Health Insurance. Perception & Reality. Salman Rawaf MD PhD FRCP FFPH. Professor of Public Health Erbil Iraq 2-4 Feb 2011 s.rawaf@imperial.ac.

Transcription

1 WHO Collaborating Centre Imperial College London Health Insurance Perception & Reality Salman Rawaf MD PhD FRCP FFPH Professor of Public Health Erbil Iraq 2-4 Feb 2011

2 Content Health System Goals...What? H Insurance...Types? Experience with H insurance Iraq.. The Way Forwards WHO Centre, London WHO C Centre, IC London

3 Health Systems

4 Better Health Health System Goals Responsiveness to needs Financial Protection WHO C Centre, Imperial College London

5 Achieve Better Health: How? Improve Healthy Behaviour, Health Promotion & Disease Prevention Improve Health Status Improve Clinical Outcomes

6 Funding Health Systems

7 LIC MIC HIC Private OOP Private Pooled Government WHO C Centre, IC London S Rawaf 2006

8 14 Health Expenditures and Ageing United States Korea Taiwan Canada Australia New Zealand Ireland France Finland Switzerland Russia Germany Sweden Italy Norway Belgium Spain Japan Portugal United Kingdom Denmark Greece 4 Malaysia Singapore Hong Kong Aged Dependency Ratio (>65/Aged 15-64)

9 Health Insurance

10 Health Insurance: is a form of collectivism by means of which people collectively pool the risk of incurring medical expenses.

11 Collectivism Usually publically owned Organised on non-profit basis Managed by for-profit companies

12 Publically owned National Health Insurance Social Insurance Non-profit basis Social Insurance For profit Private Insurance

13 Publically owned NH Insurance Social Insurance Non-profit basis Social Solidarity Social Insurance For profit Ability to Pay (Groups / Individuals) Private Insurance

14 Publically owned Non-profit basis Normally provided universally: By Governments, as: 1. Social Solidarity (Europe) 2. Gov Charity (US: Medicaid)

15 Financial Protection: The Process Estimating the overall costs of health & Health Care Or Estimating the overall risk of health care expenses Develop a finance structure (collecting, pooling etc) State-controlled National Wealth (natural resources) OPC Payroll Tax & other Taxation UK Monthly Premium US Resource Allocations Or Identify benefit and beneficiaries Managed by: The State / Government Agency / Private Business

16 Types of Health Insurance

17 Insurance Role of State: Financial Protection Type of Insurance: The Wealth of the Country Types Social Protection Management Cost Tax-based funding (National H Insurance) Pop-based Insurance (Social Insurance) Extremely High Very high Very Low Low/Medium Private Insurance Very Low Very High WHO Centre, Imperial College London

18 For profit health insurance Private H Insurance Types Coverage Cost Comprehensive Scheduled % of the costs + vast array of benefits Day to day healthcare Basic Very Expensive High potential benefit payout Low/Medium Limited benefits

19 For profit health insurance Private H Insurance Types Coverage Cost Comprehensive Scheduled % of the costs + vast array of benefits Day to day healthcare Basic Very Expensive High potential benefit payout Low/Medium Limited benefits Not effective for catastrophic events

20 For profit health insurance Rising Costs of Private Insurance Increased utilization (consumer demands) New Treatment Intensive Diagnostic Testing Ageing population? Advance in medical technology Lifestyles (Obesity, alcohol, smoking, drugs etc) Physicians Competencies, safety, behaviour Shifting costs Lack of investment in public health PWC 2010, other studies

21 Impact of social protection or lack of it

22 Source: Xu et al, 2007

23 National Health Expenditure MENA 2006

24 Coverage Rate by H Financing Scheme MENA 2008 Source: MoHs Various years

25 Forgone Health Care Use due to Financial Costs MENA 2008

26 Average OOP Spending in Healthcare in MENA 2006 Egypt: Substantial increase between

27 OOP Spending across Soci-economic Status MENA 2006

28 OOP by Insurance Coverage Lebanon 2005

29 Regional Examples

30 Service Delivery Multiple Public Providers Resource Allocation Lack of a formula Inefficiencies Private Insurance Regulations & Control Private Providers Regulations & Quality Regulations Medical/HPs/Providers Pharmaceutical Sectors WHO Centre, Imperial College London S Rawaf 2009

31 United Arab Emirates: 33 Health Insurance Schemes (32 Private) Unit Costs up by 60% No Federal Regulations WHO C Centre, Imperial College London

32 Private Insurance: Aim is make profit No Social Responsibility

33 WHO C Centre, IC London

34 Population Context

35 Do we provide enough social protection? Source: BBC 2011 Jan 30 th Cairo Tahrir Square

36 Population s Health Needs WHO C Centre, London

37 WHO C Centre, IC London

38 Iraq

39 Iraq 2010 Resource Rich Country High level of low income (?60+ High level of employment Morbidity Needs exceed supply

40 Iraq 2010 Resource Rich Country High level of low income (?60+ High level of employment Morbidity Needs exceed supply

41 Iraq Modernise the health system & services HRD Quality & Safety Laws & Regulations Financial protection (wealth distribution)

42 Iraq Financial Protection National Health Service (State funded)

43 Iraq Financial Protection National Health Insurance Gov Expenditure (12-14%) (80% of THE) Taxation on tobacco, alcohol, petrol, vehicle, proceed food, etc

44 Iraq Financial Protection National Health Insurance $12 b (2011 prices) Gov Expenditure (12-14%) (80% of THE) Taxation on tobacco, alcohol, petrol, vehicle, proceed food, etc

45 Iraq Financial Protection National Health Insurance $12 b (2011 prices) 100% coverage Comprehensive Free Gov Expenditure (12-14%) (80% of THE) Taxation on tobacco, alcohol, petrol, vehicle, proceed food, etc

46 Examples Worldwide

47 But, we have to address: 1. The Concept of Free Services 2. Family Practice based Primary Care 3. Separating funding from provision 4. Public vs Private 5. Governance & Accountability WHO Centre, Imperial College London

48 Regional Health System Progressive Health System Real Investment - Financial - Workforce - Primary care State Responsibility Non-Progressive HS Lack of real investment Shifting Responsibility to Individual (Financial) Financial Protection: State Private Sector, Private Insurance Strong Regulations (+ PH Laws) Loose/Weak Regulations Strong Leadership/ stability Strong CC (MoH) on Policy/Directions/Performance Engaged Population Weal Leadership/ changes Weak CC Professional Control WHO Centre, Imperial College London People centered care

49 Thank You