Pacific Partnerships for Health Charting a Course for the 21st Century (1998) / Chapter Skim
Currently Skimming:
Appendix D
Appendix D
Pages 95-154
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 95... ...
Each assessment is organized into four parts: an overview of the jurisdiction's government, economy, population, and 2. the organization of its health care delivery system; 3.
|
From page 96... ...
census; the health care budget is from Fiscal Year 1995. OVERVIEW American Samoa is the only U.S.
|
From page 97... ...
The native Samoan population is ethnically Polynesian (rather than Micronesian, as is the case in the other U.S.-Associated Pacific Basin 'The majority of cannery workers are resident aliens, not American Samoar~s.
|
From page 98... ...
Infrastructure In general, water, waste disposal, and power systems in American Samoa have improved significantly in the last decade. For example, in 1995, 74 percent of housing units were connected to a public water system, up from 63 percent in 1990.
|
From page 99... ...
Additionally, DOI is currently withholding $2 millions dollars in capital improvement funds earmarked for the hospital until an independent authority is established to manage the hospital. Some community health centers, or dispensaries, exist in outlying villages of American Samoa, although most care is still provided through the hospital (which is relatively accessible by bus and car to most people on the main island)
|
From page 100... ...
Government employees and cannery workers typically have health insurance and make use of the government health care facilities. Government employees can opt for government health insurance coverage.
|
From page 101... ...
Nurses There are 31 registered nurses, 97 licensed practical nurses, 23 graduate nurses, and 12 nurse's aides currently working in American Samoa. Licensed practical nurses and registered nurses must meet U.S.
|
From page 102... ...
The American Samoa Community College (ASCC) has a career ladder nursing program, offering certificates for practical nurses and an associate degree for registered nurses.
|
From page 103... ...
FUTURE HEALTH CARE ISSUES The most pressing issue confronting the American Samoan health care system is getting its financial house back in order. The hospital's physical plant must be brought up to minimum safety requirements.
|
From page 104... ...
NOTES: Total population is the official estimate from the CNMI 1995 mid-decade census; health care budget is from Fiscal Year 1996. OVERVIEW The Commonwealth of the Northern Mariana Islands (CNMI)
|
From page 105... ...
citizens and elect their own governor, lieutenant governor, and a legislature with nine senators and 15 representatives. Although they have a representative in Washington, D.C., that person is a not an official congressional delegate like those from American Samoa and Guam.
|
From page 106... ...
Several private health clinics operate on the islands, some in conjunction with private health maintenance and insurance organizations. Health Care Facilities CHC serves as the main hospital for CNMI.
|
From page 107... ...
Three private health clinics and one dental clinic have also been opened in recent years. Health-Related Community Organizations The CHC Volunteers is a volunteer group dedicated to raising funds for CHC.
|
From page 108... ...
Although many are employed and have health insurance or sufficient income to cover the cost of their own health care, the CNMI Department of Public Health estimated that in 1996 it provided health care costing $1,480,000 to citizens of the freely associated states. This represents 1 1 percent of all the encounters at =,overnmentoperated health facilities (CNMI Department of Public Health, 1997~.4 Workforce Physicians The physician workforce in the CNMI is largely expatriate, with more than 90 percent of doctors coming from outside the region.
|
From page 109... ...
It also plans on continuing to promote and develop the private health care sector. At the same time, it remains committed to providing quality health care to everyone, regardless of the ability to pay a commitment backed by the CNMI government.
|
From page 110... ...
$1 3,962,807 1,177,441 1 2,785,366 $132 SOURCE: PIHOA (1997~. NOTES: Total population is the official estimate from the FSM 1994 National Census; the health care budget is from Fiscal Year 1994.
|
From page 111... ...
In light of the limited economic opportunities, it is assumed that many FSM residents will emigrate to Guam, the Commonwealth of the Northern Mariana Islands, Hawaii, and the U.S. mainland-a trend that has been on the rise since the Compacts first went into effect and presumably will still be allowed when the Compacts are renegotiated (DOI, 1996a)
|
From page 112... ...
HEALTH CARE DELIVERY SYSTEM ORGANIZATION Administration FSM has a national Department of Health located in the capital, Palikir, which is responsible for overall health planning and technical assistance. Each state has its own state department of health, which provides actual health care services through a central hospital and a variety of primary care delivery sites (dispensaries)
|
From page 113... ...
In Kosrae, both the number of cases and the total amount spent on off-island referrals has decreased in recent years, going from 34 cases accounting for 12 percent of the total health care budget in 1990 to 20 cases and 10 percent of the total health care budget in 1996 (Kosrae Department of Health Services, 1996~. Nonetheless, on the site visits committee members were told by FSM health officials tht a recent study from an outside reviewer reportedly found that 92 percent of all referrals were medically justified [need to get cite from Dr.
|
From page 114... ...
