GENERAL MANAGEMENT AND ADMINISTRATION

Program Description

Guarantees the enforcement of the precepts inculded in the Patient's Bill of Rights and Responsibilities. Coordinates, take cares and solves pertinent problems, needs and claims by identifying adequate strategies to respond fast and effectively. Is responsible for safeguarding the rights of all patients.

Objectives

• Monitor complaint patterns and corrective action plans.

• Expand the reach of the National Association of Patients (Volunteer Members of the Office), who are trained to understand patient's rights in order to take care of the specific needs of the groups they represent.

• Increase Call Center capacity to serve, assist and counsel patients.

• Establish a continuous education plan to retrain 100% of Claim Officers on processes related to complaint management.

• Audit the quality of health services, as requested by the Bankruptcy Court, in accordance with the Law.

• Conduct 100% on site inspections of health service centers, and examine first hand any violations of the Patient's Bill of Rights and Responsibilities.

• Once violations have been identified, conduct field investigations to provide an efficient tool for self-improvement for health service providers and insurers.

• Conduct surprise visits to Primary Doctors Groups (PDG) and Mental Health Clinics to guarantee compliance with patient's rights.

• Continue the systematic monitoring of complaint patterns and corrective action plans.

• Place at the public's disposal complaint information organized by provider and insurer, so that it serves as criterion for selecting an insurance company or a health provider.

• Train patient organizations, health professionals, insurance companies and education centers about the Rules of the Patient's Bill of Rights and Responsibilities, through annual educational activities.

• Offer legal advice to the different adjudicative and legal forums in order to aid in solution of cases and provide recommendations for public policy regarding the protection of the patient's rights.

• Continue to encourage a service mentality in employees to guarantee that patients are satisfied with the services received.

Statistical Data	2010	2011	2012
Calls received	22,394	32,942	40,007
Complaints resolved	6,206	7,500	7,920
Legal services requested	1,200	700	1,100
Orientations	14,961	19,633	23,100
Total number of people impacted	3,000,000	2,000,000	2,500,000

The statistical data was provided by the Agency during the Fiscal Year 2011-2012 budget formulation process.

Customers

3.8 million patients regardless of whether they have a health insurance or not.

Human Resources

Authorized and Proposed Positions	2009	2010	2011	2012
Managerial,Technical, Administrative, and Office Staff	22	19	10	9
Judges, Lawyers, and Legal Staff	5	2	0	1
Other staff	20	18	8	15
Planning, Budget, Statistics, Auditing, and Finance	5	4	1	1
Public Relations and Communications	1	0	1	1
Maintenance and General Services Staff	4	3	0	0
Families and Community Services Staff	5	5	3	6
Health Services	13	9	9	8
Information Systems	5	5	1	0
Sales and Marketing Services	4	0	0	4
Total, Positions	84	65	33	45

FISCAL YEAR 2011-2012 ADOPTED BUDGET

The adopted consolidated budget for fiscal 2011-2012 ascends to $2,558,000. The funds originate from the Joint Resolution General Fund.

Operational Expenses reflect a decrease of $54,000, compared to the funds appropriated for fiscal year 2010-2011. This decrease is due to adjustments for non-recurrent expenses.

The funds recommended will allow the Office to comply with its duties as imposed by its Organic Law, as well as the precepts contained in the Patient's Bill of Rights and Responsibilities: to coordinate, take care and solve the problems, needs and claims of insured patients who are users and consumers of medical and hospital services of Puerto Rico.

SUMMARY OF AVAILABLE RESOURCES