Four officials involved in the work of the Health Authority of Anguilla have been speaking about the continuing plans of the autonomous body to provide quality medical and health services to residents as well as visitors. They were Chairperson of the Board, Dr. Phyllis Fleming-Banks, Chief Executive Officer, Dexter James, Human Resources Manager, Meridith Gumbs, and Physiotherapist, Khalidah Banks.

Dr. Phyllis Fleming-Banks
One of the matters spoken about at length was the new regulations governing fees and charges to be paid by persons accessing the island’s medical and health services. Dr. Fleming Banks told a press briefing late last week that the regulations, made in December last year under the Health Authority of Anguilla Act, would now take effect on July 1. Other matters outlined by her for discussion at the meeting were an update on the expansion of the organisation’s revenue base in terms of arranging health insurance payments on behalf of payments by more companies; the upgrading of primary medical and health services, starting with the Welches Polyclinic; the strengthening and development of the organisation from a human resources management perspective and a health services accreditation system now being pursued.

Dexter James
Mr. James said the new regulations governing fees and charges were to provide a procedural guide to the health system with respect to how the payments would be administered. He explained that a significant provision of the regulations was a clear indication of persons who were categorized as residents as opposed to those classified as non-residents and in that regard, the fee structure was discriminatory.

He gave an explanation of how residency is defined, according to the regulations, in order to avoid misunderstanding. He stated: “An individual is ordinarily resident in Anguilla if he or she has his or her principal place of residence in Anguilla and is temporarily absent from Anguilla for the purpose of full-time attendance at a university, college, technical training school, secondary school or other educational institution; on educational leave or for medical treatment; and intends to make his or her principal place of residence in Anguilla.”

He went on: “If you are an Anguillian and you have been living in St, Thomas, St. Maarten, the United States or anywhere else substantially over the years and you come on vacation to Anguilla, you will not be classified as a resident because your principal place of residence is not Anguilla…Because our fees are already highly-subsidised by the Government, you didn’t want to create a situation where persons would just leave from wherever they are, come to Anguilla and get a pecuniary benefit when they haven’t really contributed to the health system.

“For example, won’t it be strange if we had an Anguillian, for example, who is living in St. Maarten, his principal business, abode and livelihood are generated in St. Maarten, but he takes the ferryboat, pays ten dollars to come across, goes to the Dental Unit whose rates are highly subsidized for the citizens who reside here, gets the benefits of our health services and goes back to St. Maarten. Something is not right about this.

“What the regulations therefore speak to is to tighten the classification in terms of residents and non-residents and the question of the discriminatory fee structure.

“According to the regulations, persons provided with inpatient service, will be given at least 30 days from the date of billing to make good outstanding payments to the hospital after which the bills will attract service charge at the rate of 2.5 percent per month on a compound basis. We hope we won’t get to that state because our intent is to strengthen our collections mechanisms so that we don’t have the arrears we have been seen in years before.

“The new procedure for inpatient billing is that if someone comes to the hospital and has seen the doctor in outpatient’s clinic and that person is told that he or she has to undergo a non-emergency procedure in two to three weeks’ time, they will be asked to go to the Admissions Office at the hospital. There they can discuss payment arrangements prior to the surgery being provided. In other words, persons will be required to make good their financial obligations prior to getting the service being provided as opposed to what now exists where service is provided and when they are discharged a bill is sent to them.”

Mr. James stated that in the latter arrangement over ninety percent of the bills sent out to patients were returned unclaimed to the hospital. “We are now trying to correct that problem,” he emphasised. “We are saying that for non-emergency cases you are required to come to the Admissions Office where you will cost what your length of stay [in the hospital] will be and you will be required to pay those fees and charges upfront prior to being admitted. The good thing about the arrangement is that no one will be denied health care because of his or her inability to pay – that is the first principle that we are working on. Secondly, if you are not able to pay the amount, then you have the opportunity to discuss in the privacy of that office…how you intend to make good those payments… and we have a number of options that we can put on the table to assist patients in meeting their obligations. If perchance you are not working and do not have the means to make those payments, we still have time to refer you to the Social Development Office which will assess you. Once you are assessed as a needy case, then the requisite documentation will be sent to us and care will be provided.”
Mr. James said that a massive sensitation campaign would be embarked on to make the population aware of the new regulations so that when they were launched on July 1 the public would have already been informed.

