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News and updates, april-october,fy2013

(April-September, 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 Francis Giltongin 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 Administrative Cost $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- International Attention ministrative Budget as shown in the breakd By law, the annual administrative budget s hould not ex ceed 10% of the projected Ambassador Zhang 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- $381,926 $358,729 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 $646,692 $505,620

ci l Status Reports (Octo By Davelyn Welles David Statement of Net Assets Cash and cash equivalents Premium receivable Accounts receivable, net Prepaid expenses Total current assets Noncurrent assets: Fixed assets, net LIABILITIES AND NET ASSETS Current liabilities: Accounts payable - medical claims Accounts payable- others Total liabilities 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 Financial Reports Davelyn Welles & Accounting other readers: how do you find our new The News & Updates and how else can we improve Utilization Updates Dr. Jordel Maravilla & Utilization Staff Please send in your views, comments to [email protected]. Referral Updates 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 personal purposes; 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 Non-Medical Bills 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 Urology/Ophthalmology 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. Different Diagnosis 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. $2,810,983 $2,810,983 • Endoscopic procedures for Gastrointestinal problems, ENT, $2,970,896 $2,890,940 Gynecologic disorders, Renal and Ureteral conditions, and $2,509,568 $2,763,816 Bladder disorders. $2,464,380 $2,688,957 • Arthroscopic procedures for Orthopedic disorders • Ultrasound-guided aspiration for cystic lesions; $2,478,429 $2,646,851 • Ultrasound, CT scan, MRI to determine any organ $2,065,113 $2,549,895 involvement in pathology, $2,160,916 $2,494,326 • Specialists such as ENT (e.g. Tonsillectomy) and Opthalmol- $2,600,962 $2,507,656 ogy (e.g. cataract extraction). $2,469,095 $2,503,371 $2,401,628 $2,502,482 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 $413,898.68 (31%) $630,704.11 (40%) Oncology (Cancer) $176,783.63 (13%) Oncology (Cancer) $198,331.22 (13%) $140,560.18 (10%) $188,461.07 (12%) $108,838.11 (8%) $101,899.48 (6%) $100,595.80 (7%) 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 Collecting Office 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 Donations/Fun/Walk 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 C. Off-Island-Manila 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 Female (Overall) 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 Nestor Nebarrasa 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 Kolonia, Pohnpei 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