The fees that are collected for health care services go to the state's general account. Government employees can voluntarily decide to participate in NGEHIP Virtually no private health insurance market exists at present.
|
From page 115... ...
FUTURE HEALTH CARE ISSUES The FSM Department of Health identifies the following issues as its priorities over the next 5 years (FSM, 1996~: · Health care financing: develop a secure financial base for health services and a capacity for improved cost accounting. · Primary health care systems: move the focus from curative to preventive health services, which emphasize the health needs of women and children, limit population growth, and promote healthy lifestyles.
|
From page 116... ...
. NOTES: Total population is the official estimate from the 1994 FSM National Census; health care budget is from Fiscal Year 1994.
|
From page 117... ...
Some health assistants resort to paying for supplies themselves to meet the needs of the community. According to the report, ~ l dispensaries are run out of the health assistants' homes, a situation described as "the same as none" (Medical Graduate Support Program, 1997, p.
|
From page 118... ...
Supervision of the health assistants appears to be minimal. Nurses With 55 registered nurses and 99 licensed practical nurses, Chuukese officials believe there is a nursing shortage.
|
From page 119... ...
~_~ Sansrik I`Jlalem., J f ~ utwe f ~_r l Total Population Number of Inhabited Islands and Atolls Access to Major Health Facility (percentage of population requiring more than 1 hour of travel) Total Health Budget Per Capita Health Budget 7,317 1 00% $ 1, 1 04,444 $151 SOURCE: PIHOA (1997~.
|
From page 120... ...
He is aided by one dental therapist, three dental nurses, and one dental aide. Mid-Level Practitioners Currently, the only mid-level health care workers are three health assistants.
|
From page 121... ...
APPENDIXD Nurses 121 All the nurses are Kosrean and are graduates of the College of the Marshall Islands School of Nursing. There are 34 graduate nurses, 3 licensed practical nurses, and 1 registered nurse.
|
From page 122... ...
. NOTES: Total population is the official estimate from the 1994 FSM National Census; health budget is for Fiscal Year 1994.
|
From page 123... ...
Reorganized in 1996, the Division of Primary Health Care operates a network of six primary care delivery sites (dispensaries) on Pohnpei and five on outer islands.
|
From page 124... ...
124 Nurses PACIFIC PARTNERSHIPS FOR HEALTH There are 63 registered nurses and 49 licensed practical nurses, almost all of whom are indigenous. Pre-nursing coursework is offered through the College of Micronesia.
|
From page 125... ...
NOTES: Total population is the official estimate from the 1994 FSM National Census; health budget is for Fiscal Year 1994. INFRASTRUCTURE 125 Most people within the capital center of Colonia have access to a public water system.
|
From page 126... ...
Nurses Although only one registered nurse is currently practicing in Yap, there are 12 graduate nurses, 12 licensed practical nurses, and 3 nurses aides. The University of Guam hopes to extend its distance education courses for nurses (currently being offered in Palau)
|
From page 127... ...
. Some of these health assistants may have been trained as medexes (Medical Graduate Support Program, 1997~.
|
From page 128... ...
Yigo ~ .' NORTH PACIFIC OCEAN Total Population Number of Inhabited Islands and Atolls Access to Major Health Facility (percentage of population requiring more than 1 hour of travel) Total Health Budget Per Capita Health Budget 1 55,225 90% $8 1 ,000,000 $510 SOURCE: PIHOA (1997)
|
From page 129... ...
. Economy Compared with the other U.S.-Associated Pacific Basin jurisdictions, Guam enjoys a healthy economy.
|
From page 130... ...
. Population The first settlers of Guam and the Mariana Islands, Chamorros, are believed to have originated in Southeast Asia.
|
From page 131... ...
The number of immigrants from the freely associated states has increased steadily since the implementation of the Compacts, and in 1994 there were about 6,630 FSM-born, and a few hundred RMI- and Palau-born, residents (Levin, 1996~.9 Infrastructure In general, Guam's has the most stable infrastructure of the U.S.-Associated Pacific Basin jurisdictions. GovGuam owns and operates all public utilities: telephone, power, water, and sewer systems (Bank of Hawaii, 1995b)
|
From page 132... ...
, and the Department of Vocational and Rehabilitative Services. In addition, Guam has several private health clinics.
|
From page 133... ...
Public Clinics Department of Public Health and Social Services DPHSS operates four regional health centers. One is funded through a federal Community Health Center Grant; the others are funded by DPHSS local arid other grant monies (GHPDA, 1996~.
|
From page 134... ...
