Title: WHO biregional Health Care Financing Strategies for Countries of the Western Pacific and SouthEast A
1WHO bi-regional Health Care Financing Strategies
for Countries of the Western Pacific and
South-East Asia Regions (2006-2010)and updated
HCF strategy for 2010-2015
- Phusit Prakongsai
- Kanjana Tisayatikom
- International Health Policy Program (IHPP)
- Presentation to the IHPP Journal Club
- IHPP meeting room
- 4 June 2009
2Outline of presentation
- Background of health care financing in two WHO
regions - Strategy for health care financing (2006-2010)
- Updating HCF strategies (2010-2015)
- Proposed strategy indicators for monitoring and
evaluation
3Background
- Health care financing is a key factor to
determine access to and availability of health
care, and the level of protection against
catastrophic costs of illness. - Appropriate health care financing arrangements
help governments mobilize adequate financial
resources for health, allocate them rationally,
and use them equitably and effectively. - Supporting adequate, sustainable, equitable and
effective health financing to improve health
outcomes is one of the most important goals of
WHO.
4Definition, Scope and Functions of healthcare
financing
Direct payment
Source of finance
1. Revenue Collection
2. Pooling
3. Purchasing
Health Impact
Health Services
A process of funding health care system
5Correlation of HH with catastrophic health
expenditure and out-of-pocket payments
Source Ke Xu, David B Evans, et al (2003)
6Poverty headcount (at 1) increase by OOP share
7Catastrophic spending headcounts of households
with OOP payments exceeding a threshold as share
of total hh spending(Van Doorslaer, ODonnell et
al, HE, 2007)
8- The Regional Strategy on HCF 2006-2010 was
endorsed by the RC for WP and SEA in 2005. - WHO carried out a mid-term review of the
implementation of the strategy from July to
September 2008. - The draft mid-term review and updating of the HCF
strategy for 2010-2015 was discussed during a
technical consultation of HCF experts in Manila,
25-26 March 09.
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10Strategy for health care financing (2006-2010)
- Increasing investment and public spending on
health - Achieving universal coverage and strengthening
social safety nets - Developing prepayment schemes, including social
health insurance - Supporting the national and international health
and development process - Strengthening regulatory frameworks and
functional interventions - Improving evidence for health financing policy
development and implementation - Monitoring and evaluation
11The relationships between strategy areas, health
system strengthening objectives, the achievement
of universal coverage, and improved population
health outcomes
12Updated HCF Strategy for 2010-2015
- Increase investment and public spending on health
- Improve aid effectiveness
- Improve efficiency by rationalizing health
expenditures - Increase pre-payment and pooling
- Improve provider payment methods
- Strengthen safety-net mechanisms for the poor and
vulnerable - Improve evidence and information for policymaking
- Improve monitoring and evaluation of policy
changes
13Strategy 1 Increasing investment and public
spending on health
- Key challenges
- Lack of comprehensive national policy on HCF
- Inadequate and disproportionate funding
- Low level of health spending
- Poor assessment of available resources
- Inefficient and ineffective use of limited
budgetary resources.
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15Strategy 1 Increasing investment and public
spending on health
- Enhance government commitment and vision and set
policy targets and medium and long-term action
plans to reach universal coverage and access to
quality health services. - Produce policy briefs to stimulate dialogues on
increasing fiscal space, health investment and
government spending on health. - Strengthen national capacity for resource
mobilization to support national plans and
defined health service packages for UC. - Provide national and international experience and
evidence to policy-makers for increasing
investment and government budget and health
spending, especially during the economic and
financial crisis.
16Strategy 1 Increasing investment and public
spending on health
- Increase overall awareness about economic, social
and health gains of public spending and
investment especially among political leaders and
high level government officials - Intensify resource mobilization efforts through
international partnerships to protect and secure
adequate financial resources for implementation
of national health plans for health and social
safety nets, especially to maintain poverty
reduction goals. - Carry out analyses of health service needs for
universal coverage compared to current provision,
including the quality of services and financing
practices, to identify gaps in priority health
services with largest potential health impacts. - Develop a health workforce development plan with
appropriate funding levels and identified funding
sources.
