Ensuring that health financing policy supports universal health coverage efforts

Transcription

1 National Conference on Ensuring that health financing policy supports universal health coverage efforts Matthew Jowett PhD Senior Health Financing Specialist WHO Geneva

2 What is universal health coverage? Instruments in support of UHC Health insurance lessons from elsewhere Key policy questions

3 WHO CONSTITUTION The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition (WHO Constitution)

4 WHO MISSION STATEMENT The mission of WHO is the attainment of all Peoples of the highest possible level of health

5 Universal health coverage goals Equity in service use (reduce gap between need and utilization) Quality of services (sufficient to improve health) Financial protection (no-one becomes poor as a result of paying for care)

6 3 dimensions of health care coverage

7 Some instruments to support UHC Spend on effective public health interventions Better mix, distribution, capacity of HRH Targeted incentives to those using & delivering priority services Ensure health financing as pooled as possible UHC a direction not a final destination

8 Universal Health Insurance the same as UHC? It depends (Social) insurance is about ensuring access to services with financial protection NHS UK is entirely tax financed the best insurance policy you will ever have Specific institutional arrangements are relatively unimportant. Need an intense focus on.

9 Moldova introduced national health insurance in 2004 Formal employment (payroll tax) Priority population category (state budget transfer) Self employed (purchase directly from national insurer) Member in national health insurance scheme Access to PHC and outpatient specialist services Access to hospital services Uninsured Life-saving care & public health priorities Limited consultations with PHC Otherwise, pay directly

10 Impact of introducing health insurance Being a member of the HI scheme became the main driver of entitlement - access to services in Moldova However, many people in non-salaried employment, and not officially poor, did not join the scheme. and their access did not improve (reduced?). Equity? After little progress, MoH decided to make PHC universal

11 - Formal sector workers (salaried) - Civil servants and private sector - Mandatory contributions (payroll tax) - Informal sector / non-salaried - Above the official poverty line - Voluntary contributions with no subsidy Must be COMPULSORY and there must be substantial SUBSIDY - Informal sector / non-wage - Below the official poverty line - Fully subsidized insurance contributions shared between local and national government

12 Whether the system relies mostly on general taxation, insurance contributions, external assistance, or all three How best to pool funds? Basis for entitlement? Key policy questions Which services to cover using pooled funds? How to organise purchasing? To what extent must people pay at point of service?

13 At least 3 things needed to move from concepts to practical policy Clear about where you are now - Major health, access concerns - Institutional capacity - Bad design? Clear about the direction Yes, UHC, but priorities? Physical / financial access, quality, inequality? How far, how fast? Fiscal situation Administrative and political constraints Etc.

14 Every country must define it s own pathways many mistakes have been made by adopting models without first adapting Home grown strategies informed by global evidence Important to develop national analytic capacity to interpret evidence from elsewhere, and adapt to local context

15

16 Be clear on the basis for entitlement to health services Unified national health information system Level, predictability, stability of public funds Some key considerations to inform and guide policy Strategic purchasing / results based financing More prepayment But not more prepayment schemes