Health Financing for UHC: promising directions and pitfalls to avoid
|
|
- Marjory Arnold
- 8 years ago
- Views:
Transcription
1 Health Financing for UHC: promising directions and pitfalls to avoid Joseph Kutzin, Coordinator Health Financing Policy, WHO UHC: everybody s rhetoric but whose responsibility Netherlands Platform for Global Health Policy and Health Systems Research 3 September 2014, Rotterdam
2 Overview l Who s (WHO s) responsible for what? l Clarifying core concepts l Things we know in health financing: lessons from theory and practice l Applying theory, evidence, and concepts to a core challenge for UHC in LMICs: the scale of the informal economy 2
3 WHO S (!) RESPONSIBLE FOR WHAT 3
4 WHO core responsibilities (for policy harm reduction and promising directions) l Conceptual clarity l Dissemination (and application) of what we do know about health financing policy We know more than we give ourselves credit for l Advocacy (for goals, not instruments!) Push for consensus on goals so we can have a meaningful fight about instruments l Aiming for intelligent policy dialog and debate at national and global levels 4
5 CORE CONCEPTS: UHC AND HEALTH FINANCING POLICY 5
6 Definition from our World Health Report l "Financing systems need to be specifically designed to: Provide all people with access to needed health services (including prevention, promotion, palliation, treatment and rehabilitation) of sufficient quality to be effective; Ensure that the use of these services does not expose the user to financial hardship" World Health Report 2010, p.6 6
7 Definition embodies specific aims (UHC goals) l Equity in service use; l Quality; and l Financial protection l for all l Utopian and unattainable?? 7
8 For relevance, think of UHC as a direction, not a destination l No country fully achieves all the coverage objectives And harder for poorer countries l But all countries want to Reduce the gap between need and utilization Improve quality Improve financial protection l Thus, moving towards Universal Coverage is something that every country can do Practical orientation for policy reforms Relevant to countries of all income levels 8
9 Don t forget rest of the system; financing can t do it alone l Health financing policy directly affects financial protection; policy on medicines does as well l Many parts of the system (service delivery, human resources, medicines, technologies, financing) combine to influence service utilization l Financing may only be complementary instrument for influencing quality (service delivery, human resources/ medical education, medicines, technologies, information) 9
10 What is the content of health financing policy/systems? Classifications or models l National Health System (Beveridge Model) l Social Health Insurance System (Bismarck) Doesn t help: sources are not systems (but may be politically valuable) Functions and policies l Collection l Pooling l Purchasing l Benefits and rationing Part of all health financing systems, regardless of label Understand systems (and reform options) in terms of functions, not labels or models 10
11 Beyond Beveridge and Bismarck l Labels like social health insurance or tax-funded system or community-based health insurance, (or even just insurance!!) are not helpful for understanding what a country is actually doing l Functional approach more useful Disaggregated view of collection, pooling, purchasing, benefits, and wider governance arrangements Relevant to countries at all income levels, but particularly important for countries with large informal sectors We observe a mix, with many countries coordinating different funding sources, channeling general budget revenues into a distinct purchasing agency, etc. 11
12 People Revenue collec1on Pooling Purchasing Service provision People What kinds of choices need to be and also this: made? Reforms to improve how the health financing system performs This Popula1on, service, and cost coverage; level and distribu1on of u1liza1on, extent of catastrophic and impoverishing payments
13 We are supporting countries to development health financing strategies for UHC l How to alter the system in a way that Reduces the gap between the need for and use of services, across the population, Improves quality of health services, Improves financial protection l given our starting point in terms of existing configuration of the health system, including coverage arrangements, overall current and expected fiscal constraints, and other key contextual factors, such as labor market (informality), public administration structure (e.g. decentralization), geography and population density, politics, etc.? l Over e.g. the next 5-10 years (time-bound)
14 Universal means universal, so think in terms of system, not schemes l Essential to get the unit of analysis right (for monitoring and policy) It is not about the % of the population that is in an (insurance) scheme (relevant in some countries but not in others) Effects of a scheme on its members is not of interest What matters is the effect at level of the entire system and population on UHC goals (impact of scheme on system goals) Because a scheme can makes its members better off by making others worse off l Getting this wrong can leads to useless (at best) or misleading (at worst) analysis and recommendations 14
15 Universal Coverage is not a new concept l Emerged in particular after 2 nd World War Push for social cohesion in Europe Concept of human security in Japan l WHO constitution highest attainable standard for all And later Alma Ata Health for All l Universal Declaration of Human Rights, includes right to medical care l Embedded in many national constitutions 15
16 Shift to UHC implied profound change in rationale for public policy on health coverage l Health insurance emerged in Europe as a condition of labor (first formalized as public policy under Bismarck) Increasing labor productivity (industrialization) Reducing labor radicalism and unrest Thus, social (compulsory) health insurance for wage earners l After 1945, universal coverage : affordable access to health services as a condition of citizenship or human/ constitutional right Implies a shift away from a purely (direct) contributory approach Also implies compulsion or automatic entitlement Thus, health coverage for the entire population, with explicit policies to fund coverage for the non-salaried population 16
17 Well, it should have implied a new approach to financing, but l Most advice coming to low and middle income countries was largely based on following Europe s historical path l Approach based on a conceptual flaw with serious consequences in developing countries 17
18 An approach grounded in the first half of the 20 th century, applied in the 2 nd half (and beyond?) l Starting insurance with the formal sector Improves access and financial protection for the better off Historically in Europe and Japan, coverage grew w/ economic development, growing formalization of the economy and high employment Today, however, LMIC governments face decisions on the rationing of scarce medical technology that European and Japanese governments did not face a century ago Initially covered groups defend their interests, benefits and subsidies, and concentrate scarce skills on their behalf Exacerbates inequalities, fragments the system, and is very difficult to undo 18
