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Policy and Research Implications Lancet Health System Reform Series Workshop

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Title: Policy and Research Implications Lancet Health System Reform Series Workshop


1
Policy and Research Implications Lancet Health
System Reform Series Workshop
  • Dr Henk Bekedam
  • Director, Division for Health Sector Development
  • WHO Western Pacific Regional Office.

20 October 2008 Beijing, China
2
Overall
  • Celebration
  • China is clear where it is going with Health in a
    comprehensive way
  • Evidence used as a guiding principle
  • State Council embarked on consultative process
    from institutions and public
  • Lancet series stimulating evidence for policy
    global sharing and learning
  • Greater demand for evidence Asia Pacific
    Observatory on health systems and policies
  • Some questions remain what, how, when and by whom
  • Implementation will be the major challenge
  • Rural Health prevention as focus or Primary
    Health Care
  • Not clearly articulated in HSR plan
    multi-sectoral policies and actions in
  • Environment, injury, road, water, education,
    smoke taxation and behaviour changes related to
    nutrition, physical activity

2
3
Equity Universal Access
  • Human resources
  • Lancet very good contribution
  • Least mapped and analysed
  • Mainly supply focus distribution point well
    made
  • Urgent need to develop a Human Resource plan that
    can support the new directions
  • Numbers, distribution, quality and skill-mix
  • New cadres of staff needed to strengthen rural
    and preventive health, like health inspector,
    public health nurse, nutritionist etc.
  • Review of incentives and curriculum for health
    workers
  • Requires multi-sectoral approach MoH, MoE, MoHRSS

3
4
Equity Universal Access
  • Finance (1) Lancet
  • Economic crisis globally we should not make the
    same mistakes again by returning to free market
    ideology and reduce resources for Health in case
    of financial crisis
  • China has the resources to achieve Universal
    Access (perfect storm)
  • To achieve Universal Access
  • GDP to be spent by Govt on Health to achieve UA
    (4-5 GDP)
  • Reduce OOP (out-of-pocket) to less than lt30 of
    total health expenditure
  • Importance to have targets
  • Ensure that poorer provinces and facilities at
    lower level receive adequate funding to deliver
    health services, addressing the unfunded mandates
  • Clarify responsibilities of Central and
    Provincial government

4
5
Equity Universal Access
  • Finance (2)
  • Insurance from coverage to benefit, increasing
    reimbursement to 70-80 level
  • Improvement of provider payment (Govt and
    insurance)
  • Move away from user fees towards prepayment of
    providers (salary, per capita)
  • Diagnosis-related-grouping (DRG)
  • Improve purchasing function for quality and
    price
  • Current purchasers (MoH and MoHRSS)
  • Institutional change needed to create separate
    purchasers (insurer) from the regulators (MoH and
    MoHRSS)

5
6
Quality and Safety
  • Not covered in Lancet series
  • Drug and Food safety
  • Simplify, synchronize laws across ministries and
    provinces (e.g. one food safety law)
  • Improve effective coordination of ministries and
    effective implementation across the country
  • System approach - every step of production (farm
    to fork from supplier of raw materials to
    finalised products)
  • Certification of all steps of productions
    (supplier, producer, distributor, outlet)
  • Improve capacity to implement and reinforce laws
    (HR)

6
7
Quality and Safety
  • Pharmaceuticals
  • National Medicine Policy being adopted
  • Opportunities for China to move from major
    exporter of raw materials to finalised products
    (2nd line ARV, Vaccines), improving supplies of
    essential medicines globally
  • Service delivery regulatory
  • Setting standards
  • Separating regulatory functions from implementing

7
8
New and Neglected Health Challenges
  • Environment
  • NCDs
  • Injury
  • Hepatitis B
  • Mental Health

8
9
Monitoring and Evaluation
  • Health information (Lancet Surveillance - HSP
  • Health Systems Performance Assessment define
    indicators and monitor
  • Focus on access to services and reduced OOP
  • Vital registration
  • National Health Survey good instrument and
    align with reform and ensure good population
    coverage to enable sufficient disaggregation
    (gender, income, ethnic)
  • Accountability and increased public funding
  • How funds are spent and on what?
  • Who are benefiting?
  • Leading to improved health outcomes?
  • Leading to reduced OOP?

9
10
THANK YOU
10
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