WHR2010 Regional Strategy
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Transcript of WHR2010 Regional Strategy
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Universal Health CoverageThe World Health Report 2010 and
The Regional Health Financing Strategy 2010-2015
Ke XuHealth Care Financing
WHO Regional Office for the Western Pacific
26 April 2012, ADB
The views expressed in this paper are the views of the authors and do not necessarily reflect the views or policies of theAsian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee
the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Thecountries listed in this paper do not imply any view on ADB's part as to sovereignty or independent status or necessarily conform
to ADBs terminology.
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Health Systems Financing
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Universal Health Coverage
The aspiration to attain universal coverage is not new: WHO's constitution (1948)
Alma-Ata declaration (1978)
World Health Assembly Resolution (2005)
World Health Report on Primary Health Care (2008)
Health Financing Strategy for Asia Pacific Region (2009)
World Health Report on Health Systems Financing-The
Path to Universal Coverage (2010)
Universal coverage has been adopted by most countriesin their national health plans and/or reform agenda
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Definition of Universal Coverage
Universal Coverage Everyone has access to
needed services withoutthe risk of financial
hardship linked to payingfor care.
Universal Coverage iscoverage with health
services; with financialrisk protection; for all
Three Dimensions
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Where We Are?
Access to health services (prevention, promotion,treatment, rehabilitation): More than 1 billion people cannot use the health services
they need
Financial risk protection: Around 150 million suffer financial catastrophe each year
and 100 million are pushed into poverty because they needservices, use them, but must pay at the time of use.
System efficiency:
Based on a conservative estimate, 20-40% of resources spenton health are wasted.
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Coverage of Births by Skilled Health Personnel and DPT3 Vaccination
Births attended by skilled health personnel
0
10
20
30
40
50
60
70
80
90
100
Countries (ranked from lowest to highest coverage)
Percentage
ofcov
erag
3 doses of diphtheria-tetanus toxoid pertussis
vaccine among 1 year olds (DPT3)
0
10
20
30
40
50
60
70
80
90
100
Countries (ranked from lowest to highest coverage)
Percentage
ofcov
erag
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Percentage of Births by Medically Trained Person:Poorest (Q1) and richest (Q5) quintiles
0
20
40
60
80
100
0 10 20 30 40 50
Q1Q5 Average
Source: Latest available DHS for each country (excl. CIS countries)
Q1, Q5 and Average - 22
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Millions More Suffer FinanciallyWhen They Use Health Services
- 30 60 90
WPR
AMR
SEA
EUR
AFR
EMR
Number of people (million)
impoverishment
catastrophic
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Three Fundamental Health Financing Challenges
1. The continual need to search for
sufficient funds for health;
2. The need to ensure/maintainfinancial risk protection wherefinancial barriers do not prevent
people using needed health servicesnor lead to financial ruin when usingthem;
3. The need to reduce inefficiency andinequity in using resources, and
increase transparency andaccountability.
Revenuecollection
Pooling
Purchasing
He
althFinancin
gFunctions
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Raise Sufficient Funds
Increase the efficiency ofrevenue collection
Reprioritize governmentbudget
Innovative financing
Development assistance for
health 0% 1% 2% 3% 4% 5% 6% 7% 8%
Lao PDR
Philippines
Cambodia
China
PNG
Viet Nam
Mongolia
Health expenditure as a share of GDP (2008)
public%GDP private%GDP
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Reduce Out-of pocket Payments
.01
.03
.1
.3
1
3
8
15
%ofhouseholdswithcatast
rophicexpenditure(logarithm)
3 5 8 14 22 37 61 100
out-of-pocket payment in total health expenditure % (logarithm)
OECD others
Proportion of Households with Catastrophic Expenditures vs.Share of Out-of-pocket Payment in Total Health ExpenditureOut-of-pocketpayments preventsome people usinghealth services andresult in financial ruin
for many who do
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Components of Health Expenditure, 2008
0% 20% 40% 60% 80% 100%
PNG
Mongolia
China
Philippines
Viet Nam
Lao PDR
Cambodia
OOP Other SSH Tax
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Increase Efficiency
Common causes of inefficiency:Spending too much on medicines and health technologies,using them inappropriately, using ineffective medicinesand technologies
Leakages and waste, again often for medicines
Hospital inefficiency particularly over-capacityDe-motivated health workers, sometimes workers with thewrong skills in the wrong places
An inappropriate mix between prevention, promotion,treatment and rehabilitation
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Protect the Poor and Vulnerable
Options (in addition to prepaid and pooled resources) to ensuregreater coverage and lower financial barriers:
Free or subsidized services (e.g. through exemptions orvouchers) for specific groups of people (i.e. the poor) or forspecific health conditions (i.e. child or maternal care) e.g. Sierra
Leone. Subsidized or free enrolment in health insurance e.g.
Mexico, Thailand Cash payments to cover transport costs and other costs of
obtaining care reduce some financial barriers for the poor.Sometimes these are paid only after the recipient takes actions,
usually preventive, that are thought to be beneficial for theirhealth or the health of their families.
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Summary
More money for health Search for more available funding for health
Reduce the reliance on direct out-of-pocketpayments
Maximize solidarity in the society
More health for the money
Improve efficiency and equity in use of resources.
Protect the poor and vulnerable and improveequity
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Thank you for your attention!