TOWARDS UNIVERSAL HEALTHCARE COVERAGE LESSONS FROM THE HEALTH EQUITY & FINANCIAL PROTECTION IN ASIA PROJECT
|
|
- Jonas Lang
- 8 years ago
- Views:
Transcription
1 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 Rotterdam ERSA Symposium, Feb 6, 2014 Stellenbosch Institute for Advanced Study
2 What HEFPA is Health Equity & Financial Protection in Asia EU funded, 4 year research project, Consortium of 12 research teams from Europe and Asia and World Bank Project leaders Eddy van Doorslaer, Owen O Donnell, Adam Wagstaff Project Ellen Van de Poel, Sven Neelsen Aim: identify effective & efficient ways to improve (equitable) access to healthcare & protect people from excess OOP expenditure Output: 23 working papers, 14 publications and 7 policy briefs, accessible via Today: selection of some results that may be of relevance for South Africa s push towards UHC
3 EXTENDING COVERAGE BY VOLUNTARY HEALTH INSURANCE Evidence from The Philippines & Vietnam Papers available on Philippines: Squeezing the Middle: A Randomized Experiment to Promote Voluntary Enrollment in a Social Health Insurance Program. JJ Capuno, AD Kraft, SA Quimbo, CR Tan, Jr. & A Wagstaff. Vietnam: Impacts of information and subsidies on informal sector health insurance enrolment: evidence from a randomized experiment in Vietnam. H Nguyen, A Wagstaff, H Dao, & S Bales
4 UHC s missing middle Top covered Tax-financed or compulsory insurance schemes for public sector employees & dependents Compulsory insurance schemes for formal private sector employees (& dependents)
5 UHC s missing middle Top covered Tax-financed or compulsory insurance schemes for public sector employees & dependents Compulsory insurance schemes for formal private sector employees (& dependents) Bottom covered Tax-financed schemes for the poor and other indigent groups
6 UHC s missing middle Top covered Tax-financed or compulsory insurance schemes for public sector employees & dependents Compulsory insurance schemes for formal private sector employees (& dependents) The missing middle Non-poor informal/self-employed workers & dependents Often low take-up of (subsidized) voluntary insurance & adverse selection problems Bottom covered Tax-financed schemes for the poor and other indigent groups
7 Covering the missing middle Policy options 1. Wait for the informal sector to formalize
8 Covering the missing middle 1 But dynamic growth does not coincide with formalization of the workforce in most of Asia Philippines Indonesia Thailand Vietnam
9 Covering the missing middle Policy options 1. Wait for the informal sector to formalize 2. Give free entitlement the Thai option
10 Covering the missing middle Policy options 1. Wait for the informal sector to formalize 2. Give free entitlement the Thai option 3. Compulsory premium-based insurance for the informal sector
11 Covering the missing middle Policy options 1. Wait for the informal sector to formalize 2. Give free entitlement the Thai option 3. Compulsory premium-based insurance for the informal sector
12 Covering the missing middle Policy options 1. Wait for the informal sector to formalize 2. Give free entitlement the Thai option 3. Compulsory premium-based insurance for the informal sector 4. Increase demand for voluntary, premium-based insurance
13 Why is the middle s take-up so low? Willingness to pay for insurance < premiums Lack of information Low perceived insurance benefits Underestimate probability of getting sick
14 Why is the middle s take-up low? Willingness to pay for insurance < premiums Lack of information Low perceived insurance benefits Underestimate probability of getting sick Low actual insurance benefits Low care quality (providers may even reduce quality if not paying OOP) Limited financial protection (small benefit package, high copayments)
15 Why is the middle s take-up low? Willingness to pay for insurance < premiums Lack of information Low perceived insurance benefits Underestimate probability of getting sick Low actual insurance benefits Low care quality (providers may even reduce quality if not paying OOP) Limited financial protection (small benefit package, high copayments) Low probability of getting sick Limited risk aversion
16 How can we increase take-up? Willingness to pay for insurance < premiums Lack of information Low perceived insurance benefits Underestimate probability of getting sick Low actual insurance benefits Low care quality (providers may even reduce quality if not paying OOP) Limited financial protection (small benefit package, high copayments) Low probability of getting sick Limited risk aversion Premium subsidies and better information should increase ability and willingness to pay for insurance HEFPA experimented how effective these measures are in increasing insurance take-up
17 Case 1: The Philippines Experiment: Results of 50% premium subsidy Uptake in treatment and control groups after voucher expiration (6 months) 14.9% 9.9% 33% 5pp Treatment (N = 801) Control (N = 323) Treatment effect large in relative (33%) but small in absolute (5pp) size 85% of missing middle remain uncovered after treatment
18 Case 1: The Philippines Experiment: Results: Results of 50% premium subsidy Uptake in treatment and control groups after voucher expiration (6 months) 14.9% Unsatisfactory so we designed an additional intervention to increase uptake 9.9% 33% 5pp Treatment (N = 801) Control (N = 323) Treatment effect large in relative (33%) but small in absolute (5pp) size 85% of missing middle remain uncovered after treatment