19 What UHC brings to public policy on health coverage l Coverage as a right (of citizenship, residence) rather than as a condition of employment Critically important implications for choices on revenue sources and the basis for entitlement l Shift thinking from scheme to system UHC goals should be considered at the level of the entire population and system (what s good for scheme members may/ may not be good for the entire population) 19
20 UHC and health financing: summary of key concepts Towards UHC to transform from aspiration to relevant, applicable concept UHC goals matter at level of system, not schemes Health financing: think functions, not labels (Bismarck and Beveridge really are dead) UHC changes the underlying rationale for public policy on health coverage (think/act accordingly) 20
21 THINGS WE KNOW (AND SHOULD TRUST) ABOUT HEALTH FINANCING 21
22 WHO diplomacy: The path to UHC should be home-grown l Even if broad UHC objectives are shared by all countries Specific manifestations of problems vary, so how the goals should be operationalized will vary as well Every country already has a health financing system, so starting point for each country is unique Mix of fiscal and other contextual factors also unique l But this should not be interpreted to mean that anything goes we have learned a few things over past 30 years Some do s and don ts in health financing policy Both economic theory and international experience can help to avoid repeating mistakes made by others 22
23 No amount of wishing or hoping will make this go away l No nation achieves universal coverage without subsidization and compulsion. Victor Fuchs (1996). What every philosopher should know about health economics. Proceedings of the American Philosophical Soc 140(2), p.188. l So no country gets to UHC relying principally on VHI Never has, never will: adverse selection is part of the physics of health financing policy Compulsion or automatic entitlement is essential Issue is compulsory vs voluntary, not public vs private (inserting the word community is not enough to combat adverse selection) l Compulsion refers to revenue source (i.e. some form of taxation) and basis for entitlement (mandatory/automatic)
24 For example, VHI under the label of CBHI in West Africa: low enrollment, small pools, insignificant funding impact Burkina Faso Benin Mali Togo Number of CBHIs Number of beneficiaries % population covered with CBHI Ave. beneficiaries per CBHI Ave. contribution per capita (XOF) % Total Health Expenditure 256, , ,000 16, % 1.5% 3.1% 0.3% 1, , ,000 3,000 2,500 1, % 0.25% 0.4% 0.04% Source of slide: Alexis Bigeard, WHO West Africa Intercountry Support Team
25 Similar findings in HEFPA l Subsidies, information and administrative easing did not yield great gains in voluntary prepayment/enrollment in national health insurance programs in the Philippines and Vietnam l And similar to nearly every other country s experience rich or poor with voluntary prepayment (will come to China and Rwanda soon). It is the nature of voluntary health insurance markets 25
26 Another important message: you can t just spend your way to UHC l To sustain progress, need to ensure efficiency and accountability Strategic purchasing as a critical strategy for this (and also for capacity strengthening, given link between information and resource allocation) l HEFPA and other studies reveal contrast between China and Thailand Both greatly increased public spending and enrollment in health insurance programs Thailand managed overall expenditure growth through coherent policies on benefit design and purchasing China continued to rely on fee-for-service payment with high cost sharing, with no gains in financial protection 26
27 The promising directions we seek Health financing element Revenue sources and contribution mechanisms Pooling Purchasing Benefit design and rationing policies Stewardship of financing Desirable attributes/directions for reform Towards predominant reliance on compulsory sources of funds (i.e. various forms of direct and indirect taxation) to meet the Fuchs conditions Reducing barriers to redistribution (fragmentation), increasing diversity of health risks within pools Establishing and strengthening incentives for efficiency and quality in purchasing mechanisms Promoting use of cost-effective services and limiting out-of-pocket burden, especially for the poor, and the alignment of these declared policies with other aspects of the system (particularly purchasing) Unified, coherent, goal-driven, and evidence-informed governance arrangements in the financing system 27
28 Why stylized models and labels don t help l Promoting health insurance doesn t help much unless you address all the financing functions and policies l Taxation is not a system, it s a source of funds l And for the context of most LMICs Towards compulsory sources means more reliance on indirect tax sources Improving purchasing means making such revenues much more flexible than in most public finance systems Means thinking outside our historical boxes, and intensive dialog with public finance authorities on both the level and quality of the budget allocations, while we push for new forms of accountability for the use of these funds (outputs, not inputs) 28
29 Early 21st century pathways to UHC l Thailand merged several different schemes into one, funded from general revenues, using quasi-public purchasing agency Overcame most but not all fragmentation across schemes, and progressively working to equalize benefits across them Increased service use while reducing catastrophic payments l Mexico addressing its legacy of a fragmented and unequal system by creating a budget-funded insurance program for a defined list of high-cost services for the entire population creating a program of "popular insurance" for informal sector funded largely by central budget transfers to the States, which in turn are responsible for enrolling the population Also reducing gap in per capita funding and benefits across schemes
30 More examples: slight differences in details due to differences in starting points/context l Ghana and Rwanda have explicit coordination of bottom-up and top-down financing mechanisms to create a virtual national pool, with budget revenues as main source Gains in utilization and financial protection l Kyrgyzstan and Moldova centralized pool of budget funds, combined with new payroll tax, changed from input- to output-based payment, and increased provider autonomy Impressive gains in geographic redistribution and efficiency l Chile (through the AUGE program) and Burundi (through its PBF mechanism) link purchasing to explicit benefits Demonstrable gains in use of defined priority services l India (GSHISs) and Cambodia (HEFs) link existing targeting mechanisms to budget/donor funded schemes for the poor
31 What they have in common: a functional approach to health financing policy l Recognized that the source of funds need not determine how money was pooled, how services were purchased, nor how benefits were specified l They shifted their thinking from schemes to system Pooled together or coordinated use of different revenue sources (in fact, so do Germany, Japan, Netherlands, Czech Rep, etc.) Introduced elements of performance-related payment from the prepaid funds to address specified utilization or efficiency issues Progressively increased the size of the compulsory prepaid funds while reducing the barriers to redistribution within it New organizations and institutional arrangements were key enablers/agents of change 31
