progress towards universal health-care coverage in asia and the pacific
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Progress towards universal health-care coverage in Asia and the Pacific Fourth Technical Review Meeting of the Health Policy and Health Finance Knowledge Hub Nossal Institute, Melbourne, 10-12 October 2011 Marco Roncarati, UNESCAP. ESCAP region. Universal health-care coverage. - PowerPoint PPT PresentationTRANSCRIPT
Progress towards universal health-care coverage in Asia and the Pacific
Fourth Technical Review Meeting of the Health Policy and Health Finance Knowledge Hub
Nossal Institute, Melbourne, 10-12 October 2011
Marco Roncarati, UNESCAP
ESCAP region
Universal health-care coverage
The financing and provision of health-care services so that all are covered
Those of all income levels have equal use of services
Individuals and households do not incur impoverishing expenditure in order to receive a socially-acceptable minimum level of services
Equity in use in relation to need exists, in the case of higher income economies
Equality and Equity
Laws are needed to protect those who are most excluded
Effective policies and programmes need to be directed to specific groups of people
Hence equity is an issue of fairness related to need, and needs are not equal
Social Protection
Formal Informal/traditional
Empowerment
Building an Inclusive Society for AllThrough Social Integration
ESCAP SDD Conceptual Framework and Thematic Focus
Policies, Interventions and Institutional ChangeCross-cutting: gender mainstreaming, rights-based approach, good governance
EqualityWomen
People living with HIV/AIDS
Young peoplePersons
with disabilities
Migrants
Older persons
The poor
Social insuranceSocial assistanceSocial servicesLabour market policiesLocal funds
Societal norms & traditionsCommunity-based protectionFamily-based protection
Advocacy/awareness raisingEducation and capacity-developmentEconomic, legal & political empowerment measuresLabour market policiesAccess to basic servicesNetworking
ESCAP Objective:Inclusive & Sustainable
Development in Asia-Pacific
MDGs
UN Resolutions & Mandates
Social Protection, including Health
The recent economic and financial crisis… vulnerability and the need for social protection
UN GA resolution 65/1 of 22 Sep. 2010 … united to achieve the MDGs
Heads of State/Government committed to promoting comprehensive systems of social protection that provide a minimum level of social security and health care for all
Social Protection, including Health, cont.
Social protection should:
Be integrated into broader economic and social strategies to guarantee all a minimum level of security
Move from interventions addressing symptoms of vulnerability to systemic transformations eliminating underlying causes of persistent poverty and inequality
Be accorded political commitment at the highest level
Have policies formulated and implemented by participation of multiple actors
Social Protection including Health, cont.
It is affordable and achievable
It is an investment with many long-term benefits
It can bring about more equitable and robust economic growth through:
Greater domestic consumption
Higher levels of human development
Greater shared opportunity
Annual cost of basic social protection package, selected Asia‑Pacific countries (as % of GNI)
What is good governance?
Governance in the health-care sector, cont.
Enabling conditions Political stability
Strong institutional and policy environment
Commitment to equity
Good evidence-based decision making
Strong stakeholder support
Legal approaches to resolve matters
Many countries have legislation to protect the most vulnerable
Some have laws or constitutions that entitle every citizen to benefit from health protection
In some cases anti-discrimination laws exist
In others cash transfers are conditional on health-care issues related to children and mothers
However, progress has been relatively slow in Asia and the Pacific
Health Protection; Proportion of the Population Covered by Law (%)
Country examples
China
From 1980s, growth (Socialism with Chinese characteristics) led to dramatic poverty reduction; yet, inequality rose (Western Regions remain poor)
Rising out-of-pocket medical expenditure led to a decline in equity and access to health services as well as impoverishment of families
In 2003, China launched the New Cooperative Medical System (NCMS); as of 2008, over 90% of the rural population, over 800 million people, had joined NCMS
Urban Resident Basic Medical Insurance was launched in 2007, targeting mainly urban residents without formal employment
Country examples, cont.
Sri Lanka Success in MDG achievement and poverty reduction. Emphasis
on physical access to free government health and education services
High-density but low-cost network of rural facilities
Focus on minimizing price barriers; no user fees in government facilities, but also active measures to minimize illegal fees charged by staff (good governance)
Emphasis on risk protection in budget allocations over cost-effectiveness; thus the poor have a full range of services instead of a restricted range and this has encouraged public support and confidence in the system
In sum, effective targeting of the poor with tax subsidised services
Country examples, cont.
Thailand
Long-term commitment (40 years to UC in 2002) to providing affordable health-care services to the population, especially those in greatest need
From providing free health care to the poor, step-by-step, coverage expanded over the years to the entire population
Within Health Ministry, a long history of reformers and advocates pushing hard for UC
In the health sector, the building of technical capacity has been critical in achieving UC, so too have been coalitions, such as those including the government, civil society and academia
Management is the key to sustainability
Use of Public-Private In-patient Services by Income Quintile
Bangladesh
0
10
20
30
40
50
Q1 Q2 Q3 Q4 Q5
Public Private
India
0
10
20
30
40
50
60
Q1 Q2 Q3 Q4 Q5
Sri Lanka
0
10
20
30
40
50
Q1 Q2 Q3 Q4 Q5
Malaysia
0
10
20
30
40
50
60
Q1 Q2 Q3 Q4 Q5
Indonesia
0
10
20
30
40
50
60
Q1 Q2 Q3 Q4 Q5
Hong Kong
0
10
20
30
40
50
Q1 Q2 Q3 Q4 Q5
In conclusion
Redistributive polices (tax, pricing, access to credit)
Political will and good governance
Macroeconomic stabilization
Investments in social protection, including health
Multi-sectoral approaches and stakeholder involvement
Effective legislation and good data/evidence
Awareness raising and capacity building in health, related sectors and the public at large