19 Case 1: The Philippines Follow-up experiment Sample: 628 households that received original treatment but did not enroll after 6 months Treatment: Random assignment of extended intervention packages A and B. this on take-up A Experiment tests additional effect of Premium voucher = 50% subsidy Information kit SMS enrollment reminder Partially completed enrollment form Assistance in completing and submitting enrollment form B
20 Case 1: The Philippines Experiment: Results of 50% premium subsidy Insurance uptake in intervention packages A (treatment) and B (control) after 2 months 39.7% 1,168% 36.3pp 3.4% Treatment (N = 312) Control (N = 290) Assistance in enrollment form completion and mailing increases uptake of missing middle by 36.5%-points (a more than 11-fold improvement over the control group) But 60% of missing middle remain uncovered after extended treatment package
21 Case 1: The Philippines Experiment: Results of 50% premium subsidy Insurance uptake in intervention packages A (treatment) and B (control) after 2 months 39.7% Even with large subsidy and extensive enrollment efforts, up to half of the missing middle remains uninsured 1,168% 36.3pp 3.4% Treatment (N = 312) Control (N = 290) Assistance in enrollment form completion and mailing increases uptake of missing middle by 36.5%-points (a more than 11-fold improvement over the control group) But 60% of missing middle remain uncovered after extended treatment package
22 Case 2: Vietnam Background: Financial resources for health, 2011 Health expenditure per capita (current US$) Health expenditure, total (% of GDP) $95 $95 6.8% 2.7% Indonesia Vietnam
23 Case 2: Vietnam Background: Financial protection, 2011 % insured Out-of-pocket health expenditure (% of total expenditure on health) 46% 50% 60% 56% Indonesia Vietnam
24 Case 2: Vietnam Experiment: Results change in uptake after voucher expiration Treatment 1: Subsidy 2.70% 2.30% Treatment 1: Subsidy (N = 1,316) Control: Nothing (N = 1,309) Subsidy alone does not increase uptake
25 Case 2: Vietnam Experiment: Results change in uptake after voucher expiration Treatment 1: Subsidy 2.70% Treatment 2: Leaflet 2.70% 2.30% 2.60% Treatment 1: Subsidy (N = 1,316) Control: Nothing (N = 1,309) Treatment 2: Leaflet (N = 1,353) Control: Nothing (N = 1,309) Subsidy alone does not increase uptake Leaflet alone does not increase uptake
26 Case 2: Vietnam Experiment: Results change in uptake after voucher expiration 3.80% Treatment 3: Subsidy & Leaflet 2.70% 41% 1.1pp Treatment 3: Leaflet & subsidy (N = 1,242) Control: Nothing (N = 1,309) Combination of leaflet + subsidy increase uptake by 41% compared to no intervention - but effect small in absolute size (1.1pp) & not statistically significant
27 Case 2: Vietnam Experiment: Results change in uptake after voucher expiration 3.80% Treatment 3: Leaflet & subsidy (N = 1,242) Treatment 3: Subsidy & Leaflet 2.70% > 90% of missing middle remains uncovered receiving both subsidy and leaflet Control: Nothing (N = 1,309) 41% 1.1pp Combination of leaflet + subsidy increase uptake by 41% compared to no intervention - but effect small in absolute size (1.1pp) & not statistically significant
28 Covering UHC s missing middle HEFPA Conclusion Even with large premium subsidies and extensive enrollment efforts, voluntary health insurance will not achieve Universal Coverage Actually, you won t get anywhere near UHC if you do not subsidize almost fully
29 Covering UHC s missing middle HEFPA Conclusion Even with large premium subsidies and extensive enrollment efforts, voluntary health insurance will not achieve Universal Coverage Actually, you won t get anywhere near UHC if you do not subsidize almost fully This is in line with the evidence from other countries In China and Rwanda however, voluntary schemes achieved near universal enrollment a decade after their introduction But backed up by strong positive & negative incentives for local authorities to enroll people
30 Covering UHC s missing middle HEFPA Conclusion Even with large premium subsidies and extensive enrollment efforts, voluntary health insurance will not achieve Universal Coverage Actually, you won t get anywhere near UHC if you do not subsidize almost fully This is in line with the evidence from other countries In China and Rwanda however, voluntary schemes achieved near universal enrollment a decade after their introduction But backed up by strong positive & negative incentives for local authorities to enroll people Thailand has taken the easier route cover the middle with a tax-financed entitlement in 2001
31 The fast route to UHC % uninsured in Thailand, Source: Thai Health and Welfare Survey (HWS) data
32 EFFECTIVE COVERAGE FOR THE MISSING MIDDLE - AND EVERYONE ELSE Thailand s Universal Coverage Scheme Underlying paper Universal coverage on a budget: Impacts on health care utilization and out-of-pocket expenditures in Thailand. Limwattananon S, Neelsen S, O'Donnell O, Prakongsai P, Tangcharoensathien V, van Doorslaer E, Vongmongkol V. and
33 Case 3: Thailand Background: Financial resources for health prior to UHC reform (Thailand 2001, Indonesia 2011) $167 $95 2.7% 3.3% Indonesia Health expenditure per capita (current US$) Thailand Health expenditure, total (% of GDP)