32 Health financing for UHC: things we know Predominant reliance on compulsory sources (let s agree to trust both theory and evidence on VHI) There s no such thing as enough money can t just spend way to UHC (look at my country!) Lots of documented progress in past 15 years in LMICs that have taken on these lessons Changing the role/use of general budget (including donor) funds have been at the core 32
33 HEALTH FINANCING FOR UHC AND THE CHALLENGE OF INFORMALITY 33
34 First, context: public spending on health matters Source: WHO estimates for 2012, countries with population > 600,000
35 But context of high informality poses critical challenges to realizing the Fuchs conditions l Hard to mobilize much revenue from direct taxation Personal income tax Payroll tax (i.e. SHI contributions) l Hard to collect voluntary prepayment as well Economics of voluntary health insurance (VHI) Gains (tax avoidance) from maintaining informality l Hard for system to distinguish differences in capacity to pay (poor from non-poor) within the informal sector l Not a problem IF system can ensure service guarantees and financial protection on a non-contributory basis E.g. UK, Scandinavia, arguably in Sri Lanka,
36 The problem of informality l is mainly an issue of fiscal capacity Constrains ability of countries to generate enough public revenues to ensure compulsory sources as main funding source l Other problems and challenges arise due to past policy choices and implementation failures Attachment to contributory-based entitlement Fragmented/segmented pooling reinforces underlying social differences and constrains redistribution (formal sector SHI) Weak purchasing from general budget revenues according to bureaucratic line item practices Unclear and poorly communicated entitlements 36
37 Then, reframe the problem l In terms of progress towards UHC (goals), and not merely participation in a scheme (instruments) Keep asking the goal questions: WHY is system underperforming relative to UHC goals? Keep pushing to ensure the right unit of analysis: system, not scheme (scheme as a means to an end, not itself an aim) Don t allow an inappropriate specification the problem (inability to get the nonpoor informal sector to contribute) be equated to the solution (targeting the poor and making the nonpoor pay), as there are many other options 37
38 Broad categorization of financing reform options Non-contributory-based l Universal, budget funded, population-based system UK, Scandinavia, Sri Lanka l Budget-funded for all not covered by explicit social security mechanism Thai UCS, Mexico SP l Entitlement for some groups to range of services India GSHISs, Cambodia HEFs l Universal population guarantee for specific services Burundi free MCH, Chile AUGE Contributory-based l De facto voluntary prepayment for coverage, unsubsidized Indonesia s plan, Nigeria s plan, Malawi s plan, Bangladesh s plan, l Fully (for poor) and heavily subsidized prepayment for coverage (complementarity) Rwanda CBHI, China NCMS, Switzerland, Germany, Netherlands, Czech Rep,
39 CONTRIBUTORY-BASED APPROACHES 39
40 Contributory (provocation) 1: unsubsidized contributions by the non-poor informal sector l Advantages Equitable relative to ability to contribute (if you can do it) Minimizes fiscal impact Would not impact on formalization of the workforce (in effect, it would be a means of formalizing the informal sector) l Disadvantages This has never worked anywhere (big disadvantage) Costly to implement, both targeting and revenue collection (so in fact, there would be some fiscal impact) This approach ignores global experience and effectively suggests a government that is not really interested in moving to UHC 40
41 Contributory 2. Subsidized participation with strong public commitment to universality l This approach recognizes that no country gets to universal population coverage without budget transfers; not everyone can or will contribute l In countries with contributory-based entitlement that have reached universal population affiliation, general budget transfers play key role Japan: 25% of insurance revenues from general budget transfer Hungary: over half of insurance revenues from general budget Germany: small but increasing role for general revenues as government seeks to minimize impact on labor market l Clearly not just an approach for LMICs 41
42 Challenges of de facto voluntary participation, even subsidized, in LMICs l HEFPA conclusion from analysis in Vietnam and Philippines subsidization of premia by as much as 50%, along with the provision of information on the operation and benefits of insurance, is insufficient to bring enrollment rates anywhere close to the realisation of universal coverage. l Bitran, UHC and the Challenge of Informal Employment it is difficult to enroll informally employed individuals on a voluntary basis, even if they are offered large enrollment subsidies., p.18 l But 2 successes : China and Rwanda. What can we learn from them? 42
43 China and Rwanda have achieved 90% or more coverage on a contributory basis l Some features in common that distinguish their approach (2 technical, 1 political) Level and mechanisms used for directing budget subsidies, with cost of the premium being less than the perceived value of the benefit, stimulating demand Role of local gov t officials to both inform people and enroll them into the coverage program Strong central governments able to direct local government actors and encourage population to enroll (quasi-compulsory) l Other contextual elements History: population aware that not being covered means risk of high out-of-pocket spending Services must be both physically available and deemed to be worth it by the population
44 Subsidies, pooling structure, and local gov t roles may explain Rwanda s CBHI (!) success Regulation Finance Payment Advisor Private Health Insurance District Rwanda Social Security Board + MMI Structure of Rwanda Health Insurance Ministry of Finance Rwanda Health Insurance Council National Risk Pool District CBHI Risk Pool Ministry of Health Referral Hospital District Hospital l Government led, from central to local, and not NGO response to system failure l Heavily subsidized on demand and supply sides; contributions important but not main source l Compulsory Sector Adapted from Makaka CBHI Section Population Health Centre l Pooling across schemes and whole country
45 Expanding coverage in China s New Cooperative Medical Scheme (NCMS) l Coverage 10% 2003 to 98% 2012 l Explicit mutual leveraging between gov t levels and households in contributions voluntary contribution by individual matched by subsidies from local and central governments (subsidy per person more than tripled between 2008 and 2012, now 80% gov t, 20% families) Aligned incentives: local governments get more funding with higher levels of enrollment l Approach reflects strong political will to increase coverage, and attention to inter-governmental financial relations 45
46 NON CONTRIBUTORY-BASED APPROACHES 46
47 Non-contributory (1) universal populationbased, tax-funded coverage for all l Advantages Equitable and potentially efficient (easy to implement, if you can do it) It can work (UK, Scandinavia, arguably Sri Lanka, Malaysia) No direct labor market impact (complete de-linkage) l Disadvantages Fiscal impact (many LMICs can t provide the funds needed) In practice, high risk of over-promising and under-delivering Often linked to passive purchasing and weak accountability (a practical problem, not a conceptual one budget funds can be used strategically) Many countries already have schemes, so not relevant for them 47
