health financing: trends and challenges in the caribbean dr. reynaldo holder
DESCRIPTION
. Health Financing: Trends and Challenges in the Caribbean Dr. Reynaldo Holder Health Systems Development Caribbean Programme Coordination. OVERVIEW. Financing Function of the Health System: Concepts Assurance Function Financing Health in the Caribbean: Trends - PowerPoint PPT PresentationTRANSCRIPT
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
..
..
Health Financing:Trends and Challenges in the Caribbean
Dr. Reynaldo Holder
Health Systems Development
Caribbean Programme Coordination
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
OVERVIEW
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
The Financing Function: Determining the available financial
resources in the health system, or in each sub-system;
Collection of resources (taxes, contributions, co-payments, others)
Distribution and allocation of financial flows within the system.
FINANCING FUNCTION
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Financing Systems
THE GOAL: Universal Coverage
Defined as access to health promotion and to key preventive, curative and rehabilitative health services for all, in a timely and respectful manner, with the highest levels of quality and dignity, regardless of ethnicity, social class, gender or ability to pay. PAHO, 2005
THE GOAL: Universal Coverage
Defined as access to health promotion and to key preventive, curative and rehabilitative health services for all, in a timely and respectful manner, with the highest levels of quality and dignity, regardless of ethnicity, social class, gender or ability to pay. PAHO, 2005
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Financing Systems
Purpose: To make funding available and to set the right
incentives for providers, so as to ensure that all individuals have access to effective public and
personal health services. WHO 2000
Targets: To generate sufficient and sustainable resources
for health To use these resources optimally To ensure that everyone has financial access to
health services
Purpose: To make funding available and to set the right
incentives for providers, so as to ensure that all individuals have access to effective public and
personal health services. WHO 2000
Targets: To generate sufficient and sustainable resources
for health To use these resources optimally To ensure that everyone has financial access to
health services
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Financing SystemsPolicy Issues
Financing: How are funds generated and collected and who bears
the burden of paying? What mix of services are bought? Who benefits and the extent to which access to care is
linked directly or otherwise to one’s payments/contributions?
Management: Who pools and manages the funds and organizes or
purchases health services? How are services purchased and providers
remunerated?
Financing: How are funds generated and collected and who bears
the burden of paying? What mix of services are bought? Who benefits and the extent to which access to care is
linked directly or otherwise to one’s payments/contributions?
Management: Who pools and manages the funds and organizes or
purchases health services? How are services purchased and providers
remunerated?
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Sector FinancingRole of the NHA
To guarantee, monitor, and modulate the complementarity of resources from diverse financial sources in order to ensure that the population has equitable access to health.
Actions:1. Policy-making to correct distortions in sectoral financing;2. Monitoring the sectoral financing process3. Negotiate with the principal providers4. Redistribute funds in order to compensate for market
asymmetries;5. Define the criteria for resource allocation.
Actions:1. Policy-making to correct distortions in sectoral financing;2. Monitoring the sectoral financing process3. Negotiate with the principal providers4. Redistribute funds in order to compensate for market
asymmetries;5. Define the criteria for resource allocation.
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Financing Systems
Principal Financing Mechanisms:1. Tax-based financing
2. Social Insurance
3. Private Insurance
4. User Fees
5. Community-based health insurance
6. Grants and external resources
7. Combined health financing systems
Principal Financing Mechanisms:1. Tax-based financing
2. Social Insurance
3. Private Insurance
4. User Fees
5. Community-based health insurance
6. Grants and external resources
7. Combined health financing systems
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Financing Systems
Desirable features: Mandatory pooling of income and health risk (Social
insurance or tax-based plans) Individual and household contributions on the basis of
capacity to pay Limited out-of-pocket or direct payments Purchasing plans based on value-for-money and
remuneration systems that are prospective and performance related
Public funds for public goods – private funds for private goods.
Desirable features: Mandatory pooling of income and health risk (Social
insurance or tax-based plans) Individual and household contributions on the basis of
capacity to pay Limited out-of-pocket or direct payments Purchasing plans based on value-for-money and
remuneration systems that are prospective and performance related
Public funds for public goods – private funds for private goods.
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
OVERVIEW
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Assurance Function
Guarantee of effective coverage and access to essential health services for all
Elements for analysis:1. Legal Framework2. Benefits or entitlements3. Structure and management4. Population covered5. Pooling6. Provider payment mechanisms
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Assurance FunctionRole of the NHA
Social Protection in health are the mechanisms through which society ensures that individuals or groups of individuals can meet their needs and demands in health through adequate access to services, independent of their ability to pay.
Social Protection in health are the mechanisms through which society ensures that individuals or groups of individuals can meet their needs and demands in health through adequate access to services, independent of their ability to pay.
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Assurance FunctionRole of the NHA
These mechanisms include:
1. Definition of a guaranteed package of services
2. Delimitation of populations and territories that will be
covered
3. Regulation and control of public and private
compliance with insurance plans
These mechanisms include:
1. Definition of a guaranteed package of services
2. Delimitation of populations and territories that will be
covered
3. Regulation and control of public and private
compliance with insurance plans
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Finance and AssuranceFunctions
That every resident of the country has financial accessibility to health services and is protected against catastrophic health events and health-induced poverty.
