform
During a staff meeting in Manila last October 11, the actuarial survey every 3 years to review the financial Administrator informed the Manila based staff that if health of the health insurance plan and to recom-the presence of MiCare office in the Philippines will mend ways and means to improve its financial sol-cause legal ramification, it is more likely that closure vency, including possibility of premium adjustments of our operation as a referral coordination office will and legal actions to adjust coverage and exclusions. be soon in effect. One possible option is to close
The first actuarial survey was done in 2007.
the MiCare Due to the financial constraints, subsequent surveys
in could not be carried out . There was an attempt in
Manila until 2010 but no consultants were interested because of ongoing ne-
the low bid amount.
The next actuarial survey will be performed
the between January and March 2014. Bidding an-
Manila Staff: Glenda Remo, Rogean and Peter Gugol
Philippines nouncements have been published and sent out to G o v e r n -
the prospective consultant groups.
ment has become official.
4. POHNPEI STATE TAKES SERIOUS STEPS TO AD-
Another option is to place our Manila opera-
DRESS NCD EPIDEMICS CRISES
tion under a Third Party Administrator (TPA). Sev-eral prospective TPAs have approached MiCare and
Governor of Pohnpei, the Honorable John Esha,
some voluntarily expressed interests to coordinate recently issued an Executive Directive establishing
MiCare's referral programs in Manila. MiCare also measures to seriously address the None-Communicable
informed the Manila Office staff to establish their Disease epidemic in Pohnpei. The Executive OrderNo own TPA, if interested.
01-10 cited the status of NCD in Pohnpei based on the
Several unscheduled meetings were also con-
recent Step Survey conducted in Pohnpei:
ducted to discuss the interest of organizations and 1. 32.1% of adults have Diabetic Mellitus;
2. 73.1% of the NCD patients are suffering
individuals who may have the potential to become from obesity or overweight caused by fat;
3. 21.2 % of NCD epidemic patients are suffer-
ing from hypertension (high blood pressure);
2. FY2014 Admin Budget (Story on page 1)
4. 46.6% of NCD epidemic patients are suffer-
ing from hyperlipidemia (excessive of fat)
After the Board approved the FY2014 Adminis-
5. 63.8% of NCD epidemic patients are suffer-
trative Budget, the table below shows the adjusted alloca-
ing from physical inactivity.
tion for each budget activity. (story on page 1)
The Executive Directives calls for the establish-
ment of a NCD Task Force "to formulate, coordinate
and manage a Pohnpei State NCD Strategic Plan to ad-
dress the crises" and further calls upon all leaders, gov-ernment and non-governmental organization to assist
the NCD Task Force in the implementation of the NCD Strategic Plan.
3 Fixed Assets $39,250 $1,500
The Task Force will monitor and report to the
Governor about its progress.
The Executive Order was issued last November
ci l Status Reports (Octo
By Davelyn Welles David
Statement of Net Assets
Cash and cash equivalents
Accounts receivable, net
Total current assets
Fixed assets, net
LIABILITIES AND NET ASSETS
Accounts payable - medical claims
Accounts payable- others
Commitments and contingencies
Invested in fixed assets
Total net assets
Total liabilities and net assets
NET ASSET PICKS UP in FY2013 but is still
Net Asset: FY2005-FY2013
below the levels attained in FY2010 and FY2011 based on the unaudited Statement of Net Assets presented
recently by the Accounting Division of MiCare.
The FY2013 closes with a net asset of $633,926 about $276,326. more than in FY12. This is about
44% increase from the audited FY2012 Net Asset of
$357,600. A fluctuating trend in the Net Asset will continue
into the ensuing years until a stabilization measure is
taken up to ensure a continuous upward growth. Stabilization action would include the adjustment to
the premiums fees and exclusions of the pre-existing
conditions, among other things. (see table at left)
The News & Updates
MiCare Is Bound Towards Financial Weaken-
Promissory Notes Complying Members
ing Due to Unpaid Promissory Notes
1. Jimmy Eldridge 8. Arsenia Ligohr
Since 2010, MiCare instituted an easy repay-
2. Guston Lighor 9. Carmen Ngirmidol
ment approach to assist referral patients who en-
3. Santos Wilson 10. Mirah Waguk
counter difficulties in advancing 50% of prosthesis
4. Parmenio Pelep 11. Ismael Lebehn
(artificial hips, stent, etc.) costs. The approval proc-
5. Julie Gilmete 12. Reynold Seymour
ess included a notarized Promissory Note commit-
6. Julie Solomon 13. Apeleen Nayor
ting a patient and/or family members to pay back the
amount owed upon returning from referral treat-
The period of repayment, as stipulated in the
A Very Big Thank You!
signed Promissory Note is six (6) months.
As of the end of fiscal year 2013, the total
amount under the Promissory Notes was $157,178.
