Do I have to register upon arrival at the Emergency Department?
Anyone requiring medical attention at the Emergency Department must be registered. If your condition requires immediate treatment, you will be assigned a bed in the treatment area. If you do not require immediate medical care, you will be directed to a registration area where you will be asked to present your NHIP card (if you have one) and pay the required fees. All patients must present to the hospital with picture identification (ID). The preferred ID is your National Health Insurance Plan (NHIP) card so that eligibility can be confirmed at this time. Other forms of a picture ID are acceptable. This is also a patient safety goal, as we wish to ensure we are providing the right care and treatment to the right patient. All persons who legally reside and are permanently employed in the TCI should have a valid NHIP card. Verification of eligibility and coverage is done at each visit to the hospital, since employment or eligibility changes may occur between visits. Patients are encouraged to register at the main entrance to the Hospital, in the foyer. It is advisable to have NHIP contributions paid up to date to prevent any delay in accessing care. If the card is active, you will be asked to pay the co-pay amount. If the card is not active, you will be considered a private patient and you must pay as a private-pay patient. If there are any issues with eligibility of the card, you may be directed to the NHIP office to resolve the matter.
Why are some patients referred to Primary Health Care after registration to the Emergency Department?
The $10.00 co-pay fee paid during registration to TCI Hospital is non-refundable in cases where patients are transferred to the Ministry of Health Clinic after triage. Persons are encouraged to directly visit the Ministry of Health clinic located inside both TCI Hospital facilities in the Primary Health care section. The clinic located at Cheshire Hall has extended hours until 9pm. These clinics are free-of-charge and primarily cater to patients with less severe, benign conditions and associated triage scores of 4 and 5. Patients who are assigned these triage scores may be occasionally transferred to the Primary Healthcare Clinic after a preliminary medical assessment by a triage nurse. This partnership between both independent healthcare agencies helps to reduce waiting times for patients in the Emergency Department. Patients with non-emergent conditions are also encouraged to schedule an out-patient appointment to visit our Family Practice clinics. Hours of operation are 8:00 a.m. to 5:00 p.m. Monday through Friday except on public holidays. We encourage making appointments as far in advance as possible, although at the Cockburn Town Medical Centre same-day appointments are offered when available.
What is a co-pay fee and how much am I expected to pay?
Co-pay is a common feature of many healthcare insurance plans, where the insured pays a set out-of-pocket amount for health care services during registration. If you are NHIP-eligible, the co-pay fee is $10. Between the hours of 11 pm and 7 am, the co-pay fee is $50 for non-emergency care (triage level 4 & 5 patients). Additional diagnostic tests will incur an additional $10 co-pay fee. If you do not have NHIP coverage, you will be billed at the non-NHIP private patient established rates. Please note, all NHIP co-pay fees are paid over to the National Health Insurance Board and are not retained by the Hospital.
What is the difference between NHIB, NHIP and TCI Hospital?
The National Health Insurance Board (NHIB) is the entity responsible for the management of all activities involving the TCI’s National Health Insurance Plan also referred to as NHIP. TCI Hospital is an entirely independent organisation. The health care facility provides patient care to NHIP beneficiaries as the National Health Insurance Board’s preferred in-country provider. TCI Hospital is managed by InterHealth Canada via a Public Private Partnership agreement with the Turks and Caicos Islands Government(TCIG).
Why do we have to pay a co-pay fee?
In the UK, the cost for healthcare is borne wholly by government through taxation. However, the arrangements established by the Turks and Caicos Islands Government mirrors the system used in a number of countries, which provide national health coverage for legally employed residents. The cost of health care services is covered by mandatory contribution deductions from workers' income, and payments made at the point of service delivery, which is the co-pay fee.
Is TCI Hospital involved in the determination of co-pay fees?
TCI Hospital provides services which are identified by the TCI government and covered under the National Health Insurance Plan. The Hospital collects co-pay fees on behalf of the National Health Insurance Board. All co-pay fees paid at the Hospital are transferred to NHIB and are not retained by the Hospital. TCI Hospital is not responsible for determining co-pay fees. These fees are dictated solely by the National Health Insurance Board (NHIB). All monthly income contributions in accordance with the NHIP Ordinance are deducted by and paid to NHIB and not to TCI Hospital. TCI Hospital receives revenue from private insurance and self-paying patients who are not covered under the National Health Insurance Plan.
Why are more services not available at TCI Hospital?