34 This is still way lower than what South Africa spends on health care Healthcare expenditure (2011: Indonesia, RSA; 2001: Thailand) Health expenditure per capita (current US$) Health expenditure, total (% of GDP) $689 $167 $95 8.5% 2.7% 3.3% Indonesia RSA Thailand
35 Case 3: Thailand Background: Financial protection prior to UHC reform (Thailand 2001, Indonesia 2011) 71% 46% 50% 33% Indonesia Thailand % insured Out-of-pocket health expenditure (% of total expenditure on health)
36 Very different again from the South African picture Financial protection (2011: Indonesia, RSA; 2001: Thailand) % insured Out-of-pocket health expenditure (% of total expenditure on health) 100% 71% 46% 50% 33% 7% Indonesia RSA Thailand
37 Case 3: Thailand Background: health insurance Coverage 1. Tax-financed cover for public sector workers (retirees) & their dependents 2. Mandatory payroll-based cover for formal sector workers 3. Tax-financed free care for indigent population: poor households, children, age 60+, and other indigent groups 4. Voluntary & subsidized premium based HI targeted to nearpoor households but open to entire Middle US$/year premium for 1 year covers entire family Covers 21% of the population
38 Case 3: Thailand Background: health insurance Coverage 1. Tax-financed cover for public sector workers (retirees) & their dependents 2. Mandatory payroll-based cover for formal sector workers 3. Tax-financed free care for indigent population: poor households, children, age 60+, and other indigent groups 4. Voluntary & subsidized premium based HI targeted to nearpoor households but open to entire Middle US$/year premium for 1 year covers entire family Covers 21% of the population Benefits: comprehensive in all schemes (at least in theory)
39 Case 3: Thailand Background: health system challenges Missing middle: 29% remain uninsured Underfunding of voluntary and indigent programs (13 US$ per beneficiary for treatments) Adverse selection into voluntary scheme Poor targeting of indigent program Regional disparities in healthcare access and health outcomes
40 Case 3: Thailand The UCS reform Universal Coverage key in Thai Rak Thai party s 2001 election campaign that it wins by landslide Universal Coverage Scheme (UCS) roll-out begins 04/2001, is complete within a year
41 Case 3: Thailand The UCS reform Universal Coverage key in Thai Rak Thai party s 2001 election campaign that it wins by landslide Universal Coverage Scheme (UCS) roll-out begins 04/2001, is complete within a year UCS entitles everyone not insured through formal sector schemes to mainly tax-financed healthcare Covers uninsured Missing Middle and replaces public voluntary health insurance scheme and free healthcare scheme for the indigent Entitlement comprehensive: OP, IP, medicines (stepwise inclusion of some initially excluded high cost treatments) 30 Baht (US$ 1) copayment for non-poor, non-elderly (abolished in 2006)
42 Case 3: Thailand The HEFPA study Giving entitlements is easy, but is coverage effective in reality? UCS budget: is this feasible for a capitation of 1202 Baht (31 US$) per beneficiary (risen to 2020 Baht in 2009) Shallow/ineffective coverage may fail to reduce OOP spending and/or increase utilization like in China, Colombia, Mexico, Indonesia, Research question: has UCS increased utilization and reduced OOP spending?
43 Case 3: Thailand Evaluation design Nationwide reform: difference-in-differences method 2001 (before UCS introduction) (after UCS introduction) UCS target group UCS beneficiaries Control for differences in SES before and after UCS Public sector scheme beneficiaries Public sector scheme beneficiaries Impact UCS
44 Case 3: Thailand Evaluation design Nationwide reform: difference-in-differences method 2001 (before UCS introduction) (after UCS introduction) UCS target group UCS beneficiaries Control for differences in SES before and after UCS Public sector scheme beneficiaries Public sector scheme beneficiaries Impact UCS
45 Case 3: Thailand: Did UCS improve access? Results not using ambulatory care when sick 11% reduction in probability to forgo care when sick overall *p<.1, **p<.05, ***p<.01 Data: Thai Health and Welfare Survey (HWS)
46 Case 3: Thailand: Did UCS improve access? Results not using ambulatory care when sick Especially large effects for elderly, rural & poor *p<.1, **p<.05, ***p<.01 Data: Thai Health and Welfare Survey (HWS)
47 Case 3: Thailand: Did UCS improve access? Results inpatient admission 18% increase in inpatient admissions overall *p<.1, **p<.05, ***p<.01 Data: Thai Health and Welfare Survey (HWS)
48 Case 3: Thailand Results inpatient admission Especially large effects for elderly & poor *p<.1, **p<.05, ***p<.01 Data: Thai Health and Welfare Survey (HWS)
49 Case 3: Thailand: Did UCS improve access? Results inpatient admission But small & insignificant increase for rural *p<.1, **p<.05, ***p<.01 Data: Thai Health and Welfare Survey (HWS)
50 Case 3: Thailand: Did UCS improve financial protection? Yes, it did Results OOP spending The higher the spending, the higher the reduction *p<.1, **p<.05, ***p<.01 Data: Thai Socioeconomic Survey (SES)
51 Case 3: Thailand Results Public share of total health expenditure Micro data mirrored in national accounts: OOP down
52 Case 3: Thailand: How did it do it? How Thailand made the entitlement effective Cannot pin down what part(s) of UCS reform package/thai healthcare system was most crucial But can describe the reform package