Unlike the other islands, however, the decision to refer a patient for off-island tertiary care is left mostly to the doctor in charge of the patient's care and does not rest with a political entity. Some of the private health plans have agreements with hospitals in Hawaii and southern California for referrals.
|
From page 135... ...
Because a number of off-island tertiary care referrals are self-initiated or are paid for through private health insurance, costs attributed to off-isla~d referrals are difficult to estimate. GovGuam, through the Medically Indigent Program (MIP)
|
From page 136... ...
. Many citizens of the freely associated states, however, find jobs on Guam, have health insurance, or can pay for the costs of their owls care.
|
From page 137... ...
In 1995, there were no nurse's assistants, 166 at GMH, and the remainder with the DPHSS (GHPDA, 1996~. Although Guam may have a reasonable supply of registered nurses and licensed practical nurses, serious problems with recruitment and retention have led to shortages of nurses at GMH and public health clinics.
|
From page 138... ...
The committee was also told that the hospital fired :7 Filipino M.D.s and that as many as 90 percent of the Filipino-trained registered nurses were reclassified as nurse's assistants. Other Health Care Personnel A variety of allied health care personnel provide support and auxiliary health care services on Guam.
|
From page 139... ...
FUTURE HEALTH CARE ISSUES With a private health care system already well established, Guam's attention and hopes for its future rest with public-private partnerships. The current governor has initiated the Vision 2000 Campaign for Guam.
|
From page 140... ...
140 PACIFIC PARTIVERSlIIPS FOR f-~EALTH privatize GMH; focus efforts on disease prevention, especially diabetes arid cardiovascular diseases; increase the numbers of physicians, and increase the amount of available specialty care services, equipment, and technology so that more can be provided on-island and so that Guam can be more widely used for regional referrals; and · make health care accessible and affordable by controlling costs (e.g., contracting out Medicaid and MIP to private managed care) and enhancing public health programs and services that can reduce the need for acute care.
|
From page 141... ...
The total health budget excludes money for people exposed to radiation. OVERVIEW The people of the Republic of the Marshall Islands (RMI)
|
From page 142... ...
Population growth is one of the primary social concerns in the Marshall Islands and an issue that has been given top priority in government planning (Republic of the Marshall Islands, 1990~.
|
From page 143... ...
In 1995, less than a quarter of the households in RLMI were connected to a public water system, and according to the World Bank, between 1983 and 1985'4 only about 31 percent of the population had access to safe drinking water (World Bank, 19944. At the time of the committee's site visit, water had been cut off in Ebeye for almost a week.
|
From page 144... ...
The structure of the Marshall Islands Medical Care Program is in the process of being changed to place a greater emphasis on providing more holistic and community-based care to the individuals served by this program (Bell, 19971. Section 177 Health Care Program The Compact of Free Association also provided money for a "Four Atoll Health Care Program" to provide health care services to people of the four atolls affected by U.S.
|
From page 145... ...
. Off-Island Care RMI spent approximately 33 percent of its total health care budget serving 148 patients in 1996 (PIHOA, 1997~.
|
From page 146... ...
funds for primary health care and public health, and other grants. The universal health care system (the Marshall Islands Health Plan)
|
From page 147... ...
The program, funded by a HRSA grant, enrolls high school graduates in a special 18-month training program that includes 4 months of formal classes at MOH and 5 months of work in the Majuro Hospital before they are sent out to staff the dispensaries. Nurses The College of the Marshall Islands (CMI)
|
From page 148... ...
, staffed by health assistants, and regularly visited and assisted by primary health care teams consisting of doctors, nurses, dentists, and social services staff. The primary health care team has already begun its work on Ebeye with l O community health councils.
|
From page 149... ...
Total Health Budget Per Capita Health Budget SOURCE: PIHOA (1997~. NOTE: Total population is the official estimate from the 1990 U.S.
|
From page 150... ...
In addition, unlike the Compacts of Free Association with the Federated States of Micronesia and the Republic of the Marshall Islands, Palau's Compact with the United States provides for a trust fund for long-term capital investments. Infrastructure Although nearly all housing units in Palau (92 percent in 1995)
|
From page 151... ...
. Referrals accounted for lS percent of the total health care budget in 1995 (PIHOA, 1997~.
|
From page 152... ...
In 1997 U.S. federal grants and aid from other international donors accounted for $2,350,500 or roughly 20 percent of the total health care budget.
|
From page 153... ...
, and one contract surgeon from Burma. One Palauan doctor who trained in the United States and returned to Palau has opened a private health clinic and is doing extremely well; patients have been known to come from as far away as Yap for treatment.
|
From page 154... ...
Comprehensive medical licensure legislation for various health professionals is pending in the national congress. FUTURE HEALTH CARE ISSUES Palau plans to continue to improve its primary health care system.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.