Estimating Universal Health coverage
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Estimating Universal Health coverage Dr. N. Devadasan, Institute of Public Health, Bangalore, India
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Estimating Universal Health coverage. Dr. N. Devadasan, Institute of Public Health, Bangalore, India. UHC. Universal health coverage ? Universal health care ?. - PowerPoint PPT Presentation
Transcript of Estimating Universal Health coverage
Estimating Universal Health coverage
Dr. N. Devadasan,Institute of Public Health,
Bangalore, India
Presentation at NHSRC 2
UHC
• Universal health coverage ?
• Universal health care ?
Ensuring that ALL people can use the health
services they need of sufficient quality to be
effective, while also ensuring that the use of
services do not expose the use to financial
hardship 3/01/2013
Presentation at NHSRC 3
Coverage
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Presentation at NHSRC 4
Why estimate?
• UHC is about moving from point A to point B
• We need to know where we are currently
• Point B is usually 100% coverage
• We need to develop the strategy to reach Point B
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Presentation at NHSRC 5
WHR 2010
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Presentation at NHSRC 6
What to estimate
• Financial
• Population
• Services – Quantitative– Qualitative
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Presentation at NHSRC 7
Indicators for financial coverageIndicator Source of data% of population who are insured IRDA reports% of population who are covered under a pooled fund
Census
THE as a % of GDP NHAOOP as a % of THE NHAIncidence & Intensity of CHE NSSO Incidence & Intensity of Impoverishment
NSSO
% of patients who make OOP ? NSSO, NFHS, Simple studies
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Presentation at NHSRC 8
Examples …
Thailand Philipines Indonesia Vietnam Cambodia Laos Malaysia0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Proportion of insured among select SE Asian Countries
UninsuredInsured
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Presentation at NHSRC 9
Examples …
Thailand Philipines Indonesia Vietnam Cambodia Laos Malaysia0%
10%
20%
30%
40%
50%
60%
70%
19%
55%
30%
55%60% 62%
41%
OOP payments as a proportion of THE
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Presentation at NHSRC 10
Population coverageIndicator Source of dataQuintiles / MPCE National surveysPopulation Attributable risk National surveysConcentration index National surveysSC / ST ??
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Examples
Ailments treated - urban Institutional delivery Admissions*0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
78%
34%25%
95%
58%
91%
Lowest Highest
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Presentation at NHSRC 12
Indicators for service coverage
Ideally one needs to define the essential health package
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Presentation at NHSRC 13
Indicators for service coverage …
• ILO’s access deficit method
• MDG countdown method
• SARA method
• Composite coverage index
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Presentation at NHSRC 14
Indicators for service coverage - Quantitative
Indicator Source of data% of antenatals with full ANC NFHS, DLHS, CEC% of institutional deliveries NFHS, DLHS, CEC% of unmet FP needs NFHS, DLHS% of children fully immunised NFHS, DLHS, CEC% of children who received ORT NFHS% of children who received ARI Rx NFHSTB Case detection rate RNTCP reports% of children who slept under a ITN ?
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Presentation at NHSRC 15
Indicators for service coverage - Quantitative
Indicator Source of dataOP contact rate NSSO 60th roundIP admission rate NSSO 60th round% of diabetics on regular treatment ?% of women screened for CA Cervix ?% of households with access to toilets
Census
% of households with access to potable water in their house
Census
?
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Presentation at NHSRC 16
Indicators for service coverage – Quality of care
Indicator Source of dataDrop out rate – ANCDrop out rate – ImmunisationDrop out rate – TBInfection rate in hospitalsDrop out rate – IUCD ?
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Presentation at NHSRC 17
Service coverage: Examples …
Full ANC Institutional delivery Full immunisation Unmet FP needs0%
10%
20%
30%
40%
50%
60%
70%
80%
Annual health survey 2012. X state3/01/2013
Presentation at NHSRC 18
Service coverage: Examples..
Treated for ARI % of ailments treated
Admission rate* TB case detection rate
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
DLHS, NSSO 60th Round, RNTCP 2012. India 3/01/2013
Presentation at NHSRC 19
What to do
• All indicators?
• A single composite indicator?
• A mixture?
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Presentation at NHSRC 20
Services + Population
Drinking water at home
Full ANC
Full immunisation
Met FP needsAilment treated
Institutional delivery rate
Admission rate*
0%
25%
50%
75%
100%
LowestHighest
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Presentation at NHSRC 21
Services + OOP
Drinking water at home
Full ANC
Full immunisation
Met FP needsAilment treated
Institutional delivery rate
Admission rate*
0%
25%
50%
75%
100%
Lowest
OOP
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Financial coverage
Incidence of OOP
Incidence of CHE
Incidence of impoverishment
OOP as a % of THE 0%
25%
50%
75%
100%
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Presentation at NHSRC 23Population coverage
Fina
ncia
l cov
erag
e
Service co
verageCURRENT STATUS
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Limitations
• Agreement on package
• Agreement on indicators
• Availability of disaggregated data
• Validation of this tool
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Disclaimer
• Please note that this is a work in progress
• Suggestions and criticisms are welcome
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Thank you
Dr. N. Devadasan, MBBS, MPH, PhD
Institute of Public Health,Bangalore