53 Case 3: Thailand: How did it do it? How Thailand made Universal Coverage effective Cannot pin down what part(s) of UCS reform package/thai healthcare system was most crucial But can describe the reform package A comprehensive entitlement Broad benefit package no enrollment fee, premiums, no/small copays Aggressive campaigning to avoid stigmatization
54 Case 3: Thailand How Thailand made Universal Coverage effective Cannot pin down what part(s) of UCS reform package/thai healthcare system was most crucial But can describe the reform package A comprehensive entitlement Broad benefit package no enrollment fee, premiums, no/small copays Aggressive campaigning to avoid stigmatization An effective supply side Presence of an already developed public provider system (facilities, workforce) Introduced integrated primary care provider networks (health volunteers, health centers & district hospitals closely collaborating) Regulating from the center while granting the budget autonomy to the district level Over time increase in UCS resources, doubling over first 10 years
55 Case 3: Thailand: How did it do it? An efficient supply side Replaced retrospective budgeting with globally capped budget, negotiated with MoF annually Single payer system powerful position in negotiations with e.g. pharmaceutical firms Gradually introduced a purchaser-provider split Provider reimbursement by a mix of capitation (ambulatory & preventive) and DRGs (inpatient) Gatekeeper system with a focus on primary care Focus on public providers, private if necessary
56 Case 3: Thailand: How did it do it? An efficient supply side Replaced retrospective budgeting with globally capped budget, negotiated with MoF annually Single payer system powerful position in negotiations with e.g. pharmaceutical firms Gradually introduced a purchaser-provider split Provider reimbursement by a mix of capitation (ambulatory & preventive) and DRGs (inpatient) Gatekeeper system with a focus on primary care Focus on public providers, private if necessary A dynamic economy Robust economic growth to finance increase in healthcare spending
57 Case 3: Thailand: How did it do it? Supply side effectiveness & efficiency enabled UHC on a budget GDP share of health about stable thanks to robust growth THE per capita doubles in first 10 years after UCS but still low in intl. comparison
58 Case 3: Thailand Conclusion: UHC on a budget is possible with the right amount of political will
59 Case 3: Thailand: Conclusion Conclusion: UHC on a budget is possible with the right amount of political will But getting the supply side right is crucial and a challenge Despite many steps taken to improve effectiveness & efficiency, Thailand continues to wrestle with Underservicing of rural areas (IP) A large spending gap between its public servant scheme and the UCS And the financial sustainability of the UCS in light of an ageing population that is ever more affected by costly chronic illnesses
60 Summary of HEFPA findings that may be relevant for South Africa 1. Voluntary health insurance is not an effective tool to achieve universal coverage
61 Summary of HEFPA findings that may be relevant for Indonesia 1. Voluntary health insurance will is not an effective tool to achieve universal coverage 2. Rather, tax financed entitlements are the way to go
62 Summary of HEFPA findings that may berelevant for Indonesia 1. Voluntary health insurance will is not an effective tool to achieve universal coverage 2. Rather, tax financed entitlements are the way to go 3. But paramount is an effective and efficient supply side Focus on primary care Prospective provider payment
63 Summary of HEFPA findings that we consider relevant for Indonesia 1. Voluntary health insurance will is not an effective tool to achieve universal coverage 2. Rather, tax financed entitlements are the way to go 3. But paramount is an effective and efficient supply side Focus on primary care Prospective provider payment 4. Political will and momentum are crucial
64
Universal Coverage Scheme and the poor: Thai experiences. Dr Pongpisut Jongudomsuk Director Health Systems Research Institute (HSRI)
Universal Coverage Scheme and the poor: Thai experiences Dr Pongpisut Jongudomsuk Director Health Systems Research Institute (HSRI) Thailand in 2004 Source: World Development Indicators 2005. Indicators
More informationMoving from universal health coverage to effective financial protection: Evidence from a health insurance experiment in the Philippines
Moving from universal health coverage to effective financial protection: Evidence from a health insurance experiment in the Philippines SA. Quimbo University of the Philippines School of Economics Prince
More informationUniversal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand
TI 2013-067/V Tinbergen Institute Discussion Paper Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand Supon Limwattananon 1 Sven Neelsen 2 Owen
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 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 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 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 informationSocial health protection : Comparison between Belgium and Thailand. Thomas Rousseau COOPAMI-NIHDI
Social health protection : Comparison between Belgium and Thailand Thomas Rousseau COOPAMI-NIHDI 3.11.2014 Overview 1. Comparison between Belgium and Thailand 2. The Belgium system more in detail Overview
More informationCan Expanded Health Insurance and Improved Quality Protect Against Out-of-Pocket Payments?