48 Non-contributory (2): fully fund coverage for uncovered from general budget revenues l Well-known examples include Thai Universal Coverage Scheme, Mexico s Seguro Popular Both began with intent to have co-contribution from covered population, but gave up not worth collection cost l Advantages Administratively simple, no targeting, no additional revenue collection costs or bureaucracy for this purpose Evidence shows clearly that this can work l Challenges/potential disadvantages Fiscal constraints limit scope unless strong political commitment May contribute to reducing rate of formalization of labor force Risk of fragmentation if separate scheme for non-contributors 48
49 Is it fiscally feasible? Key question, and answer is definitely it depends Government health spending with Indonesia s fiscal constraint but other countries priorities GDP per capita Public spending as % GDP Health as % of total public spending Government health spending as % GDP Country Indonesia 4, % 5.3% 0.9% Malaysia 15, % 6.1% 1.1% Viet Nam 3, % 9.4% 1.6% China 8, % 12.5% 2.2% Thailand 8, % 14.5% 2.5% Australia 40, % 16.8% 2.9% Source: WHO health expenditure estimates for 2011, applying different country resource allocation priorities to Indonesia s fiscal level 49
50 Non-contributory (3). Prioritizing specific groups for tax-funded coverage l Equitable if it can be implemented, and targeting costs can be mitigated if health uses an existing mechanism rather than creating our own l As with any targeted approach, challenge is managing the boundaries Errors of inclusion and exclusion Even if targeting administered by others, connecting the list to the health financing system is not easy 50
51 Examples l With purchaser-provider split Cambodia s Health Equity Funds: donor and gov t money pays user fees on behalf of poor RSBY and several State schemes in India RSBY: BPL list determines eligibility, but eligible persons must still enroll w/very small fee Andhra Pradesh: all on the list automatically covered l Without purchaser-provider split Simple fee exemptions, often relying on health facilities to determine who can pay and who can t, and with few incentives for effective implementation Puts all burden on facilities and doesn t work very well 51
52 Non-contributory (4): selective universalization of services (purchasing and benefits) l Make certain services universal/guaranteed for all (in defined target group), irrespective of whether or not they are insured Expands coverage via purchasing and benefits rather than via contribution and population affiliation In line with priorities and capacity, can build on this to increase scope of service coverage guaranteed to all, funded from general revenues l To avoid this being an empty declaration, link benefit to an explicit purchasing mechanism Nigeria: Jigawa State free MCH program, with explicit line in the budget Burundi: transforming President s decree into reality by linking PBF to the declared benefits
53 Thinking through Burundi s selective free care w/pbf as a path towards UHC Free MCH services Reduce cost sharing and fees What next? Include other services Direct costs: propor8on of the direct costs covered Extend to non- covered Current Pooled Funds Services: which services are covered? Popula'on: who is covered? 53
54 Reflections on selective universalization of services, especially for poorest countries l Advantages Reflect public commitment to at least something for everyone Brings more explicit budget financing commitment Universalizing certain services from budget revenues can reduce amount needed for premiums to get insured for the rest Avoids the adverse selection and capacity to prepay problems Foundation for UHC built on purchasing rather than contribution and pooling - needs to be an explicit option for consideration instead of sole focus on getting people into insurance schemes l Disadvantages Leaves out potentially important services that people want, with access to these dependent on insurance status or ability to pay 54
55 Towards UHC in contexts of high Get the question right, or all you will focus on is how to get people to contribute (and you will fail) informality Recognize that at least some degree of de-linkage of entitlement from contribution will be needed Changing role (and often level) of general budget revenues key to all viable options Focus on purchasing and not just (or even mainly) revenue collection 55
56 SUMMING UP: CORE MESSAGES FROM THIS APPROACH TO HEALTH FINANCING POLICY 56
57 Things to remember about health financing policy for UHC Conceptual clarity on both goals and systems is essential Size of informal economy is major fiscal challenge for moving towards UHC in LMICs UHC is fundamental shift in foundation for public policy on health coverage Changing role of general revenues at heart of successes ; new dialog w MOFs Trust what both theory and evidence tell us, and don t believe in magic Towards UHC: what problem to solve, not what model to choose 57
58 Thank you 58
TOWARDS UNIVERSAL HEALTHCARE COVERAGE LESSONS FROM THE HEALTH EQUITY & FINANCIAL PROTECTION IN ASIA PROJECT
TOWARDS UNIVERSAL HEALTHCARE COVERAGE LESSONS FROM THE HEALTH EQUITY & FINANCIAL PROTECTION IN ASIA PROJECT Eddy van Doorslaer Institute for Health Policy & Management & School of Economics Erasmus University
More informationIntroduction to Universal Health Coverage and Financing
Introduction to Universal Health Coverage and Financing Awad MATARIA, PhD Health Economist World Health Organization Eastern-Mediterranean Regional Office Regional Workshop on Cost-Effectiveness Analysis:
More informationEnsuring that health financing policy supports universal health coverage efforts
National Conference on Ensuring that health financing policy supports universal health coverage efforts Matthew Jowett PhD Senior Health Financing Specialist WHO Geneva What is universal health coverage?
More informationUniversal Health Coverage: Concepts and Principles. David B Evans, Director Health Systems Financing
Universal Health Coverage: Concepts and Principles David B Evans, Director Health Systems Financing Outline Universal Coverage: definitions and the state of the world Health financing systems for Universal
More informationCurrent challenges in delivering social security health insurance
International Social Security Association Afric ISSA Meeting of Directors of Social Security Organizations in Asia and the Pacific Seoul, Republic of Korea, 9-11 November 2005 Current challenges in delivering
More informationHarmonization of Health Insurance Schemes in China
Harmonization of Health Insurance Schemes in China Hai Fang Professor of Health Economics China Center for Health Development Studies Peking University China Presentation at the First National Conference
More informationSupporting Governments in Improving Access through Health Financing: Policy Perspectives of GIZ & the Framework of Providing for Health (P4H)
Supporting Governments in Improving Access through Health Financing: Policy Perspectives of GIZ & the Framework of Providing for Health (P4H) Jenni Kehler GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit
More informationPROPOSED MECHANISMS FOR FINANCING HEALTHCARE FOR THE POOR.
