Medical referrals cost CNMI $15 million in 2019

In a bid to cut down on the $15-million medical referral costs that the CNMI incurred in 2019, the government is looking for ways to reduce this fraction of government spending.

“For every single fiscal year, the Commonwealth government has always had a longstanding deficit of having to deal with the Medical Referral program,” said government spokesman Kevin Bautista. “The Medical Referral program has always been something where that deficits almost always exist.”

In the simplest terms, the medical referral program allows for patients who could not be treated on island to be referred for off-island treatment, whether in Guam, Hawaii, or in the Philippines.

Bautista explained that the Commonwealth government has been on a limited budget for the most part of fiscal year 2019 because of austerity measures that were implemented to stay within budget.

“Our budget was cut down by $30 million. For us to stay within that was important. When the deficit occurs, it’s usually medical referral. And then the small fraction of it is also overtime costs for law enforcement, [Department of Public Safety, Department of Fire and Emergency Medical Services, Department of Corrections, and Division of Customs],” he said.

Aetna Insurance
Gov. Ralph DLG Torres and legislators also recently met about steps that could be taken to keep medical referral costs down.

House vice speaker Lorenzo Deleon Guerrero (R-Saipan) said that they talked about the initiative that the governor has implemented, which is, for Aetna Insurance to handle all the appointments of each patient for their specific medical needs and taking care of insurance requirements, including documentations.

“The administration assured us that we would see a significant 40% reduction in costs by allowing Aetna to provide this particular services for the medical referral office of the Commonwealth,” Deleon Guerrero added.

The lawmaker also said that during the meeting, the governor insisted that the Health Committee chairs of both the House and Senate, Rep. Jose Itibus (R-Saipan) and Sen. Justo Quitugua (R-Saipan), respectively, meet with Medical Referral Services director Ronald Sablan to discuss all issues concerned.

“We felt that is the first step that we should take and then hear it from the chairpersons, and give us a report on what they have discussed.”

“Medical referral is a huge challenge because of the increases in medical expertise in different fields that we don’t have, which is not available here in the CNMI so we end up sending folks overseas. …We are taking steps in regards to reducing the deficit incurred by the medical referral office,” Deleon Guerrero added.

What’s next?
Aside from having Aetna Insurance come in, other medical referral cost-reduction measures proposed include reaching out to private health clinics to complement the Commonwealth Healthcare Corp.

“It was proposed also that we reach out to a private health clinic or a health center to assist in reducing the inflow of patients at our local hospital, our only local hospital. It was proposed during our meeting, [that] we look into a private health clinic to complement the hospital,” Deleon Guerrero said.

Another proposal is to invest in local facilities.

“What we would also like to look at is identifying at least $10 million and give it to the hospital, and the hospital would purchase all the equipment that we don’t have and that would be one way of reducing the cost of medical referrals,” the vice speaker said.

This was echoed by Sen. Vinnie Sablan (Ind-Saipan) who, for this year, has identified improving the local healthcare industry among his priorities.

“The government spends an average of $15 million sending our patients off island for medical treatment that cannot be performed here,” Sablan said. “I have this vision of beginning to invest in our facility here.”

“If we start coming to the table and saying let’s invest in an MRI machine or some equipment that’s needed for the physicians and providers to provide quality health care, we could decrease that number [of medical referrals].”

Doing so would also decrease the burden on the families that need to go with their loved ones on these trips, Sablan added.