Since opening in 2010, additional services have been introduced and the Hospital remains eager to bring more services on-island to lower the cost of sending patients overseas for treatment. The Turks and Caicos Islands Government decides whether to expand current healthcare services after a full financial and quality analysis has demonstrated that the new service will bring cost savings to the country. New services introduced since 2010 include medical oncology, plastic/cosmetic surgery, neurology, urology, ophthalmology, ENT and nephrology. Turks and Caicos Islands Hospital is an acute-secondary health care facility, and therefore complex tertiary level care is provided overseas through the National Health Insurance Board’s Treatment Abroad Program. The services currently provided are as follows: On-shore Services: * Accident and Emergency Department * Internal Medicine * Outpatient Hemodialysis * Medical Oncology – Consultation and Chemotherapy * Obstetrics & Gynaecology * Orthopaedics * General Surgery and Endoscopy * Paediatrics/Special Care Baby Unit * Secondary Dentistry/Faciomaxillory * Diagnostic Imaging * Surgical services * Laboratory and Histopathology * Physiotherapy/Rehabilitation * Inpatient Pharmacy * Ambulatory Services – Family Practice and Specialty Clinics Visiting Consultant Specialties: * Adult Neurology * Plastic Reconstructive Surgery * Otorhinolaryngology (Ear, Nose & Throat) * Secondary Urology * Ophthalmology * Oncology
Who makes the decision to transfer patients overseas for medical treatment and secures his/her travel arrangements?
If the Hospital physicians find that a patient’s medical care needs cannot be provided at our facility, the NHIB is informed through a referral process. All emergency referrals are submitted directly to the NHIB for execution and transfer of those patients needing services that are covered and eligible under the NHIP. Patients referred to the NHIB by the hospital physicians for non-emergency services are discussed in a weekly Joint Referrals Meeting with representatives from the hospital, TCIG and NHIB. At this meeting referrals are discussed and a preliminary decision is made on conditional approval. The conditionally approved referral is submitted to the NHIB with whom lies the remit for final approval, selection of the location where the patient will obtain the care and organization of the transfer overseas. The patients receiving care overseas via the NHIB operated Treatment Abroad Program are assigned a case manager who takes over the management of the overseas transfer process. The NHIB is solely responsible for deciding the country and healthcare facility where the patient will be transferred. TCI Hospital is not involved in travel arrangements.
What factors determine the waiting time for patients in the Emergency Department?
The time between arrival and treatment depends on the seriousness of the patient's condition and how many other patients are in need of emergency care. Patients are given priority based on the triage scores cited above. The most seriously ill patient must be seen first. Persons with less serious medical conditions may be required to wait longer, even if they arrive in the Emergency Department first. TCI Hospital staff will do their best to estimate your waiting time.
What should I do if I have questions about my benefits or concerns with my NHIP card?
Queries related to healthcare benefits should be directed to Customer Service Representatives of the National Health Insurance Board. The Board is responsible for the approval of NHIP coverage and identification cards. NHIB has provided the Hospital’s patient registration services with software to allow quick identification of eligibility when the NHIP card number is entered into our system. For more information contact: NHIB Providenciales Branch: +1 649 941 8861 or NHIB Grand Turk Branch: +1 649 946 2611.
What is triage?
Triage is a process by which injured or sick patients are classified according to their degree of illness or need for emergency medical attention. For your information, the Canadian Triage and Acuity Scale CTAS is a five-level emergency department triage algorithm used by Turks and Caicos Islands Hospital to classify patients . The CTAS levels are numbered one through five, with level one indicating the greatest urgency. 1 Resuscitation Immediate, life-saving intervention required without delay 2 Emergent High risk of deterioration, or signs of a time-critical problem 3 Urgent Stable, with multiple types of resources needed to investigate or treat (such as lab tests plus X-ray imaging) 4 Less Urgent Stable, with only one type of resource anticipated (such as only an X-ray, or only sutures) 5 Non urgent Stable, with no resources anticipated except oral or topical medications, or prescriptions After triage, you will be seated in the waiting area until you are called by a doctor.
What are the requirements for Hemodialysis?
The following is a list of requirements for Hemodialysis Services at Turks and Caicos Islands Hospital once confirmation of an available spot is received: Medical Records, Treatment orders, Chest x-ray and EKG done within the last three months, Monthly lab test done within the last thirty (30) days, HIV and Hepatitis results within thirty (30) days, Three flow sheets, Access type, Multiple Drug Resistance Panel (MRSA, ESBL Klebsiella Pneumoniae, ESBL E. Coli, MDRO Morganella morganii, MDRO Acinetobacter). The cost per dialysis session for private patients or self-payers is as follows: US $150 initial consultation fee US $400 on a regular shift requiring no overtime US $500 on a shift that requires overtime. The fees above are subjected to change. Additional fees will be charged for any medications and supplies that the patient does not bring with them. Please feel free to contact the Nurse in charge of Dialysis Unit or Straudy Jackson, Administration Manager via email@example.com for more information.
What is the process for requesting medical records?