The Chief Executive Officer of the Health Authority disclosed that the organisation had entered into a new arrangement with other major providers of medical insurance coverage in addition to British American Insurance. These are NAGICO, ALICO and SAGICO. “What that does for the policy holders,” he stated, “is that it allows them…to tender their medical benefits card to the hospital where the Admissions Officer will meet with them…and ask the policy holders just to sign the claim forms and care will be provided for them. They will not have to take money out of their pocket to pay for services and then seek reimbursement from the insurance companies.”

Mr. James also spoke about plans to upgrade primary health care services at the Polyclinic at Welches, the Valley Health Centre and the South Hill Health Centre. “We are at this time seeking to expand the Welches Polyclinic and the Valley Health Centre,” he continued. “What we are attempting to do is to implement in these two centres initially a core practice of primary medical services which revolves around a general walk-in clinic Monday to Friday for the populations in and around those areas to see a physician between the hours of 8 - 4.

“These two facilities will also have a full-time pharmacist so that when the doctor prescribes, patients can go to the pharmacist and get their prescriptions filled at those centres. We will also have routine nursing services, specialist clinics on selected days by appointment…We expect to see a reduction of the number of primary medical cases that would come to the hospital for services that could be provided either at Welches or the Valley.”

He described the Polyclinic at Welches as an excellent facility which since its construction had been grossly under-utilised. He noted that it currently only provides a specialist medical clinic and ophthalmology clinics. “What we are seeking to do,” he pointed out, “is to implement an expanded range of services which include general walk-in clinics, pharmaceutical services, specialist clinics, internal medicine, obstetrics and gynecology. We have an ophthmalmology clinic there – and minor surgical procedures - at that facility. It is our intent to also move the antenatal care from the hospital to the Welches Polyclinic.

“Expanded services will be provided in the areas of dentistry. We already have the equipment on the island and we expect the supplier over the week of June 23 - 26. So we will be setting up at Welches a dental chair and x-ray machine which will provide a package of all-health services for the population in and around that area including the schools. We also will be relocating the physiotherapy services from the hospital to Welches.”

KHALIDAH BANKS: Physiotherapy Services
Miss Banks who will be carrying out those services stated: “In terms of the launching of the physiotherapy clinic at the Welches Polyclinic, the same way patients have been referred to me at the Princess Alexandra Hospital will be the same way it will be done at Welches.
“All patients come for physiotherapy with a referral from a doctor… who does the assessment and then makes the referral. The patient is given a referral card and asked to contact the physiotherapist to set up an appointment. We have restructured the payment plan…Mr. James and I and also personnel from the Finance Department have decided on new fees. Upon entering the clinic with their referral, patients will go straight to the cashier or receptionist…and discuss such matters as whether they have insurance or will pay out of pocket.

“We are also going to implement a cancellation policy which is something we have not looked at before. Sometimes a patient may be scheduled for a certain time but does not show up. We have to look at the fact that while we are providing a health service it is also a business and have to be reimbursed for our services. Therefore in an instance where a person does not show up for therapy, it is a time slot where we would be able to generate some more revenue [hence the requirement for persons to pay a small fee for not informing the Health Authority about the cancellation].”

Miss Banks noted that as is the case with all the other services there would be different fees for residents and non-residents.

MERIDITH GUMBS
Meanwhile, Meridith Gumbs, Human Resources Manager, spoke about personnel and training matters. She mentioned mainly a series of workshops for staff members on team building being conducted by Dr. Linda Banks. She observed that the organisation was performance driven and there was a need for a cultural change as well, hence the training sessions. The workshop series will continue until July 6. Mrs. Gumbs added that the workshops were aimed at making all departments of the Health Authority aware that each of them needed the support of the various units so that the organisation could function well.

Mr. James wrapped up the press briefing by announcing that efforts were being made to initiate a health services accreditation system. He stated that Anguilla might be one of the first places in the Caribbean which was seeking accreditation, but it was seen as a strategic imperative to ensure that the changes now being made in the health system would enable it to sustain itself.

Unpacking equipment (L-R) Kenesa Brooks, Steve McDowall, Khalidah Banks, Wendy Petty-Lloyd and Wayne Hazell.

“What this health accreditation process would mean is having an international body come in and look at the health systems – primary, secondary and incorporate services and assess the level of service against a pre-defined standard,” James explained. “The benefits that will come from accreditation are many. A few of them are that it provides and shows a commitment to quality. You can gain valuable education and advice from accreditation surveyors. It is a powerful strategic tool for institutional development. It improves communication and collaboration within and among health care providers and promotes team-building.”

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