AN APPEAL TO THE RECIPIENTS OF THE
About 40% , or $63,082 has been paid off, and 60%
or $94,096 has not been paid.
If the unpaid amount is increased or the cur-
Since 2010, The Promissory Notes Has Been Very Help-
rent unpaid balance is not paid in a timely fashion,
ful To Nearly 100 Referral Patients, And The Number Is
there will be a significant adverse impact to the op-
Growing By Every Week.
erations of MiCare.
In Order To Continue The Program and Not To Inter-
The Management of MiCare is considering
rupt Your Future Access, Please Come To MiCare and
developing remedial actions to avoid financial weak-
Settle Your Account
By Settling Your Account, We
ening of its operations. While we are contemplating
Will Avoid The Following Inconveniences To Both Mi-
to come up with some administrative actions, we
Care and You: (1) Decision to stop the program; (2)
also wish to thank all those MiCare members and
Denial to the program's access; (3) Hiring a Collec-
families who have paid off their Promissory Notes.
PLEASE, VISIT MICARE OFFICES IN ALL
THE FOUR STATES, NOW!
Reserved Fund Glides Over 50% of Target
The MiCare Board of Directors has established a Reserved Fund level of $2.5 million as a target for
the next five years. As of the end of FY2013, the level of the Reserved Fund has just glided over the 50% of the target with about $1.4 million.
Due to the unpredictability of level of demands for covered services, especially off-island referrals,
a reserved fund was established by the
MiCare law. The Board of Directors
accordingly established in 2012 $2.5
million as a target which could hope-
fully be reached within the next few
As shown on the chart at left, a
gradual glide is shown since fiscal year
2010 and subsequently $1.0 million,
following by $1.2 mil. In fy2011, $1.3
mil in fy2012, and as the FY2013 has
yet to be audited, it shows a new level of $1.4 million.
The News & Updates
Referrals To The New Guam Regional Medical City (GRMC) Hospital Becomes
The opening of the 137 bed Guam Regional Medical City Hospital in Au-
gust, 2014 will provide tertiary state of the art diagnostic and medical treatment for the western pacific region, including FSM.
The meeting with Ms. Margaret A. Bengzon, the President/CEO of the
Medical City Hospital in Manila, is the third consultation between the Medical City and the MiCare.
On April 19, 2012, the MiCare Administrator met with The Medical City's
Manager of Relationship and Business Development Department, Ms. Millet P.
Margaret A. Bengzon
Escasinas, and Assistant Manager, Ms. Shirley J. Songco. During the meeting, the possibility of referring MiCare patients to the new Guam based Hospital was discussed. MiCare was informed that referral to the new Hospital in Guam will be prioritized based on those "faithful" utilizer of the Medical City Hospital in Manila. Although MiCare has an affiliation MOU with the Hos-pital, it is not a basic referral facility for MiCare patients. Only a few supplemental referrals went to the Hospital during the past several years.
During her presentation to the APIL last June 14-16 in Honolulu, the President/CEO Ms. Mar-
garet A. Bengzon confirmed to the legislative body that the new regional hospital in Guam will pro-vide the best medical services in the region and will accept referral patients from all the Micronesian jurisdictions, including MiCare members. While in Honolulu, the President/CEO and her staff ex-tended the invitation to meet with MiCare.
The meeting in Manila last Octo-
ber 10, 2013 was to reaffirm the com-mitment in Hawaii through an official af-filiation Memorandum of Understanding (MOU). A draft MOU was advanced to the President/CEO. However, she re-quested that since the Hospital will be up and will be in operation by August, 2014, a final meeting sho
nated so the draft MOU could be exe-
cuted, including the types of diagnostic and medical services to be provided and the appropriate fee schedules to be
Located at Dedeto, near the Micronesian Mal , The New Guam Regional Medical City Hospital is
under construction , wil be opened in August 2014. (Photo taken last October 20, 2013)
applied to the MiCare members.
(Photo taken last October 20, 2013)
The News and Updates
WE'D LOVE TO HEAR FROM
We would like to know from our members and
Davelyn Welles & Accounting
other readers: how do you find our new The
News & Updates and how else can we improve
Dr. Jordel Maravilla &
Please send in your views, comments to [email protected]
Glenda Ramo, Manila
Shrue Joseph, Main Office
The News & Updates
ANNOUNCEMENT TO REFERRAL PATIENTS AND FAMILY ATTENDANTS
Please, be informed that the following items are not covered by MiCare and should be billed directly to the patients: 1. Personal items of Family Attendants (toiletries, towel, linen, food and water, pillows) 2. Slippers 3. Xerox of any material not related to claim processing 4. Phone calls with charges 5. Basin and Dippers that will be issued that are not part of medical care or room packages but rather for
6. Laundry and Ironing 7. Extra utensil and cups/tumblers other than what is issued in the admitting kit 8. Extra towels that is not part of the usual accommodation package of the room 9. Disposable pillows 10. Extra linen that is not part of the usual accommodation package of the room 11. Special food requests 12. Special Requests that are not part of the medical treatment and not sanctioned by MiCare 13. Extra Tissue Paper that is not part of the room package 14. Toiletries not part of the admitting kit and room package like soap, lotion, powder, gel, shampoo, condi-
tioner and body wash,
15. Take home over the counter items. The MiCare Management Seeks Cooperation from All in order to Continue Extending Services
To Other Members.
