Overseas medical referral: the health system challenges for Pacific Island Countries

Overview

Health system constraints and the small and dispersed population of the Pacific Island Countries make it a challenge to meet the demand for specialized clinical services in PICs. Overseas medical referral (OMR) is one solution to fill the gap in the lack of SCS domestically and will continue to be a necessary component of the health system in PICs. OMR brings with it challenges of cost, quality, equity, and integration with the wider health system. 

Most governments in the Pacific Islands provide some form of support to access treatment overseas via government-funded OMR schemes, many of which are often co-funded through agreements with donors. In many PICs, OMR is also treated as an activity outside the gamut of the national health system. Findings indicate the number of OMR patients seem to be rising, with increased expenditure on OMR by PICs. In addition, even though most countries have policies on OMR, there are challenges with implementation and knowledge of the policies. Often, some OOP expenses are incurred by beneficiaries. Quality of care is a major limitation of OMR schemes. There is a need to make OMR an effective, efficient, and equitable part of the national health system. Key findings and recommendations are:

Access and financial protection: Challenges in awareness of OMR policies in PICs, and in the implementation of policies. Limited data on impact of OOP on any negative impact on access
Quality of treatment: Poor national coordination, and integration with the national health system is a limitation for OMR schemes
Efficiency in service delivery: Variations in spending on OMR cases indicate potential for better efficiency.

Although this policy Brief is based on research done in the Pacific Island Countries, its finding and recommendations are also applicable to other small countries with developed OMR programmes.