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Dr. Khin Maung AyeVice President

Myanmar Medical Association

WHO stated that health is : -

Basic Human RightWorldwide social goal Is Essential to the satisfaction of basic human

needs

“Health is Wealth”

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breeds

Ill-health

Poverty

Relationship between poverty and health

Good health

Higher income

Health Care Financing

ODA

Direct OOP Gov: budget Social security Voluntary Health Insurance

ProviderDonations

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Basic model for insurance

Provider

UserInsurer

Health services

Contribution (premium, pre-payment)

Risk pooling: provider/insurer spilt

Provider payment(e.g.: capitation) =purchase of services Information on

utilization and expenditure

Universal coverage

Universal coverage is defined as securing access by all citizens to appropriate promotive, preventive, curative and rehabilitative services at an affordable cost.

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Health Expenditure as a % of GDP

0

1

2

3

4

5

6

7

8

Myanm

ar

Lao

PDRInd

ia

Bangla

desh

Singapo

re

Indon

esia

Philipp

ines

Brunei D

aruss

alam

Cambo

diaNep

al

Malaysia

Sri Lan

kaChin

a

Thaila

nd

Papua

New

Guin

ea Fiji

Viet N

am

Dem. P

eople

's Rep

. of K

oreaBhuta

n

Vanuatu

Tonga

Repub

lic of

Korea

Cook I

sland

s

Samoa

Mongo

lia

Solomon

Islan

ds

Perc

enta

ge o

f GD

P

Government health spending Private health spending

Source: WHO, Health Financing Strategy in Asia and the Pacific (2010-2015), 2009

Universal Coverage:• Difficult to achieve if OOP payments are greater than 30 % of THE

A Core Technical Meeting on a Feasibility Study and Possible action Plans on a Pilot of Child Health Protection, ThingahaHotel, Nay Pyi Taw 20 July 2010

0%

20%

40%

60%

80%

100%

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Time Series Analysis of Total Health Expenditures by Source (1998-2007)

Public Private External

Source: Myanmar National Health Accounts, 1998-2007

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Catastrophic health expenditure

It defined as spending more than 40% of household consumption expenditure, excluding food, on health, or more than 10% of total household consumption expenditure on health.

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Three path to move toward Universal Coverage

Total Health Expenditure

Breadth: population cover

Depth & QualityService cover

Hei

ght:

Cost

sha

ring

Public Expenditureon Health

Cover vulnerable

Reduce OOPScale-up PHC

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Community Cost Sharing Schemes

implemented with support from various organizations initiated in 1990.Community Health Management and Financing

(CHMF)Myanmar Essential Drug Project (MEDP)Central Medical Store Depot (CMSD) Trust Funds

Government tax

Social health insurance Pre-payment

Private International agencies N.G.O – international, local Charity and voluntary contribution - corporate social

responsibilities Community financing

Financial Sources

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Government

Hospital Doctor Nurses Staffs

Non-Profit Private Hospital meant for community & poor people

Social Health Insurance Advocacy Education to public

Drugs Local pharmaceutical factories

Reduction of out-of-pocket payment

Most drugs are imported

Prices are high

Unaffordable by most patients

Need pharmaceutical industries locally to make adequate supply for all

Government guidelines for use of essential drugs in day-to-day practice to reduce the cost of medications

Medicine

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Population coverage by financial protection schemes

The population groups are re-categorized the formal group, the poor group and the informal and the rest of the population group.

The rest of the population consists of non-poor children and elderly dependents and other economically inactive groups.

Protecting the formal employment sector

• Different provider payment arrangements can have different effects on doctors’ clinical decisions and behaviour on resource use.

• International experience indicates that a fee for service payment stimulates unnecessary diagnosis, prescription, and treatment, resulting in cost escalation; closed-end payment such as capitation and case-based payment have lower costs.

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Health Financing Strategy for the Asia Pacific Region (2010-

2015) South-East

Universal coverage usually is attained in countries in

which public financing of health is around 5% of gross domestic product

(GDP). This is an important goal for all countries in the Asia Pacific region to

consider as they move towards universal coverage.

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target indicators

(1) out-of-pocket spending should not exceed 30%–40% of total health expenditure;

(2) total health expenditure should be at least 4%–5% of the gross domestic product;

(3) over 90% of the population is covered by prepayment and risk pooling schemes; and

(4) close to 100% coverage of vulnerable populations with social assistance and safety-net programmes.

The eight strategic areas are:

(1) increasing investment and public spending on health

(2) improving aid effectiveness for health (3) improving efficiency by rationalizing health

expenditures (4) increasing the use of prepayment and pooling

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The eight strategic areas are:

(5) improving provider payment methods (6) strengthening safety-net mechanisms for the poor

and vulnerable (7) improving evidence and information for

policymaking, and (8) improving monitoring and evaluation of policy

changes.

Efficiency issues in the Asia Pacific region

70% of desirable health interventions can be delivered at the primary level, but an average of only 10% of health resources are used for primary level care in Asia.

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Social safety-net mechanisms aim to

increase social protection by reducing barriers that exclude the poor and vulnerable from accessing health services.The barriers may be economic,

political, social and cultural, or a complex interaction of all these factors.

What are the Obstacles to Universal coverage?

Exclusion linked to factors outside the health system – inequalities in income, education and social exclusion associated with e.g. ethnicity, gender and migrant status

Weak health systems: Insufficient health workers, medicines and health technologies. Ineffective service delivery.

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What are the Obstacles to Universal coverage?

Health financing systems that do not function. This is critical because the other parts of the health system cannot function if the financing system is weak

Three Fundamental Health Financing Problems The need to raise sufficient funds for health– more

money for health.Heavy reliance on direct out-of-pocket payments to

finance health in many countries, discouraging people from seeking care and resulting in financial hardship when they do.

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Three Fundamental Health Financing Problems

Inefficiency and inequity in use of resources,, reducing the amount of "health for the money“ –more health for the money

To initiate a pilot health insurance model.

To explore options of community based health financing mechanisms.

To seek external technical inputs.

NGOs like MMA can take part in advocacy and participation in the pilot project.

Conclusion