Can Expanded Health Insurance and Improved Quality Protect Against Out-of-Pocket Payments? Experimental Evidence from the Philippines SA. Quimbo University of the Philippines School of Economics N Wagner
More informationWP-27. Economic impact of illness with health insurance but without income insurance. HEFPA working paper
WP-27 HEFPA working paper Institute of Health Policy & Management Economic impact of illness with health insurance but without income insurance Sven Neelsen Supon Limwattananon Owen O'Donnell Eddy van
More informationThe equity impact of Universal Coverage: health care finance, catastrophic health expenditure, utilization and government subsidies in Thailand
The equity impact of Universal Coverage: health care finance, catastrophic health expenditure, utilization and government subsidies in Thailand Limwattananon S, Vongmongkol V, Prakongsai P, Patcharanarumol
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 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 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 informationEconomic Impact of Illness with Health Insurance but without Income Insurance
TI 2015-060/V Tinbergen Institute Discussion Paper Economic Impact of Illness with Health Insurance but without Income Insurance Sven Neelsen a Supon Limwattananon b,c Owen O'Donnell a,d,e Eddy van Doorslaer
More informationUniversal Coverage Scheme in Thailand: Equity Outcomes and Future Agendas to Meet Challenges
Universal Coverage Scheme in Thailand: Equity Outcomes and Future Agendas to Meet Challenges Viroj Tangcharoensathien, Winai Swasdiworn, Pongpisut Jongudomsuk, Samrit Srithamrongswat, Walaiporn Patcharanarumol,
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 informationHealth Financing for UHC: promising directions and pitfalls to avoid
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
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 informationProviding Health Insurance for the Poor: The Philippine Experience. Leizel P Lagrada MD MPH PhD Berlin Global Learning Forum/ June 23-27, 2015
Providing Health Insurance for the Poor: The Philippine Experience Leizel P Lagrada MD MPH PhD Berlin Global Learning Forum/ June 23-27, 2015 Experience of Enrolling the Poor in selected JLN countries
More informationUniversal Health Coverage in Africa. Germano Mwabu University of Nairobi and Kobe University, June 1, 2013, TICAD V, Yokohama, Japan.
Universal Health Coverage in Africa Germano Mwabu University of Nairobi and Kobe University, June 1, 2013, TICAD V, Yokohama, Japan. Introduction Health status in Africa has improved over the last two
More informationUniversal Health Coverage Assessment: Taiwan. Universal Health Coverage Assessment. Taiwan. Jui-fen Rachel Lu. Global Network for Health Equity (GNHE)
Universal Health Coverage Assessment Taiwan Jui-fen Rachel Lu Global Network for Health Equity (GNHE) December 2014 1 Universal Health Coverage Assessment: Taiwan Prepared by Jui-fen Rachel Lu 1 For the
More informationSingle Payer Systems: Equity in Access to Care
Single Payer Systems: Equity in Access to Care Lynn A. Blewett University of Minnesota, School of Public Health The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform Journal of
More informationComparison of Healthcare Systems in Selected Economies Part I
APPENDIX D COMPARISON WITH OVERSEAS ECONOMIES HEALTHCARE FINANCING ARRANGEMENTS Table D.1 Comparison of Healthcare Systems in Selected Economies Part I Predominant funding source Hong Kong Australia Canada
More informationHealth Financing Reform in Thailand: Toward Universal Coverage under Fiscal Constraints
Health Financing Reform in Thailand: Toward Universal Coverage under Fiscal Constraints Piya Hanvoravongchai Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public
More informationVOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT
Health and Population - Perspectives and Issues 24(2): 80-87, 2001 VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT The rural poor suffer from illness are mainly utilising costly health
More informationColombia REACHING THE POOR WITH HEALTH SERVICES. Using Proxy-Means Testing to Expand Health Insurance for the Poor. Differences between Rich and Poor
REACHING THE POOR WITH HEALTH SERVICES 27 Colombia Using Proxy-Means Testing to Expand Health Insurance for the Poor Colombia s poor now stand a chance of holding off financial catastrophe when felled
More informationVietnam Social health insurance
Vietnam Social health insurance Report of study visit 21-24 October 2014 Thomas Rousseau Project collaborator COOPAMI 2 Programme Agenda Tuesday, 21 October Morning: Meeting with the Health Insurance Implementation
More informationImproved Medicare for All
Improved Medicare for All Quality, Guaranteed National Health Insurance by HEALTHCARE-NOW! Single-Payer Healthcare or Improved Medicare for All! The United States is the only country in the developed world
More informationSouth Africa s health system What are the gaps? Ronelle Burger
South Africa s health system What are the gaps? Ronelle Burger Features of SA health system Quadruple burden of disease (Mayosi et al, 2009) communicable diseases e.g. tuberculosis and HIV/AIDS growing
More informationHealth and Rural Cooperative Medical Insurance in China: An empirical analysis
Health and Rural Cooperative Medical Insurance in China: An empirical analysis Song Gao and Xiangyi Meng Abstract China abandoned its free universal health care system and privatized it since 1980s. The
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 informationImproved Medicare for All
Take Action: Get Involved! The most important action you can take is to sign up for Healthcare-NOW! s email list, so you can stay connected with the movement and get updates on organizing efforts near