17Strategy 2 Improve aid effectiveness (1)
- Revise national targets, plans, priorities,
actions and resource requirements with a clear
result focus that will constitute the basis for
external aid and support. - Carry out need assessments to identify systemic
constraints and implementation bottlenecks for
the delivery of essential services and the
required process to address them. - Plan capacity development linked to policy and
institutional needs including assessing
complementarities with other sectors, and
analyzing roles of non-state partners (NGOs,
civil society, and private sector). - Ensure that the activities and program donor
support are fully aligned with government
programs and plans.
18Strategy 2 Improve aid effectiveness (2)
- Reduce fragmentation by improving coordination,
harmonization and integration of domestic and
external resources to attain nationally defined
health policy goals and objectives. - Ensure consistency between health development
plans, sector-wide approaches, and the overall
budget, considering other sectors and
macro-economic framework. - Increase the proportion of aid that can be
programmed by the ministry of health, and general
budget support. - Work with all partners to increase the duration
of commitments and reduce volatility.
19Strategy 3 Improve efficiency by rationalizing
health expenditures (1)
- Improve health sector administration and
management skills and practices at all levels of
the health systems. - Improve national planning processes, by using
Medium Term Expenditure Framework (MTEF) and
other tools to develop financial plans to attain
universal coverage base on available and
projected government and external financing
resources. - Undertake public health expenditure reviews (PER)
and result-based budgeting where feasible to
attain greater efficiency from public spending. - Improve budgeting and financial planning
practices to efficient and equitable allocation
of resources to fund essential health service
package accessible to all population.
20Strategy 3 Improve efficiency by rationalizing
health expenditures (2)
- Establish budget disbursement monitoring to
assure that primary health care facilities in
rural and underserved areas receive sufficient
budgets on regular and timely basis. - Review tertiary hospital expenditures including
all levels of public health facilities to find
possible areas of cost savings. - Explore options to minimize costs of
pharmaceutical supply and distribution including
improving prescribing practice and eliminating
financial incentives for over-prescription. - Strengthen regulation of the private sector and
enable the private sector to participate in
delivering primary health care. - Explore innovative approaches to support rational
use of drugs and medical technologies.
21Strategy 3 Improve efficiency by rationalizing
health expenditures (2)
- Establish budget disbursement monitoring to
assure that primary health care facilities in
rural and underserved areas receive sufficient
budgets on regular and timely basis. - Review tertiary hospital expenditures including
all levels of public health facilities to find
possible areas of cost savings. - Explore options to minimize costs of
pharmaceutical supply and distribution including
improving prescribing practice and eliminating
financial incentives for over-prescription. - Strengthen regulation of the private sector and
enable the private sector to participate in
delivering primary health care. - Explore innovative approaches to support rational
use of drugs and medical technologies.
22Strategy 3 Improve efficiency by rationalizing
health expenditures (3)
- Increase health workforce motivation and career
development by analyzing government provided
salary levels and performance based financial
incentives. - Review policies to discourage inappropriate
health workforce behaviors affecting health care
costs and financial burden borne by households. - Monitoring employment in the health sector during
the economic crisis - Promote home-based care and other services for
the elderly and the most vulnerable.
23Strategy 4 Increase prepayment and pooling (1)
- Improve advocacy and public information to
support of government policy commitment and
actions needed to achieve UC. - Generate country-specific evidence on financial
protection against catastrophic and impoverishing
health payments. - Define appropriate prepayment options, including
social health insurance schemes with affordable
contributions. - Undertake costing of nationally defined health
benefit package to advocate universal access. - Develop and implement action plans to increase
population coverage and access to essential and
quality health services.
24Strategy 4 Increase prepayment and pooling (2)
- Strengthen communication strategies and
mechanisms to improve public relations, consumer
satisfaction and information on prepayment and
pooled mechanisms. - Increase awareness and understanding of the
prepayment and pooling concepts by the health
workforce and leadership to enhance their ability
to managing resources effectively and deliver
quality health care. - Improve coordination, collaboration and
capacities to negotiate, purchase, and deliver
quality health services supported by standards
and norms, legislative and accreditation
mechanisms.
