Universal Health Coverage Strategies
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ADB Health Sector GroupUniversal Health Coverage Strategies
Uploaded by
ADB Health Sector GroupUniversal Health Coverage
The World Health Report 2010 and The Regional Health Financing Strategy 2010-2015
Ke Xu
Health Care Financing WHO Regional Office for the Western Pacific 26 April 2012, ADB
The views expressed in this paper are the views of the authors and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. The countries listed in this paper do not imply any view on ADB's part as to sovereignty or independent status or necessarily conform
to ADBs terminology.
Universal Health Coverage
The aspiration to attain universal coverage is not new:
WHO's constitution (1948) Alma-Ata declaration (1978) World Health Assembly Resolution (2005) World Health Report on Primary Health Care (2008) Health Financing Strategy for Asia Pacific Region (2009) World Health Report on Health Systems Financing-The Path to Universal Coverage (2010)
Universal coverage has been adopted by most countries in their national health plans and/or reform agenda
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Health Systems Financing
Definition of Universal Coverage
Universal Coverage
Everyone has access to needed services without the risk of financial hardship linked to paying for care. Universal Coverage is coverage with health services; with financial risk protection; for all
Health Systems Financing
Three Dimensions
Where We Are?
Access to health services (prevention, promotion, treatment, rehabilitation):
More than 1 billion people cannot use the health services they need
Financial risk protection:
Around 150 million suffer financial catastrophe each year and 100 million are pushed into poverty because they need services, use them, but must pay at the time of use.
System efficiency:
Based on a conservative estimate, 20-40% of resources spent on health are wasted.
Health Systems Financing
Coverage of Births by Skilled Health Personnel and DPT3 Vaccination
Births attended by skilled health personnel
100 90 80 70 100 90 80 70
3 doses of diphtheria-tetanus toxoid pertussis vaccine among 1 year olds (DPT3)
Percentage of coverage
60 50 40 30 20 10 0
Percentage of coverage
60 50 40 30 20 10 0
| Countries (ranked from lowest to highest coverage)
Health Systems Financing
Countries (ranked from lowest to highest coverage)
Percentage of Births by Medically Trained Person: Poorest (Q1) and richest (Q5) quintiles
100
Q1, Q5 and Average - 22
0
0
20
40
60
80
10
20
Q5
30
Q1 Average
40
50
Source: Latest available DHS for each country (excl. CIS countries)
Health Systems Financing
Millions More Suffer Financially When They Use Health Services
EMR AFR EUR SEA AMR WPR
impoverishment catastrophic
30
60
90
Number of people (million)
Health Systems Financing
Three Fundamental Health Financing Challenges
1. Health Financing Functions The continual need to search for sufficient funds for health; Revenue collection
2.
The need to ensure/maintain financial risk protection where financial barriers do not prevent people using needed health services nor lead to financial ruin when using them;
The need to reduce inefficiency and inequity in using resources, and increase transparency and accountability.
Pooling
3.
Purchasing
Health Systems Financing
Raise Sufficient Funds
Increase the efficiency of revenue collection
Mongolia
Health expenditure as a share of GDP (2008)
Reprioritize government budget Innovative financing Development assistance for health
Viet Nam PNG China Cambodia Philippines Lao PDR
0% 1% 2% 3% 4% 5% 6% 7% 8%
public%GDP
private%GDP
Health Systems Financing
Health Systems Financing
Reduce Out-of pocket Payments
Out-of-pocket payments prevent some people using health services and result in financial ruin for many who do
% of households with catastrophic expenditure (logarithm)
Proportion of Households with Catastrophic Expenditures vs. Share of Out-of-pocket Payment in Total Health Expenditure
8 15 1 3 3
.01
.03
.1
.3
14
22
37
61
100
out-of-pocket payment in total health expenditure % (logarithm)
OECD others
Health Systems Financing
Components of Health Expenditure, 2008
Cambodia Lao PDR Viet Nam Philippines China M ongolia PNG
0% 20% 40% OOP Other 60% SSH Tax 80% 100%
Health Systems Financing
Increase Efficiency
Common causes of inefficiency:
Spending too much on medicines and health technologies, using them inappropriately, using ineffective medicines and technologies Leakages and waste, again often for medicines Hospital inefficiency particularly over-capacity De-motivated health workers, sometimes workers with the wrong skills in the wrong places An inappropriate mix between prevention, promotion, treatment and rehabilitation
Health Systems Financing
Protect the Poor and Vulnerable
Options (in addition to prepaid and pooled resources) to ensure greater coverage and lower financial barriers:
Free or subsidized services (e.g. through exemptions or vouchers) for specific groups of people (i.e. the poor) or for specific health conditions (i.e. child or maternal care) e.g. Sierra Leone. Subsidized or free enrolment in health insurance e.g. Mexico, Thailand Cash payments to cover transport costs and other costs of obtaining care reduce some financial barriers for the poor. Sometimes these are paid only after the recipient takes actions, usually preventive, that are thought to be beneficial for their health or the health of their families.
Health Systems Financing
Summary
More money for health
Search for more available funding for health
Reduce the reliance on direct out-of-pocket payments
Maximize solidarity in the society
More health for the money
Improve efficiency and equity in use of resources.
Protect the poor and vulnerable and improve equity
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Health Systems Financing