PROPOSED MECHANISMS FOR FINANCING HEALTHCARE FOR THE POOR. Concept Summary Aug 2014 Insight Health Advisors Dr. Gitonga N.R, Prof. G. Mwabu, C. Otieno. PURPOSE OF CONCEPT Propose a mechanism for mobilizing
More informationPrinciples and key features of required reform
3 Principles and key features of required reform Given the realities outlined in Chapters 1 and 2 the Pensions Commission believes that minor changes in policy, tinkering with the present system, will
More informationHEALTH INSURANCE IN VIETNAM: HEALTH CARE REFORM IN A POST-SOCIALIST CONTEXT
HEALTH INSURANCE IN VIETNAM: HEALTH CARE REFORM IN A POST-SOCIALIST CONTEXT By Amy Dao, Columbia University Vietnam s economic and social reform program in 1986 called Đổi Mới (Renovation) signaled the
More informationThe Evolution and Future of Social Security in Africa: An Actuarial Perspective
w w w. I C A 2 0 1 4. o r g The Evolution and Future of Social Security in Africa: An Actuarial Perspective Presented by Members of the Actuarial Society of South Africa Social Security Committee Fatima
More informationSocial Protection in ASEAN Policy gaps and common challenges. Cheng Boon Ong 17 November 2014, Bangkok
Social Protection in ASEAN Policy gaps and common challenges Cheng Boon Ong 17 November 2014, Bangkok Methodology ABND for 7 Member States: Vietnam 2010-2011 Cambodia 2011-2012 Indonesia 2011-2012 Thailand
More informationhttp://mig.tu-berlin.de
Voluntary health insurance in Europe a structured introduction into objectives and status-quo Reinhard Busse, Prof. Dr. med. MPH FFPH Dept. Health Care Management, Technische Universität Berlin (WHO Collaborating
More informationUNIVERSAL HEALTH COVERAGE IN THE AMERICAS. Dr. Carissa F. Etienne Director PAHO/WHO
UNIVERSAL HEALTH COVERAGE IN THE AMERICAS Dr. Carissa F. Etienne Director PAHO/WHO Population in LAC 1900-2010 LAC North America LAC North America age age Number of people of both sexes Number of people
More informationHealthcare Reform: Opportunity for Public-Private-Partnership
Healthcare Reform: Opportunity for Public-Private-Partnership Sam Yeung Munich Re Session Number: MBR7 Joint IACA, IAAHS and PBSS Colloquium in Hong Kong www.actuaries.org/hongkong2012/ HEALTHCARE REFORM:
More informationHealth Financing in Vietnam: Policy development and impacts
Health Financing in Vietnam: Policy development and impacts Björn Ekman Department of Clinical Sciences Lund University, Sweden Sydney 17 September, 2008 Outline of Presentation Part A: Health financing
More informationIntroduction of a national health insurance scheme
International Social Security Association Meeting of Directors of Social Security Organizations in the English-speaking Caribbean Tortola, British Virgin Islands, 4-6 July 2005 Introduction of a national
More informationVOLUNTARY HEALTH INSURANCE AS A METHOD OF HEALTH CARE FINANCING IN EUROPEAN COUNTRIES
VOLUNTARY HEALTH INSURANCE AS A METHOD OF HEALTH CARE FINANCING IN EUROPEAN COUNTRIES Marta Borda Department of Insurance, Wroclaw University of Economics Komandorska St. No. 118/120, 53-345 Wroclaw, Poland
More informationAn Overview of Reasons for Public- Private Partnerships to Fund Healthcare Systems
IAA Health Section Colloquium Cape Town, Republic of South Africa May 13-16, 2007 An Overview of Reasons for Public- Private Partnerships to Fund Healthcare Systems Howard J. Bolnick, FSA, MAAA, HonFIA
More informationUNIVERSAL HEALTH COVERAGE Why health insurance schemes are leaving the poor behind
176 OXFAM BRIEFING PAPER 9 OCTOBER 2013 Manana Mikaberidze, 52, is a doctor from the Gori region of Georgia. She is not eligible for government-sponsored health insurance and cannot afford to join a private
More informationSocial Health Insurance In Three Asian Countries: China, Thailand and Vietnam 1 July 2014 Roli Talampas Asian Center UP Diliman
Social Health Insurance In Three Asian Countries: China, Thailand and Vietnam 1 July 2014 Roli Talampas Asian Center UP Diliman Outline Objectives & Questions Framework Methods Findings Summary Objectives
More informationCOUNTRY CASE STUDIES TAX AND INSURANCE FUNDING FOR HEALTH SYSTEMS FACILITATOR S NOTES. Prepared by: Health Economics Unit, University of Cape Town
COUNTRY CASE STUDIES TAX AND INSURANCE FUNDING FOR HEALTH SYSTEMS FACILITATOR S NOTES Prepared by: Health Economics Unit, University of Cape Town Preparation of this material was funded through a grant
More informationHealth Care Financing in China
Health Care Financing in China Social vs. private insurance Jin MA, Professor, MSc, MA, PhD Shanghai Jiao Tong University School of Public Health April 11, 2011, Atlanta, USA Outline Health Financing bet
More informationPublic / private mix in health care financing
Public / private mix in health care financing Dominique Polton Director of strategy, research and statistics National Health Insurance, France Couverture Public / private mix in health care financing 1.