NEW MEMBERSHIP CARD WITH PHOTO
BEGINNING JANUARY 1, 2014, MICARE WILL
Care ($3.00 ea.)
START ISSUING A NEW MEMBERSHIP CHARD WITH
PHOTO AS SHOWN ON THE RIGHT.
THE COST OF THE NEW CARD IS $3.00.
THOSE MEMBERS RESIDING IN POHNPEI MAY COME
TO THE MAIN OFFICE TO ACQUIRE YOUR NEW CARD.
Care ($1.00 ea.)
THOSE MEMBERS IN YAP, CHUUK AND KOSRAE MAY GO TO THE RESPECTIVE FIELD OFFICES TO APPLY AND TAKE YOUR PHOTO. THEY WILL BE SEND TO
CALL MICARE AT THE FOLLOWING NUMBERS:
THE MAIN OFFICE FOR PROCESSING AND WILL BE
1Yap Field Office 350-2115
RETURNED TO THE FIELD OFFICES FOR ISSUANCE.
2.Chuuk Field Office 330-5891
THE CURRENT BLUE COLOR CARD WILL STILL
3.Kosrae Field Office 370-2935
BE USED UNTIL SEPTEMBER 30, 2014.
4.Main Office 320-2549
Legalizing MiCare Presence in Manila … from page 1
MiCare has been attempting to legalize its presence in Manila since February, 2012 but to no avail.
After the recent consultation meeting with the Philippine Undersecretary of Foreign Affairs, the Honorable Madame Laura Del Rosario, last September, 2013 in Pohnpei, MiCare Management and the Board of Direc-tors were briefed on steps to officially register MiCare to operate in Ma- nila.
A breakfast consultation meeting was arranged for the Undersecre-
tary and other PI officials who accompanied her to the FSM including, Ber-nardita L. Catalla, Exective Director of Office of Asian and Pacific Affairs, PI Consulate General in Guam, Bayani Mangibin, and Dr. Merlyn Abello-Alfonso, the newly designated Philippine Honorary Consul in the FSM.
The efforts to legitimize MiCare's coordination activities in Manila
was initiated early 2012 when the Main Office was alerted about the need to register with the Philippine Government.
Undersecretary of Foreign Affairs, the Honorable Madame Laura Del Rosario
The initial face-to-face discussion with PI Official was made in
March 6, 2013 when the Director of Office of Asian and Pacific Affairs Ms. Bernardita L. Catalla visited MiCare Main Office here in Pohnpei to familiarize herself with the MiCare coor-dination needs and other related issues in Manila.
The meeting in Manila between Assistant AG, Mr. Gallen and the Attorneys for the Paras and Manla-
paz law firm will hopefully bring a legal status for MiCare coordination activities in the Philippines
MiCare Negotiates Unified Billing with Capitol Medical Center
On October 9 & 14, 2013, the MiCare negotiated with Capitol Medical Center (CMC) to have a uni-
fied billing system to merge the Professional Fees and Hospital base services. The intent of a Unified Billing system is to avoid multiple processing of payments to numerous doctors offices separate from the Hospital bills. The current system results in additional costs and unclear and sporadic billings even for a single pa-tient. It also delays billing submission to MiCare and at times numerous complaints directly to MiCare for late payments.
Currently, Affiliation Agreements are executed between MiCare and the Hospitals. However, there
are two types of billings: one from the Hospital and one from each doctor's office, better known as the Pro-fessional Fees. The Physicians' Offices seemed autonomous and not legally obligated to bind with the MOU executed by MiCare and the Hospitals. Hence, individual physician may refuse to attend to MiCare referral patients if he/she does not agree with the established doctor's fee. Likewise, MiCare has no legal obligation to reimburse those physicians attending to our patients because the MOUs with the Hospitals do not estab-lish the working relationship between MiCare and the physicians.
If the Unified Billing works out well with CMC, similar arrangement will also be negotiated with
other affiliated Hospitals in Manila.
The email exchanges on this issue between MiCare and CMC is ongoing and hopefully the proposed
unified billing system will be implemented by January, 2014.
