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WHO biregional Health Care Financing Strategies for Countries of the Western Pacific and SouthEast A

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Title: WHO biregional Health Care Financing Strategies for Countries of the Western Pacific and SouthEast A


1
WHO 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

2
Outline 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

3
Background
  • 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.

4
Definition, 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
5
Correlation of HH with catastrophic health
expenditure and out-of-pocket payments
Source Ke Xu, David B Evans, et al (2003)
6
Poverty headcount (at 1) increase by OOP share
7
Catastrophic 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.

9
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10
Strategy 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

11
The relationships between strategy areas, health
system strengthening objectives, the achievement
of universal coverage, and improved population
health outcomes
12
Updated 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

13
Strategy 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.

14
(No Transcript)
15
Strategy 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.

16
Strategy 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.

17
Strategy 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.

18
Strategy 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.

19
Strategy 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.

20
Strategy 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.

21
Strategy 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.

22
Strategy 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.

23
Strategy 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.

24
Strategy 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.

25
Health care financing triangle Asia(ODonnell,
Van Doorslaer et al, 2006)
26
Strategy 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.

27
Strategy 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.

28
Strategy 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.

29
Strategy 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.

30
Strategy 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.

31
Strategy 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.

32
Strategy 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.

33
Strategy 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.

34
Strategy 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.

35
Proposed 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.
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