More informationComparisons of Health Expenditure in 3 Pacific Island Countries using National Health Accounts
Comparisons of Health Expenditure in 3 Pacific Island Countries using National Health Accounts Hopkins Sandra* Irava Wayne. ** Kei Tin Yiu*** *Dr Sandra Hopkins PhD Director, Centre for International Health,
More informationThinking of introducing social health insurance? Ten questions
Thinking of introducing social health insurance? Ten questions Ole Doetinchem, Guy Carrin and David Evans World Health Report (2010) Background Paper, 26 HEALTH SYSTEMS FINANCING The path to universal
More informationAddressing the coverage gap schemes for informal sector workers Robert Palacios, World Bank Tokyo, February 22, 2008 The coverage gap Almost all countries mandate pension coverage for formal sector workers
More informationhttp://mig.tu-berlin.de
Strategic purchasing to improve health systems performance Issues and international trends Reinhard Busse, Prof. Dr. med. MPH FFPH Dept. Health Care Management, University of Technology, Berlin (WHO Collaborating
More informationFinancing Private Health: A focus on Community Based Health Insurance. Dr. Ambrose Nyangao Intervention Manager 5 h June 2014
Financing Private Health: A focus on Community Based Health Insurance Dr. Ambrose Nyangao Intervention Manager 5 h June 2014 Comparing Kenya s private health markets with neighbouring markets: A focus
More informationNational Health Insurance Policy 2013
National Health Insurance Policy 2013 1. Background The Interim Constitution of Nepal 2007 provides for free basic health care as a fundamental right of citizens. Accordingly, the Government of Nepal has
More informationPrivate Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff
Private Health Insurance Options in Egypt Discussion with EISA Chairman and senior staff Ibrahim Shehata April 27, 2006 Background Health expenditure is dominated by household direct out-ofpocket payments
More informationPUBLIC-PRIVATE PARTICIPATION IN UNIVERSAL HEALTH COVERAGE
PUBLIC-PRIVATE PARTICIPATION IN UNIVERSAL HEALTH COVERAGE Dr PHUA Kai Hong AB cum laude SM (Harv), PhD (LSE) Lee Kuan Yew School of Public Policy National University of Singapore The Challenge of Universal
More informationUnofficial payments and health financing policy: WHO s perspective
Unofficial payments and health financing policy: WHO s perspective Joseph Kutzin WHO Regional Advisor, Health Systems Financing Visiting Fellow, Imperial College Centre for Health Management 8 th annual
More informationHealth Insurance as Social Protection in Latin America
Health Insurance as Social Protection in Latin America Marcos Vera-Hernandez (m.vera@ucl.ac.uk) University College London & Institute for Fiscal Studies 1 st Kenya Social Protection Conference Week Enhancing
More informationStrengthening Health Financing in Partner Developing Countries
Strengthening Health Financing in Partner Developing Countries RAVINDRA P. RANNAN-ELIYA* THE HEALTH CHALLENGES CONFRONTING DEVELOPING COUNTRIES Three serious health challenges confront developing countries
More information1. Bank Group Support to Health Financing
1. Bank Group Support to Health Financing Highlights The way that health services are financed affects human welfare because it influences how health systems perform in improving health outcomes, and more
More informationMedical Insurance for the Poor: impact on access and affordability of health services in Georgia
Medical Insurance for the Poor: impact on access and affordability of health services in Georgia The health care in Georgia is currently affordable for very rich and very poor Key informant Key Messages:
More informationI can finally afford UC without making a huge upfront investment. COO, market leader in the health care industry
1 I can finally afford UC without making a huge upfront investment. COO, market leader in the health care industry 2 Contents 01 Investing in an anytime, anywhere, connected workforce 02 On-premise, hybrid,
More information2 nd EUA Funding Forum: Strategies for efficient funding of universities
2 nd EUA Funding Forum: Strategies for efficient funding of universities Bergamo, 9-10 October 2014 Forum report Liviu Matei, General rapporteur Table of contents I. Executive Summary 3 II. What is the
More informationCLOSING THE COVERAGE GAP. Robert Palacios, World Bank Pension Core Course March 2014
CLOSING THE COVERAGE GAP Robert Palacios, World Bank Pension Core Course March 2014 Different types of coverage gaps 2 In a subset of richer countries, the main kind of gap is related to adequacy rather
More informationHealth financing: designing and implementing pro-poor policies
Issues paper Health financing reforms are a core part of health sector development in low and middle income countries. The current focus of the international debate is on the need to move away from excessive
More informationIs health care financing in Uganda equitable?
Is health care financing in Uganda equitable? Zikusooka CM 1, Kyomuhang R 2, Orem JN 3, Tumwine M 1 1- HealthNet Consult, Kampala 2- Medical Research Council, Uganda 3- World Health Organisation/Uganda
More informationPublic and private health insurance: where to mark to boundaries? June 16, 2009 Kranjska Gora, Slovenia Valérie Paris - OECD
Public and private health insurance: where to mark to boundaries? June 16, 2009 Kranjska Gora, Slovenia Valérie Paris - OECD 1 Outline of the presentation Respective roles of public and private funding
More informationSocial insurance, private insurance and social protection. The example of health care systems in some OECD countries
Social insurance, private insurance and social protection. The example of health care systems in some OECD countries References OECD publications on Health care Swiss Re publications Sigma No 6/2007 on
More informationPrivate Health insurance in the OECD
Private Health insurance in the OECD Benefits and costs for individuals and health systems Francesca Colombo, OECD AES, Madrid, 26-28 May 2004 http://www.oecd.org/health 1 Outline Q Background, method
More informationDo risk sharing mechanisms improve access to health services in low and middle-income
August 2008 SUPPORT Summary of a systematic review Do risk sharing mechanisms improve access to health services in low and middle-income countries? The introduction of user charges in many low and middle-income
More informationPresentations by panellists were followed by a dialogue with members of the Council. These discussions are hereunder summarized.
Panel Discussion on Universal Health Coverage at the Center of Sustainable Development: Contributions of Sciences, Technology and Innovations to Health Systems Strengthening Geneva, 3 July 2013 On 3 July
More informationEmpowerment through decent work and social protection floors
Empowerment through decent work and social protection floors Vinicius Pinheiro Deputy Director, ILO Office for the UN in New York EGM on Policies and Strategies to Promote the Empowerment of People in
More informationHow To Get Health Insurance For Low Income People
Willingness to Pay for Health Insurance: An Analysis of the Potential Market for Health Insurance in Namibia Abay Asfaw World Bank Consultant Emily Gustafsson-Wright Amsterdam Institute for International
More informationThe Israeli Healthcare System: from Health Funds Dominance to a National Health Insurance Law
1 The Israeli Healthcare System: from Health Funds Dominance to a National Health Insurance Law Yair Babad & Tuvia Horev International Health Seminar ICA 2002 Israeli Healthcare System - ICA 2002 2 Health
More informationHealth insurance for the rural poor?
