whr2010 regional strategy

8/2/2019 WHR2010 Regional Strategy

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Universal Health CoverageThe World Health Report 2010 and

The Regional Health Financing Strategy 2010-2015

Ke XuHealth Care Financing

WHO Regional Office for the Western Pacific

26 April 2012, ADB

The views expressed in this paper are the views of the authors and do not necessarily reflect the views or policies of theAsian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee

the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Thecountries listed in this paper do not imply any view on ADB's part as to sovereignty or independent status or necessarily conform

to ADBs terminology.


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Health Systems Financing

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Universal Health Coverage

The aspiration to attain universal coverage is not new: WHO's constitution (1948)

Alma-Ata declaration (1978)

World Health Assembly Resolution (2005)

World Health Report on Primary Health Care (2008)

Health Financing Strategy for Asia Pacific Region (2009)

World Health Report on Health Systems Financing-The

Path to Universal Coverage (2010)

Universal coverage has been adopted by most countriesin their national health plans and/or reform agenda


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Definition of Universal Coverage

Universal Coverage Everyone has access to

needed services withoutthe risk of financial

hardship linked to payingfor care.

Universal Coverage iscoverage with health

services; with financialrisk protection; for all

Three Dimensions


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Where We Are?

Access to health services (prevention, promotion,treatment, rehabilitation): More than 1 billion people cannot use the health services

they need

Financial risk protection: Around 150 million suffer financial catastrophe each year

and 100 million are pushed into poverty because they needservices, use them, but must pay at the time of use.

System efficiency:

Based on a conservative estimate, 20-40% of resources spenton health are wasted.


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Coverage of Births by Skilled Health Personnel and DPT3 Vaccination

Births attended by skilled health personnel

0

10

20

30

40

50

60

70

80

90

100

Countries (ranked from lowest to highest coverage)

Percentage

ofcov

erag

3 doses of diphtheria-tetanus toxoid pertussis

vaccine among 1 year olds (DPT3)

0

10

20

30

40

50

60

70

80

90

100

Countries (ranked from lowest to highest coverage)

Percentage

ofcov

erag


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Percentage of Births by Medically Trained Person:Poorest (Q1) and richest (Q5) quintiles

0

20

40

60

80

100

0 10 20 30 40 50

Q1Q5 Average

Source: Latest available DHS for each country (excl. CIS countries)

Q1, Q5 and Average - 22


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Millions More Suffer FinanciallyWhen They Use Health Services

- 30 60 90

WPR

AMR

SEA

EUR

AFR

EMR

Number of people (million)

impoverishment

catastrophic


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Three Fundamental Health Financing Challenges

1. The continual need to search for

sufficient funds for health;

2. The need to ensure/maintainfinancial risk protection wherefinancial barriers do not prevent

people using needed health servicesnor lead to financial ruin when usingthem;

3. The need to reduce inefficiency andinequity in using resources, and

increase transparency andaccountability.

Revenuecollection

Pooling

Purchasing

He

althFinancin

gFunctions


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Raise Sufficient Funds

Increase the efficiency ofrevenue collection

Reprioritize governmentbudget

Innovative financing

Development assistance for

health 0% 1% 2% 3% 4% 5% 6% 7% 8%

Lao PDR

Philippines

Cambodia

China

PNG

Viet Nam

Mongolia

Health expenditure as a share of GDP (2008)

public%GDP private%GDP


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Reduce Out-of pocket Payments

.01

.03

.1

.3

1

3

8

15

%ofhouseholdswithcatast

rophicexpenditure(logarithm)

3 5 8 14 22 37 61 100

out-of-pocket payment in total health expenditure % (logarithm)

OECD others

Proportion of Households with Catastrophic Expenditures vs.Share of Out-of-pocket Payment in Total Health ExpenditureOut-of-pocketpayments preventsome people usinghealth services andresult in financial ruin

for many who do


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Components of Health Expenditure, 2008

0% 20% 40% 60% 80% 100%

PNG

Mongolia

China

Philippines

Viet Nam

Lao PDR

Cambodia

OOP Other SSH Tax


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Increase Efficiency

Common causes of inefficiency:Spending too much on medicines and health technologies,using them inappropriately, using ineffective medicinesand technologies

Leakages and waste, again often for medicines

Hospital inefficiency particularly over-capacityDe-motivated health workers, sometimes workers with thewrong skills in the wrong places

An inappropriate mix between prevention, promotion,treatment and rehabilitation


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Protect the Poor and Vulnerable

Options (in addition to prepaid and pooled resources) to ensuregreater coverage and lower financial barriers:

Free or subsidized services (e.g. through exemptions orvouchers) for specific groups of people (i.e. the poor) or forspecific health conditions (i.e. child or maternal care) e.g. Sierra

Leone. Subsidized or free enrolment in health insurance e.g.

Mexico, Thailand Cash payments to cover transport costs and other costs of

obtaining care reduce some financial barriers for the poor.Sometimes these are paid only after the recipient takes actions,

usually preventive, that are thought to be beneficial for theirhealth or the health of their families.


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Summary

More money for health Search for more available funding for health

Reduce the reliance on direct out-of-pocketpayments

Maximize solidarity in the society

More health for the money

Improve efficiency and equity in use of resources.

Protect the poor and vulnerable and improveequity


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Thank you for your attention!

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