The News & Updates
Basis Referrals in FY2013
For the Fiscal Year 2013, we had a total of 228 Basic referrals that was catered to. 1 of the referrals
was from Yap and was sent to Pohnpei for Laparoscopic Cholecystectomy and another was an ENT referral that opted to use the Veterans Option. The rest of the 226 members were sent in the Philippines for Treat-ment.
For the 226 members that was sent to Manila, Micare paid $1,578,077.29 for medical bills (missing still
3 Hospital bills and 53 Professional fee billing) and $273,837.10 for non-medical bills (airfare, ambulance, VISA). The total Utilization at present for the Basic referral is totaled at $1,851,926.10.
Table 1. Comparison of FY12 and FY 13 for Cost Utilization
No. of referrals
Total Cost of Referral
Out of the 226 people referred, 135 were male and 91 were female. That would mean that 60% of
the referral were male compared to 54% back in FY12. The age distribution for each sex were the same in both FY12 and FY13. The Male population tend to be more between the age group of 41 to 70 while the females tend to be between 31 to 60.
For purposes of referral, while FY12 had 66% of the referral to be for Diagnostic purposes, FY13 had
76% of the referrals for the same reason.
For t he Top 5 reasons for referral, we still have Cardiology as the consistent top rater for the past 3
years. It is followed again by Orthopedics which also stayed in the same ranking for 3 years. Urology is in third for the second year but this time, it is accompanied by Ophthalmology. The fourth top reason for re-ferral is Surgery and in fifth we have a tie between ENT and Neurology.
Table 2. Comparison of Top 5 reasons for referral in FY12 and FY13
Although the above mentioned are the top 5 reasons for sending patients to Manila, they are not nec-
essarily in the same ranking when it comes to actual Utilization cost of the referral.
Continue on page 13
The News & Updates
The News & Updates
KOSARE'S LEADERS EXCHANGE ISSUES WITH MICARE
During the Board of Directors meeting in Kosrae last July 2-5, the members were accorded separate
consultation meetings with the Governor, Lt. Governor and some cabinet members, Speaker and members of the Legislature, and the Director of Department of Health Services and key staff.
In his opening remark during the consultation
meeting with the Governor of Kosrae, the Honorable Lyndon H. Jackson, Chairman Kapilly Capelle "expressed the importance of going to the States to get in touch with concerns of MiCare members". In his statement to the Legislature, Mr. Capelle repeated the importance of conducting Board meetings in the States to the Speaker
L-R: Governor Lyndon H. Jackson, Speaker Gibson Siba and
Health Director Dr. Livinson Taulung
and members of the Legislature, he said, "this visit is sig-nificant since it is the first and I believe that it is important that the Board meet the heads of the different States to get a firm grasps on what is going on and what needs to be addressed.
The issues brought up during the separate meetings with the Leaders in Kosrae include the following
1. Reimbursement to the Kosrae State of unused co-payments for prosthesis;
2. Concern of increase premiums beginning FY2013 while capitation payment to the States remain the
3. Concerns that MiCare is paying for vaccines in the private clinics.
4. Membership of MiCare seems stagnated at 20% of the FSM population
5. Restructure the coverage (eliminate exclusions ) to entice enrollment
6. Operation of MiCare should be assess: (a) Management should do better marketing to promote
the plan, (b) Board as well should look into the laws and make amendments to improve services; (
7. MiCare should consider increase number of dependents from the current four;
8. Prosthesis of stent and pacemakers are life saving devices, therefore coverage should increase.
9. 5% Patient share of the airfare should be eliminated.
10. MedPharm Optometry services to continue extension with MiCare coverage
11. Some of the congenital diseases be removed from exclusions prognosis will improve if treated;
12. Support the intent of the FSM Diagnostic Facility
In an official response dated September 23, 2013 to the Governor Jackson with copies send to the
Speaker, the Chairman cited that "While many issues were addressed and clarified during our consultation meetings iand in the interim, others are yet to be answered, specifically: 1) decrease patient share of prosthe-sis cost, 20 increase capitation allocation to Kosrae, 3)elimination of 5% patient share of airfare cost, 4) in-crease number of child dependent from 4 to more, and 5) remove certain congenital anomalies from the ex-clusion clause."
The Chairman explained the next steps in his letter: "The Board met in Pohnpei from September 9-
10, 2013 to consider, among many other pressing matters, the above outstanding issues. The ?Board reaf-firmed its position and tasked the Management to undertake an internal financial analysis and procure an ac-tuarial study to analyze the current and the projected financial position of the Plan. In the process these re-quested changes will be tested so their implications can be determined in order for us to address them prop-erly forward.
Accordingly, the Micare will perform an Actuarial Survey between January and March, 2014. Funding
has been approved and solicitations for short-term consultancies has been published in the Kaselelia Press and through emails
The News & Updates
F Y2014 Enrollment
FSM Nat'l. Gov't.