Health insurance for the rural poor? For most people living in developing countries health insurance is an unknown word. It is generally assumed that, with the exception of the upper classes, people cannot
More informationThe role of health insurance and community financing in funding immunization in developing countries
The role of health insurance and community financing in funding immunization in developing countries Afsar Akal and Roy Harvey August 2001 (FINAL) Contents PREFACE...3 SUMMARY OF FINDINGS...4 1 ANALYSIS
More informationWHO Global Health Expenditure Atlas
WHO Global Health Expenditure Atlas September 214 WHO Library Cataloguing-in-Publication Data WHO global health expenditure atlas. 1.Health expenditures statistics and numerical data. 2.Health systems
More informationHealth Insurance for the Formal Sector in Africa: Yes, But
5 Health Insurance for the Formal Sector in Africa: Yes, But Joseph Kutzin Health Economist, Analysis, Research, and Assessment Division, World Health Organization Health insurance can be organized in
More informationA proposal for measures under Norwegian foreign and international development policy to combat the global health workforce crisis
A proposal for measures under Norwegian foreign and international development policy to combat the global health workforce crisis Report by the workgroup headed by the Ministry of Foreign Affairs, with
More informationThe Hospital Strategy Project in South Africa
8 The Hospital Strategy Project in South Africa Monitor Company, Health Partners International, Center for Health Policy, and National Labor and Economic Development Institute, South Africa This chapter
More informationDimension Data s Uptime Maintenance Service
Dimension Data s Uptime Maintenance Service The pace of business today simply doesn t allow for downtime. When systems go off-line, productivity drops, time and money go to waste and opportunities are
More informationTOWARDS UNIVERSAL HEALTH COVERAGE IN RWANDA
TOWARDS UNIVERSAL HEALTH COVERAGE IN RWANDA Summary Notes from Briefing by Caroline Kayonga * Permanent Secretary, Ministry of Health, Rwanda 10/22/2007 10/23/2007 OUTLINE 1. A brief history of health
More informationPrivate Health insurance in the OECD
Private Health insurance in the OECD Benefits and costs for individuals and health systems Francesca Colombo, OECD AES, Madrid, 26-28 May 2003 http://www.oecd.org/health 1 Outline Background, method Overview
More informationHealth Systems and Human Resources Development : The Changing Roles of Public and Private Sectors
Policy Issues in HMD Health Systems and Human Resources Development : The Changing Roles of Public and Private Sectors Dr.Damrong Boonyoen Director General, Department of Communicable Diseases Control,
More information3. Financing. 3.1 Section summary. 3.2 Health expenditure
3. Financing 3.1 Section summary Malaysia s public health system is financed mainly through general revenue and taxation collected by the federal government, while the private sector is funded through
More informationA FRAMEWORK FOR NATIONAL HEALTH POLICIES, STRATEGIES AND PLANS
A FRAMEWORK FOR NATIONAL HEALTH POLICIES, STRATEGIES AND PLANS June 2010 A FRAMEWORK FOR NATIONAL HEALTH POLICIES, STRATEGIES AND PLANS June 2010 This paper reviews current practice in and the potential
More informationOECD Reviews of Health Systems Mexico
OECD Reviews of Health Systems Mexico Summary in English The health status of the Mexican population has experienced marked progress over the past few decades and the authorities have attempted to improve
More informationRESOLUTION. (Adopted on Committee Two of CNMUN 2010)
RESOLUTION (Adopted on Committee Two of CNMUN 2010) Council: UN Human Rights Council Committee Two Topic: the Impact of Financial Crisis on the Universal Realization and Effective Enjoyment of Human Rights
More informationThe pension coverage gap: Issues and options Robert Palacios Social Protection Department, South Asia World Bank-SECP Pension Reform Workshop Lahore, Pakistan April 14-15, 2006 Presentation structure The
More informationIAPO Information Paper: Universal health coverage. 6th Global Patients Congress, 2014
Universal health coverage 6th Global Patients Congress, 2014 International Alliance of Patients Organizations (IAPO) March 2014 Contents Introduction... 2 How is universal health coverage defined?... 2
More informationIntroduction of Long-term Care Insurance in South Korea
Introduction of Long-term Care Insurance in South Korea Soonman KWON, Soo-Jung KIM and Youn JUNG (School of Public Health, Seoul National University, South KOREA) Background In July 2008, Korea introduced
More informationMaternal and child health: the social protection dividend in West and Central Africa
Briefing Paper Strengthening Social Protection for Children inequality reduction of poverty social protection February 2009 reaching the MDGs strategy social exclusion Social Policies security social protection
More informationfinancing policy: a guide for decision-makers Health Financing Policy Paper 2008/1 individuals pooling of funds Stewardship of financing
provision of services Stewardship of financing purchasing of services pooling of funds individuals collection of funds Health financing policy: a guide for decision-makers Health Financing Policy Paper
More informationHybrid Wide-Area Network Application-centric, agile and end-to-end
Hybrid Wide-Area Network Application-centric, agile and end-to-end How do you close the gap between the demands on your network and your capabilities? Wide-area networks, by their nature, connect geographically
More informationNumber 2 2005 DESIGNING HEALTH FINANCING SYSTEMS TO REDUCE CATASTROPHIC HEALTH EXPENDITURE
Number 2 2005 DESIGNING HEALTH FINANCING SYSTEMS TO REDUCE CATASTROPHIC HEALTH EXPENDITURE Every year, more than 150 million individuals in 44 million households face financial catastrophe as a direct
More informationQuestions and Answers on Universal Health Coverage and the post-2015 Framework
Questions and Answers on Universal Health Coverage and the post-2015 Framework How does universal health coverage contribute to sustainable development? Universal health coverage (UHC) has a direct impact
More informationOpting Out of Mandatory Health Insurance In Latin American Countries. Implications for Policy and Decision Making in Russian Federation
Opting Out of Mandatory Health Insurance In Latin American Countries Implications for Policy and Decision Making in Russian Federation Hernan Fuenzalida March 2003 Health, Nutrition and Population (HNP)
More informationFDI performance and potential rankings. Astrit Sulstarova Division on Investment and Enterprise UNCTAD
FDI performance and potential rankings Astrit Sulstarova Division on Investment and Enterprise UNCTAD FDI perfomance index The Inward FDI Performance Index ranks countries by the FDI they receive relative
More informationShaping national health financing systems: can micro-banking contribute?
