Financing Private Health: A focus on Community Based Health Insurance. Dr. Ambrose Nyangao Intervention Manager 5 h June 2014

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1 Financing Private Health: A focus on Community Based Health Insurance Dr. Ambrose Nyangao Intervention Manager 5 h June 2014

2 Comparing Kenya s private health markets with neighbouring markets: A focus on healthcare financing

3 Introduction Based on the Desktop research done by Oxford Policy Management Overall goal was to better understand the current landscape of pro-poor Health financing models Purpose Inform the stakeholders Meant to inform choice of interventions in Healthcare Financing

4 Health Financing by Country S Africa 1 Zimbabwe 1 Namibia 2 Kenya 2 Uganda 2 Nigeria 2 Private Health Expenditure (PvtHE) as % of total health expenditure Private health insurance expenditure as % of PvtHE Out-of-pocket health expenditure as % of PvtHE Source: WHO Global Health Expenditure Database

5 Systems of Health Accounts Health financing schemes Government schemes & compulsory contributory schemes Voluntary health care payment schemes Household out-ofpocket payment Rest of world financing schemes Government schemes Voluntary health insurance schemes Non-profit institutions serving households Enterprise financing schemes Compulsory contributory health insurance (social health insurance & compulsory private insurnace) Government-based voluntary insurance Medical savings accounts Risk-rated private health insurance Employer-based insurance Community-based health insurance, including microinsurance for health Derived from WHO (2011). System of Health Accounts.

6 Types of Health Insurance Risk-rated Private Health Insurance Employer-based Health Insurance Enterprise Financing Schemes Micro Health Insurance Community-Based Health Insurance

7 Community-Based Health Insurance Mode of participation Benefit entitlement Basic method for fund-raising Mechanism and extent of pooling funds voluntary Based upon contribution Defined at local level Typically at individual scheme level, often described as being local community level. CBHI (i) Community prepayment health organizations (ii) Provider based health insurance and (iii) Government-run but community-involved health insurance.

8 Community-Based Health Insurance CBHI schemes took root in Africa in the 1990s in response to user fees as part of structural adjustment programmes (SAP) Implementation Support from international donor organizations with little community initiative Some were initiated by faith-based health facilities More recently, some governments are supporting their existence as part of universal health coverage initiatives Rwanda Tanzania and Ghana Population coverage, CBHI schemes exist within localised communities.

9 WHY CBHI Stronger in reaching out to marginalized groups Schemes where the community plays a role in scheme design and implementation are better at ensuring access to health care & financial protection CBHI implicitly provides complementary or supplementary - often in contexts where the individuals are legally entitled to the services of government health schemes, but where such schemes are not fully effective. BUT Community-run schemes tend to be limiting in number and capacity Schemes that have access to external sources of financing, in addition to premiums, are more effective but not sustainable & still does not reach the indigent. - This pattern suggests that subsidies are more likely to flow to the relatively better-off.

10 Recommendation: Private Health Financing Schemes Design Financial protection Affordable premiums. Standardizing benefit packages limits innovation and the range of plans available in the market; Too costly for some and Offer the wrong mix and level of services for others limiting participation in voluntary markets. Effect of Co-payment Policy-makers must consider equity and affordability. Extent to which schemes provide coverage for the poor. The alternative of investing more in larger-scale prepayment

11 THE BIG QUESTION? Can community based Health decisions, including financing mechanisms, deliver better Quality healthcare?

12 Discussion

13 For more information Please join our linkedin group M4P in Health To get more reports and documents on our project, please go to https://psp4hpublic.sharepoint.com/reports/research-reports. WIFI password - Ken4a2014 (psp4h)

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