Due to patient confidentiality, patient records can only be obtained by the patient upon completion of the medical release form authorizing the release of his/her records. This form can be obtained from our patient service associates or contact us at 941-2800 ext. 71300, 71303 or 71302. Once the form is completed and the processing fee has been paid, the records are printed and ready for pick up by the end of the next business day. The processing fee is determined based on the volume of records requested. Fees may range from US$10 - $100 or potentially more based on the request. Once the form is submitted, the fee is calculated and provided.
What is the process for payment via private insurance?
The hospital accepts private insurance in cases of emergency; otherwise patients who have private insurance will be encouraged to pay the bill with cash, credit or debit card and then seek reimbursement from his/her insurance company. The reason for this is the difficulty the hospital experiences when trying to verify private insurance coverage and a guarantor of payment for the bills within 30 days. This process is even more challenging when the company is located outside of the Turks and Caicos Islands. Patients who have private insurance will be provided with an itemized bill as well as the accompanying records to assist with their reimbursement process. The hospital encourages visitors to purchase travel insurance before travelling to the Turks and Caicos Islands as this will provide patients with a lower-cost option and peace of mind while on vacation, in the event access to medical care is needed either locally or abroad (if required services are not available locally.) Our experience with patients who have travel insurance has been very positive. The processing fee is determined based on the volume of records requested. Fees may range from US$10 - $100 or potentially more based on the request. Once the form is submitted, the fee is calculated and provided.
How does a patient access specialty clinics operated by visiting consultants?
Specialists in the area of Plastic Surgery, Urology, Neurology Ophthalmology, Oncology and ENT offer specialty clinics and conduct surgical procedures. These specialty consultants visit the island on a quarterly and sometimes monthly basis; however frequency of some of the specialist visit is dependent on demand and availability of the specialist. Patients must be referred to these specialists by a primary care physician.
What is the protocol for the introduction of new health care services?
Under the Project Agreement, changes made to existing clinical services at TCI Hospital must undergo a Change Request Procedure seeking pre-approval from government. Change enquiries are submitted to TCI Government by the hospital private management company, once patient volumes and patient demands reach the necessary levels to create a sustainable service model. A change enquiry is a detailed proposal, which outlines clinical data, epidemiological information, statistical data, cost estimates, patient volumes and other supporting information to justify the need for additional equipment, staffing requirement, and or an expansion in services.
What is the hospital’s involvement in the procedure for issuing birth records?
The hospital does not have any involvement in the requesting or issuance of birth records. Under the agreement with TCIG, the hospital is responsible for providing birth certification records to the birth registry and the vital statistic department at TCIG. At the end of each month a detailed report is sent to both departments listing all births that occurred at the hospital. The birth registry is solely responsible for the issuance of birth certificates.
What is the procedure for filing a complaint?
Feedback is encouraged and supports our commitment to continuous quality improvement. Complaints received at Turks and Caicos Islands Hospital are investigated in accordance with our Complaint’s procedure, which has been agreed with the Turks and Caicos Islands Government. Our full-time Quality, Risk & Patient Safety Manager follow this procedure to ensure that a complaint is thoroughly investigated and responded to within a responsible time-frame, and in accordance with patient wishes. Complaints can be made to any member of staff in verbal or written form or by email. Complaint forms are available in multiple languages on our website: www.tcihospital.tc. If a complaint is made on behalf of someone else we may require their signed consent in order to protect patient confidentiality. What will we do? If your concern cannot be resolved to your satisfaction within 24 hours, it will be treated as a formal complaint, regardless of whether you expressed the concern verbally, in writing or by email. We will handle all formal complaints as follows: • Our Quality, Risk and Patient Safety Manager will let you know within three working days that we have received your complaint; • We will investigate any issues raised; • We aim to provide you with a full explanation and response to your complaint within 20 working days but will reach agreement with you if more time is needed; • We will share information relevant to your complaint with the TCI Government to satisfy them that you are treated fairly; • We will ensure that you receive an open, honest and proportionate response to your complaint. This may involve meeting with you; • We will learn from the complaint you have made and make changes where appropriate. Complainants have the right to request independent review of his/her complaint by the TCI Government if he/she remains dissatisfied with the outcome of the review undertaken by TCI Hospital.
What Governance Structures are in place to ensure accountability?
TCI Hospital has two main governance structures: The Service Review Board is responsible for reviewing complaints, potential or existing litigations and key performance indicators with a clinical view. The board meets quarterly and consists of eight senior healthcare representatives from Turks and Caicos Government, National Health Insurance Board and InterHealth Canada TCI Ltd and an independent clinical chairperson. The Contract Management Committee works collaboratively with InterHealth Canada to review performance and discuss strategic initiatives related to any changes in good clinical practice or good industry practice. The committee also reviews trends, new technology and relevant innovations in the health care Industry along with key performance indicators.