Shaping national health financing systems: can micro-banking contribute? Varatharajan Durairaj, Sidhartha R. Sinha, David B. Evans and Guy Carrin World Health Report (2010) Background Paper, 22 HEALTH
More informationDEMOGRAPHICS AND MACROECONOMICS
1 UNITED KINGDOM DEMOGRAPHICS AND MACROECONOMICS Data from 2008 or latest available year. 1. Ratio of over 65-year-olds the labour force. Source: OECD, various sources. COUNTRY PENSION DESIGN STRUCTURE
More informationPricing the right to education: There is a large financing gap for achieving the post-2015 education agenda
Education for All Global Monitoring Report Policy Paper 18 March 2015 This paper shows there is an annual financing gap of US$22 billion over 2015-2030 for reaching universal pre-primary, primary and lower
More informationThe Community Health Fund in Tanzania
10 The Community Health Fund in Tanzania R. M. Shirima, Community Health Fund Consultant, Ministry of Health, Tanzania In collaboration with the World Bank and other donors, the government of Tanzania
More informationChild Survival and Equity: A Global Overview
Child Survival and Equity: A Global Overview Abdelmajid Tibouti, Ph.D. Senior Adviser UNICEF New York Consultation on Equity in Access to Quality Health Care For Women and Children 7 11 April 2008 Halong
More information(OECD, 2012) Equity and Quality in Education: Supporting Disadvantaged Students and Schools
(OECD, 2012) Equity and Quality in Education: Supporting Disadvantaged Students and Schools SPOTLIGHT REPORT: AUSTRIA www.oecd.org/edu/equity This spotlight report draws upon the OECD report Equity and
More informationSocial protection for migrant workers: ILO s approach and ASEAN perspective
Social protection for migrant workers: ILO s approach and ASEAN perspective Loveleen De, ILO Presented at the Asian Conference on Globalization and Labor Administration: Cross-Border Labor Mobility, Social
More informationAMarriott@oxfam.org.uk 25/02/2010 11:49 Subject: Ghana: where 'successful health insurance' is neither successful nor in fact health insurance
AMarriott@oxfam.org.uk 25/02/2010 11:49 Subject: Ghana: where 'successful health insurance' is neither successful nor in fact health insurance Dear all In Oxfam s continuing efforts to promote discussion
More information(OECD, 2012) Equity and Quality in Education: Supporting Disadvantaged Students and Schools
(OECD, 2012) Equity and Quality in Education: Supporting Disadvantaged Students and Schools SPOTLIGHT REPORT: NETHERLANDS www.oecd.org/edu/equity This spotlight report draws upon the OECD report Equity
More informationDevelopment of Health Insurance Scheme for the Rural Population in China
Development of Health Insurance Scheme for the Rural Population in China Meng Qingyue China Center for Health Development Studies Peking University DPO Conference, NayPyiTaw, Feb 15, 2012 China has experienced
More informationDecember 2013. Renewing health districts for advancing universal health coverage in Africa
be cause health Belgian Platform for International Health Be-cause health matters December 2013 Renewing health districts for advancing universal health coverage in Africa Regional conference on health
More informationUniversal Health Coverage: Perceptions, Policy Drivers and the Way Forward
Universal Health Coverage: Perceptions, Policy Drivers and the Way Forward Javadi D, Ranson M, George A and Ghaffar A (2013) - DRAFT - Universal Health Coverage: Perceptions, Policy Drivers and the Way
More information53rd DIRECTING COUNCIL
53rd DIRECTING COUNCIL 66th SESSION OF THE REGIONAL COMMITTEE OF WHO FOR THE AMERICAS Washington, D.C., USA, 29 September-3 October 2014 CD53.R14 Original: Spanish RESOLUTION CD53.R14 STRATEGY FOR UNIVERSAL
More informationTotal Purchases in 2012
Fighting Hunger Worldwide Food Procurement Annual Report 2012 Maize, Niger WFP/Rein Skullerud Procurement Mission Statement To ensure that appropriate commodities are available to WFP beneficiaries in
More informationEnsuring access: health insurance schemes and HIV
Ensuring access: health insurance schemes and HIV Joep M.A. Lange Academic Medical Center, University of Amsterdam Amsterdam Institute for Global Health & Development With great help from: Onno Schellekens
More informationCurrent Issues, Prospects, and Programs in Health Insurance in Zimbabwe
11 Current Issues, Prospects, and Programs in Health Insurance in Zimbabwe T. A. Zigora, Deputy Secretary, Ministry of Health and Child Welfare, Zimbabwe Health care is receiving increasing attention worldwide,
More informationInclusive Development in Myanmar: Learning from Neighbours. Thangavel Palanivel UNDP Regional Bureau for Asia-Pacific
Inclusive Development in Myanmar: Learning from Neighbours Thangavel Palanivel UNDP Regional Bureau for Asia-Pacific Outline Myanmar vis-à-vis its neighbours Economic reforms in selected Asian countries
More informationDimension Data s Uptime Support Service
Dimension Data s Uptime Support Service As more technology enters the world, and is introduced into organisations, the typical IT environment increases in complexity. Businesses require higher levels of
More informationNational Health. vocabulary for public
National Health Insurance: providing a vocabulary for public engagement 15 Author: Di McIntyrei A key area of contention has been whether a universal system is affordable or not. It is not the universality
More informationHealth insurance in low-income countries
Joint NGO Briefing Paper (bp no.112) Paper Health insurance in low-income countries Where is the evidence that it works? Some donors and governments propose that health insurance mechanisms can close health
More informationEach year, millions of Californians pursue degrees and certificates or enroll in courses
Higher Education Each year, millions of Californians pursue degrees and certificates or enroll in courses to improve their knowledge and skills at the state s higher education institutions. More are connected
More informationSwe den Structure, delive ry, administration He althcare Financing Me chanisms and Health Expenditures Quality of Bene fits, C hoice, Access
Sweden Single payer, universal healthcare system, with 21 county councils as the primary payer (reimburser) Administration of healthcare plan is decentralized in the hands of the county councils Central
More informationEMEA BENEFITS BENCHMARKING OFFERING
EMEA BENEFITS BENCHMARKING OFFERING COVERED COUNTRIES SWEDEN FINLAND NORWAY ESTONIA R U S S I A DENMARK LITHUANIA LATVIA IRELAND PORTUGAL U. K. NETHERLANDS POLAND BELARUS GERMANY BELGIUM CZECH REP. UKRAINE
More informationAll persons gainfully employed under age 60. Self-employed are covered also.
Prepared by First Life Financial Company. I SUMMARY Social Security Eligibility Retirement Contributions All persons gainfully employed under age 60. Self-employed are covered also. 60M/F To Social Security:
More informationHealth Systems: Type, Coverage and Financing Mechanisms
Health Systems: Type, Coverage and Mechanisms Austria Belgium Bulgaria (2007) Czech Republic Denmark (2007) Estonia (2008). Supplementary private health Complementary voluntary and private health Public
More informationMIT U.S. Income Tax Presentation Non US Resident Students
MIT U.S. Income Tax Presentation Non US Resident Students PwC Boston Nabih Daaboul Carol McNeil Rich Wagman 1 Basic U.S. Tax Overview for International Students A foreign national is a person born outside
More information