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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
John L. Fiedler, PhD, Social Sectors Development Strategies, 229 N. 10th Place, Sturgeon Bay, WI 54235-1748, 920-743-7710, jfiedler@itol.com and Gerard M. LaForgia, PhD, Department of Human Development, Latin America and the Caribbean Region, The World Bank, 1818 H Street, NW, Washington, DC 20433.
In1993 the Nicaraguan Social Security Institute (INSS) introduced a new health care financing and services delivery scheme, the Previsional Health Model (MSP). The MSP is a managed, competitive model under which INSS makes a fixed, monthly per capita payment to certified public and private sector firms to provide a basic package of health services to social security beneficiaries. The MSP constitutes a new approach marking a decisive break from the traditional modes of operation in the health sector of Nicaragua. Since its inception in late 1993, the system has steadily grown and now provides coverage to seven percent of the population, more than 350,000 persons residing in 16 of Nicaragua’s 17 departments through 46 certified medical care providing firms (EMPs). While the real value of the capitation rate has fallen by more than 20 percent since 1993, the EMPs’ efforts to introduce cost savings procedures into their practices have been limited to requiring pre-authorization of hospital admissions and by reducing average lengths of stay and providing fewer laboratory tests. With EMP physicians’ real remuneration increasing even while the real capitation rate has fallen, it may be inferred that EMP physician productivity has increased. The MSP is a “good deal” for those Nicaraguans who are enrolled in the MSP. The real cost per beneficiary is one-third less than that of INSS’ pre-Sandinista, direct delivery system. As the program and EMPs have matured and developed greater administrative capability, key original MSP features have been modified to provide more coverage, choice and flexibility.
Learning Objectives:
Keywords: Health Reform, International Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.