25Health care financing triangle Asia(ODonnell,
Van Doorslaer et al, 2006)
26Strategy 5 improve provider payment methods (1)
- Evaluate current provider payment methods in
country situations and their impacts on HSP and
HCF. - Ensure free access to PHC by using global budget,
salaries and capitation payments to guarantee
availability of defined health benefit service
package at primary care level. - Promulgate clear policy and guidelines on user
fees and eliminate charges that complement health
workers salaries and other practices that inflate
health care costs. - Increase consumer awareness, information and
education about provider payment methods and
their applications by different levels of
providers. -
27Strategy 5 improve provider payment methods (2)
- Refrain from introducing and expanding use of
fees for services that negatively affect equity,
access, poverty and impoverishment associated
with catastrophic health spending. - Restrict providers ability to establish own fees
and charges that create additional financial
barriers for low income and vulnerable population
to accessing healthcare. - Replace user fees with prospective and
results-oriented payment methods - Explore alternative provider payment methods such
as diagnostic related groups (DRG), results-based
financing (RBF) and pay-for-performance (P4P)
where feasible to support better use of financial
resources.
28Strategy 5 improve provider payment methods (3)
- Establish a mechanism to analyze and monitor the
effects of provider payments relative to health
financing policy objectives to reduce
out-of-pocket payments under pooled financing
systems. - Assign unit in ministries of health or health
insurance agencies responsible for examination,
evaluation and introduction alternative provider
payment methods with evidence-based advantages
over fee-for-service payments. - Generate evidence for negotiations with providers
to support and participate in designing new
payment methods, pilot projects and
implementation.
29Strategy 6 Strengthen safety-net mechanisms for
the poor and vulnerable (1)
- Develop and implement policy options to
strengthen safety nets for health by removing
financial barriers, limiting user fees and
eradicating unauthorized charges for publicly
financed services. - Improve country level data, information and
evidence on the major forms of OOP expenditure. - Improve methods to estimate the impacts of OOP on
different income groups to design effective
subsidy benefit uptake by the most needed
vulnerable population. - Analyze health spending patterns and behaviour
for low income and vulnerable groups living near
or below local poverty lines.
30Strategy 6 Strengthen safety-net mechanisms for
the poor and vulnerable (2)
- Evaluate and implement premium subsidies, user
fee exemptions, conditional cash transfers, and
other social assistance schemes for poor and
vulnerable groups. - Review and assess user fees regulations and
practices and their impacts on access, equity and
poverty. - Strengthen the regulatory framework needed to
attain universal coverage and provide effective
social safety nets for the poor and vulnerable
through established systems.
31Strategy 7 Improve evidence and information for
policymaking (1)
- Promote evidence informed policy decisions and
actions by developing and promoting research and
studies on macroeconomics and health, costs,
effectiveness and benefits of health
interventions, and health impacts of the global
economic and financial crisis. - Establish an anti-crisis unit within the health
ministry that can collect and analyze real time
data and information to respond rapidly to reduce
possible health impacts. - Improve health financing data and information by
expanding national and sub-national health
accounts, international standards and
classifications. - Improve data availability and quality following
international standards and practices on national
health accounts.
32Strategy 7 Improve evidence and information for
policymaking (2)
- Provide health policy researchers with training,
targeted research topics, and financial support
to provide information to not only policy makers
and government officials, but also civil society
groups. - Support studies and dialogues to address the
reorientation of health services and reallocation
of financial resources to attain universal
coverage with pro-public and pro-poor health
spending. - Review and assemble relevant existing country and
region specific studies of health equity and
health financing to analyse and monitor their
causes through robust health indicators, as well
as of improving access to health care services in
order to reduce the risk of poverty.
33Strategy 8 Improve monitoring and evaluation of
policy changes (1)
- Strengthen national capacity for monitoring and
evaluation. - Identify information requirements and gaps in
managerial and analytical skills. - Train staff in health economics and
implementation and monitoring of health financing
policies. - Integrate health financing indicators into
overall health monitoring and evaluation
framework. - Focus on most important outcomes and report OOP
levels for all parts of the health system in a
timely manner.
34Strategy 8 Improve monitoring and evaluation of
policy changes (2)
- Transform health financing evaluation results
into effective health policies - Improve collaboration between researchers and
policymakers to ensure that research is directed
at outcomes of health financing policy reforms - Encourage regional collaboration with other
groups doing monitoring and evaluation of health
financing reforms. - Provide timely reports based on NHA data to
health planners to track resource allocations to
PHC.
35Proposed strategy indicators to monitor and
evaluate progress
- Reducing the share of out-of-pocket payments
shares below 30 of total health expenditure - Attain over 90 population coverage by various
risk-pooling and prepayment arrangements. - Attain 100 coverage of vulnerable populations
with social assistance, and safety-net schemes. - Increases in public financing by at least 1 of
GDP, to reach total health spending of 4-5 of
GDP, with 50-70 of public financing.