College of Micronesia
FSM Social Security
Micronesian Leg Ser
Agencies & Private
Private Businesses Top 2014 Enrollment at 28%; Pohnpei State Slides To 27%
For the first time in the MiCare enrollment history, Private Businesses surpasses all, including previ-
ous years' topnotcher Pohnpei State, in enrolling more members to the MiCare Health Plan, at least during the beginning of FY2014. Most of the private businesses are in Pohnpei with both enrollees and dependents totaling to 4,321.
Private Businesses in Yap enrolled 488 members, followed by Kosrae's 332 and Chuuk's 105 mem-
Among the 5 Governments in the FSM, Pohnpei State enrolled 5,082 (27%), FSM National Govern-
ment enrolled 2941 (16%), Kosrae has 1713 (9%), Yap has 793 (4%), and Chuuk has 434 (2%).
College of Micronesia in Palikir and the four State campuses enrolled a significant 7% or 1,383 mem-
bers. Other participating agencies include Land Grant (42), FSM Social Security (175), FSM Development Bank (138), Bank of FSM (251) and Micronesia Legal Service (81).
The table above reflects the beginning of the fiscal years enrollment statistics. During the course of
the year, the membership may be adjusted down or up due to the additional enrollment, deaths, termination of enrollment, termination by default, changes in residency, and others. In FY2013, the beginning count was 19,191 but by June 2013 and perhaps towards the end of the fiscal year, the adjusted enrollment number was 18,593, a decrease of 3% of about 598 members.
The top five participants in the MiCare this fiscal year contribute about 87% of the enrollment or
16,373. These are Private Businesses, Pohnpei State Government, FSM National Government, Kosrae State Government and College of Micronesia-FSM.
Fluctuations of enrollment is anticipated again this fiscal year. Efforts to bring in participations of Yap
State and FSM students are still ongoing.
The News & Updates
The News & Updates
CLINICAL DIAGNOSIS IN THE FSM HOSPITALS HAS SHOWN IMPROVEMENT
Since FY2009, MiCare has been monitoring the reasons for off-island basic referrals as clinically di-
agnosed in our Hospitals in the FSM and compare it with the final diagnosis when a patient went through the more advance diagnostic procedures in the tertiary Hospitals in Manila.
The Table below shows significant improvement of Same Diagnostic from 62% in FY2009 compared
with 78% in FY2012
and 81% in FY2013.
has decreased from
38% in FY2009 to 19% in FY2013.
own advance diag-
nostic equipment with proper training, staff-
ing and appropriate support services there will be a significant reduction or elimination of Different Diagnosis . Off-Island referrals will be still needed, but purposes of referrals will be more definitive.
The average annual cost of MiCare off-island referrals over the past 10 years (since 2004) is $2.5 mil-
lions (see table at bottom). A significant portion of the cost of referral each year is attributed to the advance di-agnostic procedures and the high cost of associated professional fees. With an advance diagnostic facility in the FSM, examination results will be brought by patients to Manila and there will be no need to repeat same proce-dures while in Manila.
There are spill over benefits of having the FSM own diagnostic facility other than reduction of cost to
MiCare: (1) Other non-MiCare patients in FSM will have full and equal access to the advance diagnostic facili-ties or services; (2) Referral from both MiCare and the State Hospitals will be more definitive rather than repeat-ing the "referral for further diagnostic"; (3) More dependent on own medical technology and skills in the FSM, rather than continue to depend on other countries to run diagnostic procedures on our patients; and (4) Develop more confidence in providing quality health services in the FSM.
Based on a diagnostic capacity study in the FSM conducted by a MiCare's consultant on November-
December, 2009, types of needed di-
7 Recommendations presented by the
agnostic procedures were identified
2009 Diagnostic Capacity Study
and are listed on table at left.
• Coronary Angiogram and Echocardiography for Cardiovas-
Off-Island Referral Costs
cular Conditions •
Biopsy to rule-out malignancy (breast, lung) ;
Bone Marrow biopsy to rule out Hematologic Disorders.
• Endoscopic procedures for Gastrointestinal problems, ENT,
Gynecologic disorders, Renal and Ureteral conditions, and
• Arthroscopic procedures for Orthopedic disorders • Ultrasound-guided aspiration for cystic lesions;
• Ultrasound, CT scan, MRI to determine any organ
involvement in pathology,
• Specialists such as ENT (e.g. Tonsillectomy) and Opthalmol-
ogy (e.g. cataract extraction).
HEALTH & RELATED NEWS AROUND THE REGION
Pacific HIV response gets international attention
Monday 25 November 2013, Secretariat of the Pacific Community (SPC), Suva, Fiji –
A packed Pacific satellite session at the International Congress on AIDS in Asia and the Pacific (ICAAP) in
Bangkok, Thailand last week catapulted Pacific perspectives, data and successes onto the international stage.
