The Social Health Authority (SHA) has announced a new payment model that will link reimbursements to contracted Primary Healthcare (PHC) facilities to the proportion of prescribed medicines they dispense and record, in a move aimed at improving accountability and ensuring patients receive the full package of services they are entitled to.
In a public notice issued on July 21, SHA said the Primary Healthcare benefit package covers the complete episode of care, including consultation, diagnosis, clinically indicated investigations, treatment and prescribed medicines in line with the Ministry of Health treatment guidelines.
However, the authority said it had identified gaps in medicine dispensing at some contracted facilities, resulting in beneficiaries receiving only part of the care covered under the PHC package.
"SHA has identified gaps in medicine dispensing in some facilities, resulting in beneficiaries receiving only part of the care covered under the PHC package," the authority said.
To address the problem, SHA said it will monitor each facility's medicine-dispensing rate through the Digital Health Agency platform and reimburse facilities based on the level of service provided.
Under the new framework, SHA will first determine a facility's monthly reimbursement using the existing weighted global budget capitation model. A fixed portion of that allocation will be reserved for pharmacy services, while the remaining amount will cover consultations, staff costs, diagnostics, consumables, overheads and other service delivery expenses.
The authority will then calculate each facility's dispensing rate by comparing the number of medicines dispensed against those prescribed and recorded in the approved digital system.
"If the facility dispenses 100% of prescribed medicines, it receives the full medicine payment. If it dispenses 80%, it receives 80% of the medicine payment, while the remaining 20% is deducted," SHA explained.
The authority clarified that only the pharmacy component of the reimbursement will be adjusted, with payments for consultations and other healthcare services remaining unaffected.
SHA said the approach is designed to reward facilities that consistently provide prescribed medicines while ensuring public funds reflect the actual level of service delivered.
"This approach rewards facilities that consistently dispense prescribed medicines while ensuring payments reflect the actual level of service provided," the authority said.
SHA urged all contracted PHC facilities to provide and accurately record the complete package of care, including prescribed medicines, to ensure beneficiaries receive the services to which they are entitled.