More informationMandatory Private Health Insurance as Supplementary Financing
Chapter 12 SUPPLEMENTARY FINANCING OPTION (5) MANDATORY PRIVATE HEALTH INSURANCE Mandatory Private Health Insurance as Supplementary Financing 12.1 Mandatory private health insurance is where private health
More informationDISCUSSION PAPER NUMBER
HSS/HSF/DP.09.4 Financial risk protection of National Health Insurance in the Republic of Korea:1995-2007 DISCUSSION PAPER NUMBER 4-2009 Department "Health Systems Financing" (HSF) Cluster "Health Systems
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 informationWhite Paper on Universal Health Insurance
White Paper on Universal Health Insurance Fergal Lynch Deputy Secretary General 2 April, 2014 Starting point: Programme for Government commitment To develop an efficient and effective single-tier health
More informationWP-07. HEFPA working paper. Institute of Health Policy & Management
WP-07 HEFPA working paper Institute of Health Policy & Management The effects of term limits and yardstick competition on local government provision of health insurance and other public services: The Philippine
More informationHEALTH INSURANCE: A viable solution. Dr. Ziad Mansour, M.D.; ABOG, MHs/HE
HEALTH INSURANCE: A viable solution Dr. Ziad Mansour, M.D.; ABOG, MHs/HE June 23 rd, 2011 PRIVATE HEALTH INSURANCE Definition (1) Basic function of heath insurance: access to care with financial risk protection
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 informationHow To Buy Health Insurance
Post Retirement Health Insurance KC Cheung, FSA Regional Product Actuary Swiss Re, Life & Health Session Number: MBR10 Post-Retirement Health My Challenges What is post retirement healthcare? Post retirement
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 informationUHI Explained. Frequently asked questions on the proposed new model of Universal Health Insurance
UHI Explained Frequently asked questions on the proposed new model of Universal Health Insurance Overview of Universal Health Insurance What kind of health system does Ireland currently have? At the moment
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 informationThirty years of national health insurance in South Korea: lessons for achieving universal health care coverage
Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine ß The Author 2008; all rights reserved. Advance Access publication 12 November 2008 Health Policy
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 informationColloquium for Systematic Reviews in International Development Dhaka
Community-Based Health Insurance Schemes: A Systematic Review Anagaw Derseh Pro. Arjun S. Bed Dr. Robert Sparrow Colloquium for Systematic Reviews in International Development Dhaka 13 December 2012 Introduction
More informationTHAILAND: UNIVERSAL HEALTH CARE COVERAGE THROUGH PLURALISTIC APPROACHES
SERIES: SOCIAL SECURITY EXTENSION INITATIVES IN EAST ASIA THAILAND: UNIVERSAL HEALTH CARE COVERAGE THROUGH PLURALISTIC APPROACHES ILO Subregional Office for East Asia Decent Work for All Asian Decent Work
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 informationDESCRIPTIONS OF HEALTH CARE SYSTEMS: GERMANY AND THE NETHERLANDS
DESCRIPTIONS OF HEALTH CARE SYSTEMS: GERMANY AND THE NETHERLANDS The German Health Care System Reinhard Busse, M.D. M.P.H. Professor of Health Care Management Berlin University of Technology & Charité
More informationThe health insurance opportunity in Asia
The health insurance opportunity in Asia Brad Harris Regional Director, Health Insurance Prudential Corporation Asia 22 April 2008 On 1 December 2006 Prudential held an analyst meeting in London to discuss
More informationEnabling transition to formalization through providing access to health care: The examples of Thailand and Ghana
Enabling transition to formalization through providing access to health care: The examples of Thailand and Ghana Jennifer de la Rosa and Xenia Scheil-Adlung ILO Social Security Department I. Introduction
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 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 information2015 Medicare Low-Income Subsidy (LIS), or Extra Help
2015 Medicare Low-Income Subsidy (LIS), or Extra Help Extra Help with Prescription Drug Costs Medicare LIS Overview Patient Eligibility and Application Process How LIS Affects Patient Responsibility for
More informationImproving health-related information systems to monitor equity in health: lessons from Thailand
//FS2/CUP/3-PAGINATION/EHE/2-PROOFS/3B2/9780521705066C11.3D 222 [222 246] 30.4.2007 6:35PM 11 Improving health-related information systems to monitor equity in health: lessons from Thailand Viroj Tangcharoensathien,
More informationSubmission to the Health Information Authority on Risk Equalisation in the Irish Private Health Insurance Market
Submission to the Health Information Authority on Risk Equalisation in the Irish Private Health Insurance Market August 2010 IMO Submission to the Health Information Authority on Risk Equalisation in the
More informationFunding health promotion and prevention - the Thai experience
Funding health promotion and prevention - the Thai experience Samrit Srithamrongsawat, Wichai Aekplakorn, Pongpisut Jongudomsuk, Jadej Thammatach-aree, Walaiporn Patcharanarumol, Winai Swasdiworn and Viroj
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 informationGermany's Statutory Health Insurance:
Germany's Statutory Health Insurance: Structures, Challenges, Benefits Dr. Norbert Klusen CEO of Techniker Krankenkasse (TK), Hamburg American & German Healthcare Forum 2010, University of Minnesota Minneapolis,
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 informationHealth, Private and Public Insurance, G 15, 16. U.S. Health care > 16% of GDP (7% in 1970), 8% in U.K. and Sweden, 11% in Switzerland.