His Excellency Ratu Epeli Nailatikau, President of the Republic of Fiji, opened the session entitled ‘The Pacific
voyage: the five year response to HIV and other STIs and a glimpse beyond 2013' while Ms Joey Joleen Mataele, Tonga Leitis Association President, astounded all by singing the opening prayer in a strong, operatic voice.
Nine speakers from across the Pacific, including three from SPC's Public Health Division, participated in the
session, which featured the latest data on HIV epidemiology in the Pacific, and the successful rollout of rapid HIV testing, enabling faster diagnosis of HIV in all targeted Pacific Island Countries and Territories.
‘In the last 5 years, the smaller countries of the Pacific and its larger sister nation Papua New Guinea have
responded to both the HIV and STI epidemics in a structured and considered manner, tackling the behavioural, so-cial, cultural, legislative, health systems and economic factors that drive or hamper our responses to both HIV or STI epidemics,' said H. E. Ratu Epeli Nailatikau.
‘This satellite session pulls together some of the work that has been done both in Papua New Guinea and
the smaller island nations of the Pacific. We share our stories with you today in a celebration of our united efforts and to offer you the new direction and the approach that the Pacific will take in addressing what we consider to be the key challenges facing our people,' he said.
the Pacific satellite session was organised by the Oceania Society for Sexual Health and HIV Medicine
(OSSHHM) and made possible due to support from the Australian aid programme and the Pacific Islands HIV and STI Response Fund. The topics and speakers are included below.
Rapid diagnosis of HIV infections in Pacific Island Countries and Territories – Tebuka Toatu, SPC
Keeping Pacific Island countries HIV free – Ian Wanyeki, SPC Adherence, Side-effects and Support: Experiences of Treatments among People Living with HIV in the Pacific Is-
lands, Hilary Gorman, Cook Islands National HIV, STI & TB Committee
The Role of People Living with HIV in the Pacific HIV Response – Rebecca Kubu, Pacific Positive Working Group Church Beliefs and Professional Practice: How Christian Health Workers Respond to HIV in PNG– Lalen Simeon
and Christopher M. Sohenalo'e, Pacific Adventist University, PNG
OSSHHM Pasifika Training-of-Trainer programme on HIV and STIs: a south-south collaboration – Jason Mitchell,
Foreskin Cutting Practices and the Acceptability of Male Circumcision for HIV prevention in PNG - Rachael Tom-
mbe and David MacLaren, Pacific Adventist University/ James Cook University
The Pacific Regional Sexual Health Shared Agenda 2014 - 2018: Achieving Zero - Michelle O'Connor, SPC PNG HIV Epidemic: an Update and the Way Forward – Dr Moala Robert Kariko, Papua New Guinea AIDS Coun-
The News & Updates
Basic Referral in FY2013 … from page 8.
Table 3. Comparison of Top5 Utilization Cost of Referral in FY12 and FY13
Incidentally, in this population of referrals, it was noted that 25% had Diabetes Mellitus, 39% had Hyperten-sion and 23% had high cholesterol.
FY2013 DISBURSEMENTS EXCEEDED
COLLECTIONS BY ABOUT $73,000
Premium Due for this Current Year Col-
Collection was only 91% of the projected $6.7 mil- lected this Report Period
lion in FY2013. The final collection at the end of the fiscal
year was $6,221,370 million (see table at right).
Employee payroll payable
The disbursements on the other hand almost lev-
Chronic Refill Option Deductible **
eled off with the collection with a difference of about
$73,000. The end of the year disbursement total was Collections for Processing ID Cards **
6,294,394 (See table on page 14). Collection from Premi-
ums was $6.0 million, or about 97% of the total collections. Collections of Patient Share Accounts ** $ -
Other sources of revenue include the chronic refill option,
patient's share and the annual FSM National Government Collections from Other income-forms
The National Government and its Agencies contrib- Congress Appropriation/Escrow Account
uted about $2.0 million (33%) followed by the Pohnpei
State Government and its agencies at $1.8 million (28%);
and the Private Businesses—$1.2 million (20%). These top
three (3) participating accounts contributed about 81% of II. Premium Collections by Participating
the total collection in FY2013.
The contributors from the other three State Gov-
ernments totaled to $815,328 (13%).
Name of Participating Accounts
FSM National Govt. & Agencies
Kosrae State contributed about $457,800. Yap
Pohnpei State Govt. & Agencies
State, though it is not a participating account, contributed a Kosrae State Govt. & Agencies
significant $237,905. Chuuk State with its own health in- Chuuk State Govt. & Agencies
surance program, contributed about $119,623.
Yap State Govt. & Agencies
Individual Accounts, those who previously worked Private Businesses
with the participating agencies and were later retired but Individual Accounts
selected to continue membership as individual enrollees, Others **
contributed about $191,898.
