Universal coverage financing overview and strategies

Transcription

1 Eliminating the Catastrophic Economic Burden of TB: Universal Coverage and Social Protection Opportunities. 29 April 01 May San Paulo, Brazil Universal coverage financing overview and strategies Dorjsuren Bayarsaikhan, Health Financing Policy, Department for Health Systems Finance, WHO Geneva

2 Outline Framework Major issues Reform strategies Relevance

3 Universal health coverage Equitable, timely, affordable access and use of needed health services without financial hardship. Quality, Accessibility and Efficiency

4 Major health financing problems 1. Insufficient resources for health. 2. Financial barriers and risks. 3. Equity and efficiency. Universal health coverage Access (financial barrier) Use (financial burden)

5 Health financing for universal coverage Financing systems need to be designed to: Provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality. Ensure that the use of these services does not expose the user to financial hardship.

6 Financial burden (use) Financial barrier (access) Functions: 1. Collection 2. Pooling. 3. Purchasing Health financing reform strategies Strengthen prepayment (taxation and social health insurance) Reduce direct out-of-pocket (OOP) payment Merge separate pooling Separate purchasing and provision (single purchaser) Modify provider payment methods and incentives

7 % Revenue collection (Fiscal space, priority and commitment) Government priority and commitment to the health sector also matter Fiscal space Priority Commitment Source: WHO NHA 2011

8 OOP as % THE Revenue pool (No pooling under direct OOP payment) OOP payment is commonly used in health financing Source: WHO NHA 2011 WHO Member States

9 OOP as % THE Out-of-pocket (OOP) payment share Pooled Not pooled Source: WHO NHA 2011 WHO Member States

10 OOP share (%) and per capita GDP ($) Every country can make progresses regardless of their income level Countries Source: WHO NHA 2011

11 Catastrophic health expenditure against OOP High risk for households to face catastrophic health expenditure when OOP share is high. Source: WHR Background paper 19

12 Purchasing (Organization of health financing in Mongolia) Fragmentation, overlapping, duplication reduce efficiencies

13 TB financing practices In general, once it is diagnosed, the first line TB treatment is available and affordable. Different financing arrangements are used for TB treatment e.g government budget, health insurance, direct OOP and external financing schemes. TB diagnoses and treatments are provided mainly by publicly owned health care providers, which receive funds through different financing schemes.

14 Relevance of UHC financing to TB 1. Remove financial barriers for those who need TB diagnosis and treatment. What type of financial barriers exist for TB patients? How they relate to health system financing? Are there explicit cost recovery and cost sharing liabilities and requirements for fee for service and co-payment? 2. Ensure quality care e.g TB treatment is appropriate and complete. What provider payment incentives affect TB patients and health care providers? How health financing supports a health service referral system? How comprehensive are health service benefit packages or entitlements and how continuing health care is ensured?

15 Relevance of UHC financing to TB 3. Safeguard that the use of TB related diagnosis and treatment does not put families at financial risk. What is the role of direct OOP payment in financing for TB related services? How much households pay for TB related services relative to their family income? What data collection mechanisms and tools are feasible to obtain timely information? 4. Safeguard that TB does not impoverish people. What financial protection mechanisms exist to cover the cost of necessary treatment and loss of earnings caused by ill health (TB)? What mechanisms to cover and incentivize the poor people to access and use TB services? How to protect the low income and vulnerable from health payment related impoverishments?

16 Conclusion UC coverage is not destination, it is direction. No a single blue print. Certain principles can guide. Paths to UC should address major problems and challenges. A step by step approach. UC reforms must be homegrown.

17 THANK YOU