Health, Private and Public Insurance, G 15, 16 U.S. Health care > 16% of GDP (7% in 1970), 8% in U.K. and Sweden, 11% in Switzerland. 60% have private ins. as primary ins. Insured pay about 20% out of
More informationUnited States HIT Case Study
center for health and aging Health Information Technology and Policy Lab Howard Isenstein, Vice President for Public Affairs and Quality, Federation of American Hospitals Summary U.S. adoption of health
More informationSUBMISSION TO THE SENATE INQUIRY INTO OUT-OF- POCKET COSTS IN AUSTRALIAN HEALTHCARE. Prepared by National Policy Office
SUBMISSION TO THE SENATE INQUIRY INTO OUT-OF- POCKET COSTS IN AUSTRALIAN HEALTHCARE Prepared by National Policy Office May 2014 COTA Australia Authorised by: Ian Yates AM Chief Executive iyates@cota.org.au
More informationHealth insurance reform in Vietnam: a review of recent developments and future challenges
Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine ß The Author 2008; all rights reserved. Advance Access publication 19 April 2008 Health Policy
More informationUniversal Problems & Universal Healthcare:
In the Spring 2004 Forum, we discussed medical errors in the US and Oregon but this is not just a US problem. In May of 2004, The Canadian Adverse Events Study revealed that adverse events in Canadian
More informationWhy Accept Medicaid Dollars: The Facts
Why Accept Medicaid Dollars: The Facts If we accept federal Medicaid dollars, nearly 500,000 North Carolinians will gain access to health insurance. As many as 1,100 medically unnecessary deaths per year
More informationOverview of Policy Options to Sustain Medicare for the Future
Overview of Policy Options to Sustain Medicare for the Future Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation jcubanski@kff.org Medicare NewsGroup Journalism
More informationCritical Issues in Managing Supplemental Private Medical Indemnity Insurance in Ireland and the UK. Aisling Kennedy 19 March 2002
Critical Issues in Managing Supplemental Private Medical Indemnity Insurance in Ireland and the UK Aisling Kennedy Public health system National health system provides treatment free of charge Funded from
More informationNaoki Ikegami, MD, MA, PhD Professor & Chair Dept. of Health Policy & Management Keio University, Tokyo nikegami@a5.keio.jp
1 Aging Asia: Social insurance sustainability, chronic diseases and long term care 2009 February Stanford Conference Financing healthcare in rapidly aging Japan Naoki Ikegami, MD, MA, PhD Professor & Chair
More informationImpact of universal health insurance scheme on health information systems and health information technology
Impact of universal health insurance scheme on health information systems and health information technology Boonchai Kijsanayotin Universal Coverage Scheme Assessment of the first 10 years : Impact on
More informationHealth Insurance. Dr Sanjay Arya
Health Insurance Dr Sanjay Arya Definition A contract where individual or group purchase in advance health coverage by paying a fee called premium. Also defined as, including all financial arrangements
More informationHow Non-Group Health Coverage Varies with Income
How Non-Group Health Coverage Varies with Income February 2008 Policy makers at the state and federal levels are considering proposals to subsidize the direct purchase of health insurance as a way to reduce
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 informationAffordable Care Act: Key Provisions for People with MS
Affordable Care Act: Key Provisions for People with MS October 2013 Why reform healthcare? By 2008, 15% of the U.S. population, or approximately 47 million Americans, lacked health insurance Documented
More informationChapter 11 SUPPLEMENTARY FINANCING OPTION (4) VOLUNTARY PRIVATE HEALTH INSURANCE. Voluntary Private Health Insurance as Supplementary Financing
Chapter 11 SUPPLEMENTARY FINANCING OPTION (4) VOLUNTARY PRIVATE HEALTH INSURANCE Voluntary Private Health Insurance as Supplementary Financing 11.1 Voluntary private health insurance includes both employer
More informationA Journey to Improve Canada s Healthcare System
A Journey to Improve Canada s Healthcare System The Quest Can a public/private hospital system coexist and thrive and improve Canada s system? The Journey Visited Australia and New Zealand to find out
More informationThe Global Experience Providing Health Insurance Coverage for Informal Sector Workers
CLOSING THE GAP DRAFT for Discussion Purposes Only October 2013 The Global Experience Providing Health Insurance Coverage for Informal Sector Workers Contents I. Introduction and Objectives... 2 a. Defining
More informationThe Impact of Health Insurance in Low- and Middle-Income Countries
The Impact of Health Insurance in Low- and Middle-Income Countries Maria-Luisa Escobar Charles C. Griffin R. Paul Shaw EDITORS BROOKINGS INSTITUTION PRESS WASHINGTON, DC Contents Preface xi Acknowledgments
More informationHow To Understand Medical Service Regulation In Japanese
Overview of Medical Service Regime in Japan 75 years or older 10% copayment (Those with income comparable to current workforce have a copayment of 30%) 70 to 74 years old 20% copayment* (Those with income
More informationHealth Care Reform in Korea: Key Challenges
Health Care Reform in Korea: Key Challenges IMF Conference October 3, 2011 Soonman KWON, Ph.D. Professor of Health Economics & Policy Sh School of fpbli Public Health Seoul National University, South Korea
More informationAccess to Medicines within the State Health Insurance Program for Pension Age Population in Georgia (country)
