FINANCING UHC TO INCLUDE CANCER FOR THE AGING

Eduardo Banzon

Principal Health Specialist

SDSC-HEA, SDCC

Asian Development Bank

May 2019

Universal Health Coverage

Who should be financially protected?

How much should be covered?

What health

services should be included?

34

40

46

46

47

48

49

56

58

62

63

64

65

66

67

70

71

73

75

76

80

80

80

0 10 20 30 40 50 60 70 80 90

Afghanistan

Pakistan

Bangladesh

Nepal

Timor-Leste

Lao PDR

Indonesia

India

Philippines

Sri Lanka

Mongolia

Azerbaijan

Tajikistan

Fiji

Armenia

Malaysia

Kazakhstan

Vietnam

Thailand

China, People's…

Australia

Japan

Korea, Rep.

Universal Health Coverage Service Coverage Index, 2015

UHC: Financial Risk Protection

Using health spending indices from the 16 focus countries, health spending as % of GDP ranges from 1.5% - 7%. Does higher spending for health as % of GDP result directly to better financial risk protection?

WHO Global Health Observatory, 2014

Financial Risk Protection and the Share of Out of Pocket (OOP) spending to Total Health

Expenditure

In Viet Nam, OOP remains high (36.76%) despite its health spending reaching up to 7% of its GDP. Thailand on the other hand, managed to reduce its OOP to <20% while managing a health spending at 4% of its GDP.

Source: WHO Global Health Observatory, 2014

Financing UHC

• Financing UHC is not simply a matter of increasing the share of total health spending to GDP.

• China, Vietnam, Nepal, Azerbaijan and Cambodia have health spending that is >5% of their GDP.

• Despite this, Cambodia and Azerbaijan still has highest OOP share in their total health spending.

• Need to reduce OOP (and increase Pre-payments) while expanding pooled funding and spending

• Increased budgetary allocation • Annual budgetary processes

• Earmarked • Traditional.

• payroll taxes/premiums for health insurance • Lottery revenues for health

• New approaches • Taxes related to illnesses (sin taxes) • Share of taxes (VAT) • Fees (remittance, airline tickets, car registration)

• Leveraging private sector pre-payments • Private health insurance • Philanthropy

• External financing • Loans (advanced financing)

Increasing pre-payments for UHC

Health Insurance/Purchasing Funds and UHC all over Asia and the Pacific

From Japan, Korea, Singapore, and others

To Thailand’s Universal Coverage

And NOW…

• Philippines’s National Health Insurance Program and now UHC Law

• Indonesia’s JKN

• India’s PM-JAY

• Pakistan’s Sehat Insaf

• Mongolia’s Health Insurance Fund

• Lao PDR’s National Health Insurance Scheme

• Nepal’s National Health Insurance Act

• Cambodia’s National Social Security Fund

• Kazakhstan Compulsory Social Health Insurance System ....

Strategic Purchasing, Aging and Cancer

Global Shift Towards NCDs and Other Chronic Conditions

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

Chronic conditions defined by WHO as requiring “ongoing management over a period of years or decades” and cover a wide range of NCDs such as heart disease, diabetes, and asthma; they also include mental disorders such as depression and schizophrenia; disabilities and impairments not defined as diseases -- such as blindness and musculoskeletal disorders -- and also include cancer.

Chronic conditions include some CDs such as HIV/AIDS; and not all NCDs are chronic.

Drivers of Global Rise in NCDs and Other Chronic Conditions

Ageing

Declining fertility (although increasing numbers of “young” also beginning to experience chronic conditions due to other risk factors).

Unhealthy diet: including high intake of fat, salt, sugar, and low intake of fruits/vegetables.

Physical inactivity, obesity, malnutrition.

Tobacco consumption and harmful use of alcohol.

Exposure to environmental risk factors, including indoor/outdoor

pollution.

:

Elderly Population has Increasing Prevalence of Co-morbidities and Multi-morbidities

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

Need to Change the Health System to Address Chronic Conditions (particularly those of the Elderly

Population)

\

Current health systems geared towards acute, episodic diseases; are often ill-equipped to meet long-term fluctuating needs of those with chronic illnesses.

Acute Disease Chronic Conditions

Onset Abrupt Gradual, subtle

Duration Limited Lengthy, fluctuating, indefinite

Cause Usually single Often multiple

Cure Often possible Often no cure

Patients Passive recipients of care Active participants in treatment plans

For chronic care: patients may receive care from many different providers over time, often in different settings or institutions, even when they have only a single disease; and patients will often be asked to monitor, coordinate, or carry-out parts of their own treatment plans.

Health Service Delivery Systems are being Re-organized

Improving individual-level outcomes, enhancing responsiveness, and improving value-for-money/efficiency.

Multiple providers -- constituting a formal or informal “delivery group” – are part either of the same multi-practice organization or have a

contractual or other arrangement to work together.

Care is coordinated across settings -- inpatient, outpatient, home, doctor’s

office, etc. -- in the sense that handoffs between settings are smooth, with all

necessary information transferred along with the patient.

Prevention and promotion are pro-actively managed and, when needed, treatment is provided in

the most appropriate setting.

All providers whose services are needed share responsibility

and work together in a coordinated manner.

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

Need to Change How We Pay Care Providers

Primary health care

Ambulatory specialist

care

Hospital treatment

Long-term rehabilitative palliative care

$ $ $ $

Traditional provider payments to different types of providers are usually made in a fragmented manner

Add-On Payments

Bundled Payments

Population-Based

Payments

Line-Item

Budget

Global Budget

Per Diem

Case-Based

Fee-for-

Service Capitation

Add-On Payments

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

$ $ $ $ $ $

Adjustments made to traditional provider payment mechanisms to incentivize integration.

Designed to complement, not replace, traditional provider payment mechanisms.

Can be made to single provider or network of multiple providers; also to patients.

Traditional provider payments Add-on payments

Bundled Payments

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

$ $

Single payment made to multiple providers for all services associated with an acute or chronic episode of care such as “knee replacement” or “diabetes care” over a specified time period.

Providers constituting a “delivery group” assume financial risk for the cost of services for defined episode as well as costs associated with preventable complications.

Bundled payments

Population-Based Payments

Vinals Torres & Tandon: Strategic Purchasing for Integrated Care

Single payment made to multiple providers for all services that may be needed for a covered individual over a specified time period; also known as “global capitation”.

Providers constituting a “delivery group” assume financial and insurance risk.

Makes payments people-centric as opposed to being provider-centric.

$

Population-based payment

How ton Pay for New Digital Technology: TeleHealth/mHealth

• The increasing prevalence of chronic conditions, such as diabetes and heart disease is placing an enormous burden on health service resources in both primary and acute care

• The demand on the health service for

routine consultations to monitor chronic conditions is one of the reasons that there is increased interest in harnessing technology to help manage these patients

• Telehealth/mHealth: delivery of healthcare or information at a distance via technology, and includes services such as assessment, monitoring, communications, disease prevention, and education

2013 2015

2x Increase in % of consumers with at least one medical, health or fitness app on their mobile devices between 2013 and 2015

Source: PWC Analysis

How to Pay for New Digital Technology: Remote Monitoring

• Remote Monitoring: technology that enables monitoring of patients beyond conventional clinical settings.

• A device or software is used to collect a patient’s clinical data and the data are transmitted to a hospital, clinic or telemedicine vendor for monitoring and analysis or further therapeutic intervention

Source: Journal of medical Internet research (2014)

Source: Researchgate.net

Thank you