HIV/AIDS Service Coverage Financial Sustainability and UHC · • Surveillans • Menjangkau...

HIV/AIDS Service Coverage

Financial Sustainability

and

UHC

Poor, and Informal, Formal Workers

Uncovered Covered

Civil Servants

Coverage Mechanism

Outpatient

OI Inpatient**

Others

ART

Diagnostic

Premium Contribution Taxes

Out of pocket

Coverage of AIDS services (Generic)

Population Coverage

Service Coverage*

Cost Coverage

*) Service Coverage depicted here is just an example **) OI = Opportunistic Infection

The case of Ghana

The case of South Africa

What about INDONESIA?

• How the diagram will look?

• Coverage: Who will be covered? Under Single Payer (BPJS)…?

• Benefits Package: What would be covered under the benefit package? What services would remain through supply side subsidy to health facilities?

• What is the level of financial coverage?

Indonesia: Insurance/Universal Health Coverage “Roadmap”

2013 2014 2015 2016 2017 2018 2019

1/1/2014 Jankesmas Jamstostek Askes Military Police

Merge 360 + Local Schemes (Jamkesda)

Unique Identifiers

Merge MIS systems Harmonize Benefit Packages

New Payment Systems

Strengthen Delivery Systems

100% Enrollment How? MOF: Contributions MOH: Subsidies

Pokjas 100 %

Dapatkah kita menggabungkan paket pelayanan?

Global Fund/LSM

Kemenkes

• Test kit

• Biaya operasional

• Tambahan biaya staf

• Obat “second line” /jarum suntik

• Pemantauan dan Evaluasi

• Surveillans

• Menjangkau masyarakat

• Kondom

• Obat first line

• Gaji -upah

• Dibawah BPJS? kapan?

7

Fragmentasi HIV/AIDS (KIA juga)

Government/Donor HIV Partnership MOH, UI, UNAIDS, Global Fund, WB, ….BPJS? MOF?

Investment Case by UNAIDS

(AEM/Goals Model)

Allocative Efficiency

HIV-UHC Integration

Overall Strategy Optimisation of

allocations (Optima Model extension)


Estimating Funding Gap

Fiscal Space for Health and HIV

System Integration and Strengthening

Coverage

Benefit Package (BPJS) + Premium Calculation (MOF)

Payment Methods (Capitation + Case Mix)

M&E

COVERAGE

Definition/scope Policy research questions

– Define target beneficiaries for

the HIV benefit under UHC

– Understand current coverage (of

at risk population groups

(MARPs)) under various

insurance schemes

– Identify and examine

current/potential barriers to

cover targeted beneficiaries into

JKN

- Who, where, and also what size of target beneficiaries

- What are the current coverage by different types of insurance, and

examine to what extent there is dual coverage of JKN and other

programs.

- What are the main barriers to get the coverage, what’s preventing

access to service

- Do existing law/regulations need to be altered?

- What are key perceived issues from stakeholders

- What are the options for expansion under JKN

Activities/Data requirement

- Desk review (published, grey lit, secondary data)

- Interviews (central & local gov’t, insurance carriers, advocacy groups)

- Data: epidemiologic data; enrolment data; ART coverage; utilization data from ANC and STI clinic

Deliverables A report/ a brief report as a part of the integration-to-UHC report)

BENEFIT PACKAGE and PREMIUM CALCULATION


– Examine comprehensive list of HIV

services and current inclusion in

BBP for HIV services;

– Explore options for different

inclusion or exclusion of services;

– Premium calculation based on the

BBP scenarios;

– Primary care capitation calculation;

– Risk adjustment based on specific

disease conditions, geographical,

demographical

– Who would deliver services and

how services will be delivered and

financed.

- Which services to be included/excluded from the list, and why?

- What is the current HIV services included in the UHC BBP; for other

insurance schemes (included services in local schemes), and why?

- Does the existing list need an additional positive list of services and

consultations?

- Should cost sharing be included? How will it be folded into the current

technology assessment initiatives?

- What are potential features that should be included on the premium

calculation that may be incentives/disincentives for beneficiaries to use

HIV related services; and also to providers?

- How different level of risks to be calculated (taking into account in

premium rate calculation)?

- Is supply side prepared to provide service?



- Workshop consultation with stakeholder (MOH, KPA/NAC)

- Field visit

Deliverables

A report that includes

- Global experience/lessons learned on benefit package

- Different scenarios of BBP with HIV services and premium rates of HIV services included

PAYMENT METHODS


– Payment options for primary care

and for secondary level of care

including the

incentives/disincentives of each

option;

– Risk adjustment based on specific

disease conditions, geographical,

demographical;

– Funding allocations under the UHC

options (referring to Global

experiences).