Access to Medicines within the State Health Insurance Program for Pension Age Population in Georgia (country) Tengiz Verulava (Ilia State University, Georgia), Leila Karimi (La Trobe University, Australia)
More informationTHE MEDICAID PROGRAM AT A GLANCE. Health Insurance Coverage
on on medicaid and and the the uninsured March 2013 THE MEDICAID PROGRAM AT A GLANCE Medicaid, the nation s main public health insurance program for low-income people, covers over 62 million Americans,
More informationInformation and Health Care A Randomized Experiment in India
Information and Health Care A Randomized Experiment in India Erlend Berg (LSE), Maitreesh Ghatak (LSE), R Manjula (ISEC), D Rajasekhar (ISEC), Sanchari Roy (LSE) iig Workshop, Oxford University 21 March
More informationSummary of the Major Provisions in the Patient Protection and Affordable Health Care Act
Summary of the Major Provisions in the Patient Protection and Affordable Care Act Updated 10/22/10 On March 23, 2010, President Barack Obama signed into law comprehensive health care reform legislation,
More informationRole of private sector in Myanmar s health care system: Implications for health sector reform
Role of private sector in Myanmar s health care system: Implications for health sector reform San San Aye, Yoshimi Nishino, Khaing Soe, Ko Ko Zaw, Yin Thet Nu Oo, Wai Wai Han, Than Tun Sein, Shakil Ahmed
More informationAPPENDIX C HONG KONG S CURRENT HEALTHCARE FINANCING ARRANGEMENTS. Public and Private Healthcare Expenditures
APPENDIX C HONG KONG S CURRENT HEALTHCARE FINANCING ARRANGEMENTS and Healthcare Expenditures C.1 Apart from the dedication of our healthcare professionals, the current healthcare system is also the cumulative
More informationWorld Bank Support for Pensions
World Bank Support for Pensions Mark Dorfman, World Bank Social Protection Conference Abidjan, June 2015 1 Outline 2 Identification system assessment Social security analytical assessment tools 2 What
More informationNovember 4, 2010. Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington, DC 20515.
CONGRESSIONAL BUDGET OFFICE U.S. Congress Washington, DC 20515 Douglas W. Elmendorf, Director November 4, 2010 Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington,
More informationMICROINSURANCE PRODUCTS
MICROINSURANCE PRODUCTS Presentation at KfW/ISSSG Regional Symposium on Microinsurance Tbilisi, Georgia by Mosleh Uddin Ahmed FCA Independent Consultant 28th June 2005 MICROINSURANCE PRODUCTS Several microinsurance
More informationGovernment Sponsored Health Insurance INTL 442-2006
Government Sponsored Health Insurance INTL 442-2006 At the end of this lecture you will: 1. Be familiar with the historical policy making process that led to the enactment of the Medicare and Medicaid
More informationAn Impact Evaluation of China s Urban Resident Basic Medical Insurance on Health Care Utilization and Expenditure
An Impact Evaluation of China s Urban Resident Basic Medical Insurance on Health Care Utilization and Expenditure Hong Liu China Economics and Management Academy Central University of Finance and Economics
More informationN U R S E S F O R H E A LT H I N S U R A N C E R E F O R M. Stability and Security For All Americans
N U R S E S F O R H E A LT H I N S U R A N C E R E F O R M Stability and Security For All Americans Health Insurance Reform Action Guide Summer 2009 N U R S E S F O R H E A LT H I N S U R A N C E R E F
More informationLuncheon Briefing to HK Women Professionals and Entrepreneurs Association 16 April 2008
Your Health Your Life Public Consultation on Healthcare Reform Luncheon Briefing to HK Women Professionals and Entrepreneurs Association 16 April 2008 Problems in the Existing Healthcare System (1) Primary
More informationAccess to Medicines within the State Health Insurance Program. for Pension Age Population in Georgia (country)
Access to Medicines within the State Health Insurance Program for Pension Age Population in Georgia (country) Tengiz Verulava Doctor of Medical Science. Head of School "Health Policy and Management". Ilia
More informationUniversal Health Coverage for Inclusive and Sustainable Development. Country Summary Report for Thailand
Public Disclosure Authorized 91220 Japan World Bank Partnership Program for Universal Health Coverage Public Disclosure Authorized Public Disclosure Authorized Universal Health Coverage for Inclusive and
More informationKazushi Yamauchi MD, PhD, MPH. Office of International Cooperation, Division of International Affairs, Ministry of Health, Labour and Welfare, Japan
Kazushi Yamauchi MD, PhD, MPH Office of International Cooperation, Division of International Affairs, Ministry of Health, Labour and Welfare, Japan 1 Contents 1. Ageing in the ASEAN plus 3 countries 2.
More informationVoluntary Health Insurance Scheme (VHIS) 08.02.2015
Voluntary Health Insurance Scheme (VHIS) 08.02.2015 1 Nothing has changed except the NAME HPS VHIS 2 Voluntary Health Insurance Scheme (VHIS) standard plan structure Minimum Requirements Remarks 1 Guaranteed
More informationP E O P L E W I T H D I S A B I L I T I E S F O R H E A LT H I N S U R A N C E R E F O R M. Stability and Security For All Americans
P E O P L E W I T H D I S A B I L I T I E S F O R H E A LT H I N S U R A N C E R E F O R M Stability and Security For All Americans Health Insurance Reform Action Guide Summer 2009 P E O P L E W I T H
More informationLynn A. Blewett, Ph.D. Professor, University of Minnesota
Lynn A. Blewett, Ph.D. Professor, University of Minnesota Westlake Forum III Healthcare Reform in China and the US: Similarities, Differences and Challenges Emory University, Atlanta, GA April 10-12, 2011
More information