SEMMA Begins Payment to Health Service Providers for a Total of RD$184 Million Pesos

SEMMA Begins Payment to Health Service Providers for a Total of RD$184 Million Pesos
Dominican Republic, Santo Domingo, 07/28/2011

Executive director  of ARS SEMMA, Dr. Alberto Fiallo, reported this week that SEMMA will send checks for a total of RD$184 million pesos to Health Service Providers (PSS in Spanish), mainly to general practitioners and family doctors and specialists who work with them. The amount of money expected to go out in payments is RD$184 million pesos, which are owed to the institution’s providers.

“These amounts corrrespond to the planning and identification of legal registration and programming of the accumulated debt, being dealt with by the new technical team of SEMMA and earmarked for its financial overhaul.  Details of how these funds were used was discussed in detail among SISALRIL and the General Controller’s Office of the Republic,”

Dr. Fiallo stressed that the process of definitively settling ARS SEMMA’s debt problem with its network of providers includes the following: the constitution of a Contingency Commission calling upon all of its PSS contracts to reconcile the debt through arbitration from the Superintendence of Health and Labor Risks  (SISALRIL in Spanish); the subsequent signing of an amicable total payment agreement on amounts owed; the gradual distribution of expenditures and legal settlements on the part of creditors.  He said the checks sent and received have been reviewed, one by one, by the General Controller’s Office of the Republic.

 The Ministry of Education (MINERD), along with the Financial Ministry, made available RD$384 million pesos to be handed out in two payments: an initial payment of $200 million pesos in June of this year to clinics, hospitals, laboratories and pharmacies to definitively settle the accumulated debt or that part that has been under discussion since 2008. A second disbursement went out this month, July, for RD$184 million pesos which corresponds to payments earmarked for the process of health, reform and modernization of SEMMA.

“These amounts corrrespond to the planning and identification of legal registration and programming of the accumulated debt, being dealt with by the new technical team of SEMMA and earmarked for its financial overhaul.  Details of how these funds were used was discussed in detail among SISALRIL and the General Controller’s Office of the Republic,” said Dr. Fiallo.

“SEMMA is committed to continuing with the process of financial overhaul, reform and modernization with the main objective of providing our teachers and workers with high quality and comfortable health service opportunities,” stressed Dr. Fiallo.

Financial Recovery

Citing reforms and advances undertaken by ARS SEMMA, Dr. Fiallo pointed out that this institution is in the process of financial recovery and institutional reorganization as part of its commitment to fulfill administrative resolution No. 0012-2011, taken on April 29, 2011 as well as requirements from the Board of Directors for which they are implementing different measures geared to reach these goals.

In this sense, he said there is a new contracting modality with other legal formats and requirements, tariff systems and a real need for services in each city, in accordance with the number of affiliates and dependents involved in SEMMA.

He added that PSS is slowly re-establishing the services it had suspended as a mechanism to pressure for payment settlement of its debts contracted by ARS, based on total payment of accumulated debt from 2008 through June 2011.

In this sense, he said there is a new contracting modality with other legal formats and requirements, tariff systems and a real need for services in each city, in accordance with the number of affiliates and dependents involved in SEMMA. They are hiring 162 service providers represented by 60 clinics, 19 specialized centers, 17 rehabilitation centers, 22 diagnostic centers and 43 pharmacies.

Likewise, he reported that there is work underway in the PSS network of SEMMA in the area of institutionalization of social participation and the oversight of users and beneficiaries of the services; there is also an initiative of participation and administrative co-management with the Dominican Association of Professors (ADP in Spanish).

Other reforms implemented have been the Complimentary Plan to the Basic Health Plan to include high cost services and levels of complexity along with the development of a supportive financial scheme that implies the opening to participation of all affiliates and an increase in the volunteer quota of these plans from 30 to 75 pesos per person.

Currently, a Primary Health Care Strategy (EASP in Spanish) within the schools is being designed to take advantage of the potential access of SEMMA’s membership in the Dominican schools. These ventures are accompanied by a strengthening of Family Medicine Residents from the Santo Domingo SEMMA Teaching Hospital, (HDSSD in Spanish).