- What is the premium for HIV Services for different scenarios of BBP and

financial arrangement in the scheme; what would be financial implication

for each premium rate;

- What is the primary care capitation from the premium cost

- How different level of risks to be calculated (taking into account in

premium rate calculation)?

- What are the options for payment mechanisms; What are the

incentives/disincentives for each payment mechanism

- What are the options for financing and service delivery under the JKN

(BPJS) and what are the advantages / disadvantages of each option



- Interviews (central & local gov’t, insurance carriers, advocacy groups) – if needed

- Policy analysis of various payment mechanism; financing and service delivery mechanism

- Policy workshops

Deliverables

A report that includes :

- Assessment on various payment mechanism, how the funding is allocated to Primary care and hospital

- Global experience/lessons learned on various payment methods; financing and service delivery mechanism

- Case studies (field observation)

PERFORMANCE INDICATORS (M&E)


– Develop a list of Performance

Indicators

– Examine the current and M&E

framework and indicators of

BPJS/Other health insurance

schemes

- How to monitor performance: covering high risk population and

monitoring for quality of service?

- What are the indicators for HIV coverage?

- What information system needed to get the data?


- Desk review (published, grey lit, secondary data) especially on the JKN M&E framework

Deliverables

List of potential performance indicators

Government/Donor HIV Partnership MOH, UI, UNAIDS, Global Fund, WB, ….BPJS? MOF?

Investment Case by UNAIDS

(AEM/Goals Model)

Allocative Efficiency

HIV-UHC Integration

Overall Strategy Optimisation of

allocations (Optima Model extension)


Estimating Funding Gap

Fiscal Space for Health and HIV

System Integration and Strengthening

Coverage

Benefit Package (BPJS) + Premium Calculation (MOF)

Payment Methods (Capitation + Case Mix)

M&E

Step 10: Implementation of the HIV/AIDS Financial Sustainability Framework (3 years)

Step 9: Other Systems Issues for Strengthening and Capturing Savings and Efficiencies (Indonesia – first line drugs)

Step 8: Integration in Delivery and Health System Strengthening Issues

Step 7: Efficiency and Value for Money – Strategic Purchasing (case-mix, other frontiers)

Step 6: Pooling of Funds and Governance (PEPFAR not on board; when is separate pool ok?)

Step 5: Integrating Long-Term Sustainability Analysis (M. Hacker and others)

Step 4: Raising Additional Revenue for the Health Sector and HIV/AIDS programs

Step 3: Government Priority Setting for Funding of HIV/AIDS Programs

Step 2: The Macroeconomic and Fiscal Context and Environment

Step 1: Understanding the HIV Epidemic and Estimating the Gap

Financial Sustainability Framework

Summary and Leadership

• MOF • All

stakeholders

• MOH/NAC /BPJS/

• MOH/NAC/MOF

• NAC/MOH

Gap Analysis Fiscal Space Assessment

Implementa-tion

Health Systems Integration

HIV Allocative Efficiency Analysis

Objective To analyze optimal allocations of HIV/AIDS resources (with

decreasing contribution from Global Fund) to yield the

maximal returns and determine the impact of policy/program

alternatives

Method Optimization analysis using the Optima tool

Analyses • Optimal mix of investment with varying funding level

• Return-on investment of HIV response

• Effect of reinvesting savings using new units costs

• Establish impact of continued investment into prevention

post-GF

Outputs A revised AE report with scenario analysis

Timeline January– March 2015

Area I: HIV Allocative Efficiency Analysis

Area II: UHC – HIV Integration

Integration of HIV/AIDS Programs into JKN

Objective To analyze options for integrating HIV/AIDS programs into

Universal Health Coverage (UHC) / JKN

Method Integration analysis including assessment and review of

coverage, benefit package and premium calculation, payment

methods, and M&E

Analyses • Coverage

• Benefit package + Premium Calculation

• Payment methods

• M&E

Outputs A final report on UHC – HIV integration with background

analysis and reports

Timeline September 2014 – March 2015

Area III: Financial Sustainability Analysis

Financial Sustainability Framework

Objective Develop a strategy for financial sustainability (post GF) with

specific action areas that can be committed and implemented

by key stakeholders involved, including MOF, MOH, and

partners

Method HIV Financial Sustainability Framework

Analyses • Gap Analysis

• Fiscal space analysis for Health and HIV

• System integration

Outputs FS strategy with transition plans

Implementation agreement (between MOH/NAC, BPJS , and

MOF)

Timeline September 2014 – March 2015

HIV/AIDS Service Coverage Financial Sustainability and UHC · • Surveillans • Menjangkau...

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