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
OVERVIEW
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Sector Reform in the Caribbean(Evaluation of Results and Trends)
Financing health services is a major challenge for all English speaking Caribbean countries;
Implementation of reforms in financing mechanisms is slow;
Several mechanisms have been developed to improve allocation of financial resources (efficiency)
Limited progress in the move to ensure sustainability
Financing health services is a major challenge for all English speaking Caribbean countries;
Implementation of reforms in financing mechanisms is slow;
Several mechanisms have been developed to improve allocation of financial resources (efficiency)
Limited progress in the move to ensure sustainability
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Sources of Funding in the Caribbean
Taxes (general and earmarked) and Pooled Contributions (NHI or Social Insurance) are the predominant sources of funding
Contributions from taxes account for 21.2% of GDP, while Social Security contributions equals 0.8%
No country with good and desirable outcomes relies on grants or out-of-pocket payments
Taxes (general and earmarked) and Pooled Contributions (NHI or Social Insurance) are the predominant sources of funding
Contributions from taxes account for 21.2% of GDP, while Social Security contributions equals 0.8%
No country with good and desirable outcomes relies on grants or out-of-pocket payments
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Expenditure
Caribbean(13 countries) Range
THE%GDP 5.7 4.3 – 9.8
GHE%THE 62 45 – 83
PHE%THE 38 17 - 55
OOP%THE 34 16 – 48
THE p.c.(ppp dollars)
US$ 288(ppp US$ 431)
US$ 48 - 798
BelowAverage
8
9
---
---
---
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Health Expenditure in the Caribbean(The problems)
Insufficient Investment in Health Inefficient allocation:
Hospital-based services account for 45 - 50% of the THE and even larger percentages of the GHE (60 – 70%)
The allocation for Primary Health Care services in the region, ranges from 14 – 24 %
Personnel cost account for 60 – 70% of the budget
Coverage
Insufficient Investment in Health Inefficient allocation:
Hospital-based services account for 45 - 50% of the THE and even larger percentages of the GHE (60 – 70%)
The allocation for Primary Health Care services in the region, ranges from 14 – 24 %
Personnel cost account for 60 – 70% of the budget
Coverage
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Financing Health in the Caribbean(What is the right formula?)
Universal agreement as to the desirability of some form of national health insuranceOnly 3 Caribbean countries have NHI that offer coverage
(access) to all residents (Antigua and Barbuda, Bermuda and Cayman Islands)
Proposals under discussion in BAH, BLZ, St. Lucia, St. Vincent & the Grenadines, JAM, DOM, and T&T
The small size of the pool in individual countries is a major obstacle
Universal agreement as to the desirability of some form of national health insuranceOnly 3 Caribbean countries have NHI that offer coverage
(access) to all residents (Antigua and Barbuda, Bermuda and Cayman Islands)
Proposals under discussion in BAH, BLZ, St. Lucia, St. Vincent & the Grenadines, JAM, DOM, and T&T
The small size of the pool in individual countries is a major obstacle
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Financing Health in the Caribbean(What is the right formula?)
User Fees?? Levies and Earmarked Taxes (Jamaica National Health
Fund) Other experiences:
Drug Funds: (JADEP-JAM, NHF-JAM, C-DAP-T&T) Targeted Funds for the Poor: (PATH-JAM, MSA Health Card-
Suriname)
A balanced mix of financing mechanisms (Singapore)
User Fees?? Levies and Earmarked Taxes (Jamaica National Health
Fund) Other experiences:
Drug Funds: (JADEP-JAM, NHF-JAM, C-DAP-T&T) Targeted Funds for the Poor: (PATH-JAM, MSA Health Card-
Suriname)
A balanced mix of financing mechanisms (Singapore)
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
OVERVIEW
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Financing Function of the Health System: Concepts
Assurance Function Financing Health in the Caribbean: Trends Lessons and Recommendations from the
Caribbean Commission on Health and Development
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Caribbean Commission on Health and Development
Lessons: User fees are regressive, inequitable, and
inefficient
THE as a percentage of GDP is more sensitive to improvements to the organizational structures for delivering health and the method of health financing than to the wealth of the country
Other options vs. Viability of NHI schemes
Lessons: User fees are regressive, inequitable, and
inefficient
THE as a percentage of GDP is more sensitive to improvements to the organizational structures for delivering health and the method of health financing than to the wealth of the country
Other options vs. Viability of NHI schemes
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
Caribbean Commission on Health and Development
Recommendations: Scaling up coverage and public expenditure (THE 6% of
GDP) Additional expenditure should preferentially be directed to
Primary Health Care and to programs that benefit the poor Increase mobilization of resources from activities of the
public health inspectorate and from strategic public-private partnerships
Portable Caribbean-wide health insurance Allocation of funds for scaling up initiatives in relation to
national and regional public health goods (surveillance systems, standards and regulations, research, and sharing best practices).
Recommendations: Scaling up coverage and public expenditure (THE 6% of
GDP) Additional expenditure should preferentially be directed to
Primary Health Care and to programs that benefit the poor Increase mobilization of resources from activities of the
public health inspectorate and from strategic public-private partnerships
Portable Caribbean-wide health insurance Allocation of funds for scaling up initiatives in relation to
national and regional public health goods (surveillance systems, standards and regulations, research, and sharing best practices).
Caribbean Programme Coordination 2005
Pan AmericanHealthOrganization
THANK YOUTHANK YOU