Transcript Guidelines - shdrc.org

Designing Health Financing System
to Achieve Universal Coverage
Ke Xu
Health Systems Financing
World Health Organization
November 2008, Shanghai
1|
Health System Financing
Universal Coverage as a Policy Objective
 defined as everyone having access to appropriate care when they
need it and at affordable cost
implies financial risk protection and
equity of access
associated with equity in financing
( contribution according to ability to pay)
Resolution "Sustainable Health Financing, Universal coverage and Social Health Insurance"
May 2005. Geneva
2|
Health System Financing
Three Dimensions of Universal Coverage
3|
Health System Financing
Universal Coverage Getting the Mix Right
Revenue collection
Collect funds
(taxes or
contributions)
efficiently and
equitably
4|
Health System Financing
Pooling
Costs are shared by all
and not borne by people
when they are ill
wealthy & healthy
subsidize the poor & sick
Purchasing
Buy or provide
effective health
interventions
Incentives for
efficiency
Revenue Collection
Sustainability
Is the money collected in an
equitable way?
Equity
How much I pay and
how much others pay?
5|
Health System Financing
Does the collected sufficient?
Efficiency
How to collect a sufficient
amount of money with
minimum administrative cost?
Health Financing Mechanisms
Financing mechanisms
Tax-based
financing
Health care
services
Health System Financing
1. General tax or
other revenue
Social health
insurance
2. Payroll tax
Other
prepayment
schemes
3. Contribution or
premium
Out-of-pocket
payments
6|
Financing sources
External
resource
Household
4. Direct payment
Natural
resource
revenue
Revenue Collection
Generally a mix of different types of revenue
collection mechanisms co-exist:
– Tax based funding
•
General taxation, earmark taxes
– Compulsory insurance
•
Payroll tax and contribution
•
Formal and informal sector employees
•
Dependants
– Voluntary insurance
7|
Health System Financing
Social Health Insurance- Constrain Factors
•Income level and growth
•The structure of the economy
•The distribution of the population
•Administrative capacity
•Solidarity
•Stewardship
8|
Health System Financing
Funds Pooling

How far can solidarity go ?
–
–
–

How many pools-risk adjustment/ risk-equalisation?
–
–
–

One pool (Korea, Turkey)
Multiple pools (Germany, Netherland, Switzerland…)
Fragmentation and segmentation
How should tax-based funding be channeled?
–
–
–
9|
What level of cross-subsidies from rich to poor and from healthy to ill?
Any role for supplementary or complementary health insurance ?
Should opt-out be allowed (Latin America, Germany)?
To provider (Latin American countries)-low price services
To insurance funds- low insurance premium
To consumers (cash transfer)- to purchase services or insurance
Health System Financing
15
8
3
1
.3
.1
.03
.01
% of households with catastrophic expenditure (logarithm)
Proportion of households with catastrophic expenditures vs.
share of out-of-pocket payment in total health expenditure
3
5
8
14
22
37
out-of-pocket payment in total health expenditure % (logarithm)
OECD
others
61
100
Purchasing
Strategic purchasing
Provider payment
mechanisms
Outpatient service
Inpatient service
Drugs
High-tech medical equipments
No over provision
11 |
Health System Financing
Benefit package design
Differentiate cost sharing
among different services and
drugs
No over utilization
By Pia Schneider: Provider Payment Reforms: Lessons from Europe and America for South Eastern Europe
12 |
Health System Financing
The Design Features of Benefit Package
Risk protection
Budget constrain
The size of
benefit package
Width
The number of
services
13 |
Health System Financing
Depth
Cost-sharing
Structure
What services
and how much
OOP Components by Quintiles (Korea, 2007)
100%
80%
60%
40%
20%
0%
1
2
drug
14 |
Health System Financing
3
equipment
4
5
service
to tal
Catastrophic Expenditure by
Different Payments (Korea)
35%
30%
25%
20%
outpatient
15%
inpatient
dental
10%
drug
5%
0%
2003
15 |
Health System Financing
2004
2005
2006
2007
Percentage of Households Reporting
Non-zero Inpatient Expenditure (Korea, 2007)
6
% of households
5
4
3
2
1
0
1
2
3
4
quintiles
16 |
Health System Financing
5
Total
Stages of Coverage and
Organisational Mechanisms
Universal Coverage
•Tax-based financing
Intermediate stages
of coverage
Absence of financial
protection
Out-of-pocket
spending
17 |
Health System Financing
Mixes of community
cooperative and enterprise
based health insurance, other
private health insurance, SHI
type coverage for specific
groups and limited tax based
financing
•Social health
insurance
•Mix of tax-based and
various types of health
insurance
How Long It Takes to Reach
Universal Coverage?
Time (in years)
between first social protection
Costa Rica
20
Republic of
Korea
26
Japan
36
UK
36
Austria
79
Belgium
118
Germany
127
law and universal coverage
18 |
Health System Financing
Summary
1.
Achieving universal coverage takes time, a long-term vision is
important
2.
Revenue collects through equitable and efficient ways
3.
Increase prepayment and reduce out-of-pocket payment
4.
Improve financial risk protection through an appropriate
benefit package
5.
Improve service quality and control cost through a set of
provider payment mechanisms.
19 |
Health System Financing
Thank you for your attention!