Abstract
The delivery of specialised clinical services in the small Island nations of the Pacific region is an increasing challenge in the context of a rising burden of non-communicable diseases. Resources are limited and case-loads too low to support local specialists. This article focuses on the common practice of Overseas Medical Referral (OMR), which is an increasing challenge in the region. We collected interview and secondary data across 16 Pacific Island Countries. We found that OMR policies are often weak or incomplete, systems inadequate and reforms needed. Integrating OMR fully into national health referral systems and national strategic planning and prioritisation processes is needed. There is an additional need for collection of routine data on OMR service providers in the recipient countries and the outcomes of clinical care. With these reforms, a move towards increased regional cooperation and some form of strategic purchasing is possible.
Highlights
Health policy makers in Pacific Island Countries (PIC) are facing the need to expand the provision of specialised clinical services (SCS) to meet a perceived increase in population demand
Based on an understanding that Overseas Medical Referral (OMR) is unavoidable in the Pacific context, the purpose of this article is to analyse the healthsystem issues involved in meeting the challenge of providing more efficient and more equitable access to OMR services
Information gathered through our questionnaire and interviews addressed, in general, three critical issues in the provision of OMR services: the level and cost of service delivery, the status and implementation of OMR policy in the selected PIC, and population access to OMR services
Summary
Health policy makers in Pacific Island Countries (PIC) are facing the need to expand the provision of specialised clinical services (SCS) to meet a perceived increase in population demand. With small and widely dispersed populations and few trained medical specialists (local or international) (Biscoe, Fakakovikartay, Condon & Monteiro, 2015; Yamamoto et al, 2010), PIC cannot achieve economies of scale for most SCS or provide the caseload needed to build clinical capacity (Suzana, Walls, Smith & Hanefeld, 2018; Plowman, 2015; Irava, Mahalakanda & Prasad, 2014; Masterton, Moss, Korin & Watters, 2014; Natuzzi et al, 2011; Negin, 2011; Kushner et al, 2010; Theile & Bennett, 1998). By sending patients overseas for treatment, a process known as Overseas Medical Referral (Plowman, 2015; Blick and Smith, 2015; Irava et al, 2014)
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