The News & Updates
I. MEDICAL CLAIMS
Of f-Island Hospitals received 38%, On-Island Private
A. Off-Island- Hawaii
Clinics received 33% while State Hospitals received
1. Straub Clinic & Hospital
11% of the FY2013 Reimbursements
2. Kapiolani Medical Center
3. Mina Pharmacy
4. Various Clinics/Hospitals (Hi) 26,025.13
The FY2013 disbursement clearly repeated the usual trend of
5. Various Clinics/Hosp (US)
directing most of MiCare financial resources to off-island Hospitals
and to the local Private Clinics a cumulative percentage of 71%, leaving
B. Off-Island -Guam
1. The Doctors Clinic
a mere 11% to the four State Hospitals who are presently under capi-
2. Guam Memorial Hospital
- tation reimbursement.
3. Perezville Pharmacy
From the $2.4 million disbursed to the off-island affiliated hos-
4. Various Clinics/Hospitals
pitals, 75% was expended in Manila, 3% in Guam, and 22% in Hawaii.
The upsurge of costs in the private clinics in the FSM, mostly
1. St. Luke's Medical Center
in Pohnpei, are attributed to the following: (1) Increase number of
2. Capitol Medical Center
dental clinics and pharmacies; (2) More visitations to the private clinics
3. Philippine Heart Center
due to desirable, quicker and less queing of services, and availability of
4. National Kidney Institute
5. Delos Santos Medical Center 303,618.54 6. The Medical City
The additional affiliated clinics during FY2013 include (1) Gene-
6. Various Mla Doctors (Prof.
sis Dental Clinics (2) Genesis Physiotherapy (3) Island Smiles Dental
Clinic, (4) Caroline Dental Clinic, and (5) Caroline Pharmacy. The to-
7. Various Clinics/Hosp/Vendors 41,870.87 tal reimbursement to these new clinics was $118,951. Disbursement
to Genesis Physiotherapy is not clearly shown as it is part of the
Total Off-island Payment
D. On-Island Private Clinics
- Genesis Clinic Out-Patient and In-patient clinics.
1. Genesis Clinic (Out-Patient)
As shown in the table at left, Genesis Hospital & Pharmacy was
Genesis Clinic (In-Patient)
reimburse a total amount of $1,383,680 during the last fiscal year,
Genesis Dental Clinic
about 22% of the total reimbursement. Tracking far behind Genesis is
2. Pohnpei Family Health Clinic 136,901.93 3. MedPharm Clinic/Optical
Straub Clinic & Hospital in Honolulu with $428,497 (7%)n and Pohnpei
4. Bersysin Comm Health Clinic 111,453.87 State Hospital with 420,000 (7%). 5. Sefin Health Clinic
The Administrative Costs maintains its 10% share of $647,291
6. The Family Clinic
as required by the law.
7. Kaselehlie Dental Clinic
According to the unaudited disbursement shown on the table
8. Island Smiles Dental Clinic
9. Caroline Dental & Pharmacy 19,019.52 at left, MiCare spent about $286,186 to pay for the patients' ticket,
not including the 5% patient's share.
E. On-Island State Hospitals
1. Pohnpei State Hospital
Disbursem ents to Off-island Facilities
2. Chuuk State Hospital
3. Kosrae State Hospital
4. Yap State Hospital
F. Reimbursements (Medical
G. Replenishments of Accounts -
G. Airfare Tickets (Patients)
Total Medical Claims Paid
II. ADMINISTRATIVE EXPENSES
I Annual MiCare Walk/Run
$2,810,98 $2,970,8 $2,509,56 $2,464,3 $2,478,4 $2,065,11 $2,160,91$2,600,9 $2,469,0 $2,401,62
V GHI Premium/Deposit Refund
Accum Ave $2,810,98 $2,890,9 $2,763,81 $2,688,9 $2,646,8 $2,549,8 $2,494,3 $2,507,65 $2,503,37$2,502,4
Total Cash Disbursement
The News & Updates
2013 MiCare walk/run race results Name
1. McDonal Marcus
3. Alex Alexander
1. Relo Liza Saimon
2. Marhy Alexander
12 Years and Under
4. Redfern Nethj
18 Years and Under
1. McDonald Marquez
3. Alex Alexander
Senior—45 and Over
1. Nestor Nebarrasa
3. Robert Nakasone
2013 Fun Walk Major Sponsors - Cash Contributions 1. Genesis Hospital $500.00 2. Caroline Fisheries $200.00 3. Bank of FSM $200.00 4. Bank of Guam $100.00 Other Contributions: 1. Genesis - 4 1-month Membership cards for Wellness Center 2. Pohnpei True Value - 5 Gift Certificates ($20.00 each)
Relo Liza Saimon
Winner of Overall
Winner of 45 Years
3. United Airlines - 5 caps, 5 umbrella and 5 bags
Overall Male and18
4. SPC—25 Cases of water bottle
5. Med Pharm—20 gift certificates (worth $200.00) 6. Australian Embassy-Banner ($120.00)
WE GREATLY APPRECIATE YOUR IN-
7. Kaselelie Dental Clinic –Slow Cooker 8. Moylans Insurance - 10 cases of water bottle
VALUABLE CONTRIBUTIONS AND FOR
9. Pohnpei LP Gas - Ice Cubes 10. COM-FSM PA System
YOUR PARTICIPATIONS DURING THE
11. Department of Public Safety - Escort,Safey
3RD MICARE FUN WALK/RUN. W'LL
12. NOC - Staff Support & Coordinations
The News & Updates
N IV in the Pacific
Friday 8 November 2013, Secretariat of the Pacific Community (SPC), Suva, Fiji –
he launch of the photography book Our Voyage: Stories of Triumph in the Response to HIV and other STIs in
the Pacific on Monday 11 November will mark a number of significant achievements as a result of support from the Pacific Islands HIV and STI Response Fund, a grant funded by the Australian and New Zealand governments and man-aged by the Secretariat of the Pacific Community (SPC) Public Health Division.
he book will be launched by His Excellency, the President of the Republic of Fiji, Ratu Epeli Nailatikau and
blessed by Major Iliesa Cola, Divisional Commander, The Salvation Army, at 6pm on Monday 11 November at the Holi-day Inn hotel in Suva.
SPC recognises the importance of programming on STIs and sexual health and is consolidating the significant
gains made to date as we look to the future, in partnership with Pacific Island Countries and Territories (PICTs). STI prevention and control is a key priority as reflected in the new SPC Public Health Division strategy 2013 - 2022,' says Dr Colin Tukuitonga, Director of SPC's Public Health Division.
With rates of sexually transmitted infections such as chlamydia as high as 32%, Pacific Island countries and
territories (PICTs) are rising to the challenge – successfully implementing targeted prevention and behaviour change communication campaigns, expanding voluntary HIV counselling and testing, strengthening laboratory services and improving chlamydia testing and treatment. PICTs are also collecting data on epidemiological trends to inform evi-dence-based decision-making and programming,' says Dr Dennie Iniakwala, HIV and STI Team Leader at SPC.
Nauru and Cook Islands, for example, where chlamydia has been aggressively targeted, have made consider-
able progress. In 2009, 49% of pregnant women in Nauru had chlamydia. In Cook Islands, it was 20%. By 2012, the pro-portion of pregnant women with chlamydia in Nauru and Cook Islands had dropped to 4% and 11.5% respectively.
argeted health communication campaigns are one of eight components of the regional STI control strategy
successfully implemented by Cook Islands. Another key component of this strategy was targeted population-based presumptive chlamydia treatment. Such presumptive treatment – whereby infection is presumed in people at high risk of infection whether or not they show symptoms – rapidly reduces the chlamydia rate in targeted groups.
Azithromycin was provided to the individuals with water, and they took the tablets on the spot. Booth style
clinics were set up around the island so that people could drop in and take their medication,' explains Cook Islands National HIV STI Coordinator Ana File.
A team of certified counsellors, a doctor and a laboratory technician provided mobile voluntary confidential
counselling and testing on the islands of Aitutaki, Pukapuka, Atiu, Mitiaro, Mauke and Mangaia in Cook Islands in an effort to make STI testing more accessible. Over 800 people took advantage of the mobile testing service, including prison inmates.
Mobile testing is important because outer islands do not always have access to HIV or STI testing. Making the
effort to go to them means we can provide on the spot counselling, testing and treatment and confidentiality is as-sured,' explains Ms File.
Success in STI control is just one of ten stories featured in the photography book, commissioned by SPC and
The News and Update
Federated States of Micronesia 96941
An interprofessional case study THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICAL TRAINING CAPACITY (ICTC) PROGRAM Asthma - an interprofessional case study At the end of this presentation students will be able to: • Give a definition of asthma• Discuss what could cause asthma• Identify four triggers of asthma• Describe symptoms of an asthma flare-up• Explain three asthma treatment strategies• Develop an interprofessional plan of care for
Psychiatria Danubina, 2014; Vol. 26, Suppl. 1, pp 315–321 Conference paper © Medicinska naklada - Zagreb, Croatia COMBINING ANTIPSYCHOTICS; IS THIS STRATEGY USEFUL? Jill Christy1,2, David Burnside1,3 & Mark Agius4,5,6 1School of Clinical Medicine, University of Cambridge, Cambridge, UK 2St Catharine's College University of Cambridge, Cambridge, UK