Transcript Health System in Small Island Countries

Health System in Small Island
Nations
Challenges and Options
Dr. Shiyan Chao
Health Care Conference
Aruba
June 1-3, 2015
Outline
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• Health System in Small Island Countries
• Economic Analysis of a Health System
• Lessons learned from the Carribbean
• Options for improving health care
The goals of health systems
• The WHO Health System Performance
Framework defines the goals of health
systems as:
– Improving the health of the population they serve
– Responsiveness, i.e., responding to people's
legitimate expectations
– Fair financing, i.e., providing financial protection
against the costs of ill-health.
Responsiveness
• Defined as a measure of how well the health
system responds to the legitimate
expectations of the population
• An increasing challenge for all:
– How to define quality of care
– Necessity for some and luxury for others
– Demand and expectation will increased as aging
population and development of medical
technology.
Fairness in Financing
• Every member of society should pay the same
share of their disposable income to cover their
health costs.
• Universal access and universal coverage –
– On paper
– In reality
General Health Financing Functions and
Objectives
Revenue
collection
• Raise sufficient and
sustainable revenues in an
efficient and equitable
manner
Purchasing
Pooling
• Provide essential
services which
improves health
outcomes and provides
financial protection
and consumer
satisfaction
• Reduce Risks
• Manage these
revenues
equitably and
efficiently
There are Many Ways to Finance a Health System
Revenue
Collection
Public
Taxes
Public Charges/
Resource Sales
Risk
Pooling
Purchasing
Service
Provision
Government
Agency
Social Insurance or
Sickness Funds
Public
Providers
Private Insurance or
Community-based
Organizations
Private
Providers
Mandates
Grants
Private
Loans
Employers
Private
Insurance
Communities
Individuals
And Households
Out-of-Pocket
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Source: World Bank
Common Health Financing Models
• National Health Services System
• Social Health Insurance
• Private Voluntary (mandatory) Health
Insurance
• Community-based health Insurance
• Director purchase by consumers (user fees)
Evolution of Health Financing Systems
Low Income
Countries
Middle Income
Countries
High Income
Countries
Government
Budget/MOH
Priv. insur
Patient
Out-ofPocket
Patient Outof-Pocket
Social Insur
Social Insur
National Health
Service
Mandatory
Health Insurance
Gov’t Budget
Community
Financing
Patient Outof-Pocket
Gov’t Budget
Private
Insurance
Source: Modified from A. Maeda
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Total Health Spending as a
Share of GDP Relative to Income
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15
TOTAL HEALTH SPENDING VS INCOME
Colombia
Viet Nam
5
Ky rgy zstan
Costa Rica
Tunisia
Chile
Estonia
Sri Lanka
0
Thailand
100
250
1000
10000
25000
GDP per capita (current US$, log s cale)
Source: World Dev elopment Indicators, WHO 2007
Note: GDP per capita in current US$; Log scale
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Government expenditure on health (including external
financing) already major part of government expenditure
Source: World Development Indicators (2014)
Focusing on resources allocation and
purchasing
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For whom to buy
What to buy
From whom
How to pay
At what price
Implications to small nations
Common Vulnerabilities in Small Economy
• Susceptibility to nature disasters and
climate change
• Economies vulnerable to exogenous
shocks
• Economically less diversified
• Often rely on import of basic goods
and supplies
Challenges in providing health services
with in a Small Nation
(less than 2 million population)
• Limited infrastructure for providing all services
needed
• It is not economically and technically viable to
provide all services needed
• Limited human resources to provide all
services needed
• Brain drain in health work force
• Limited capacity in administration,
management and research for efficiency gains
Lessons Learned from the World
Bank’s Operations in the Caribbean
• Individual country development vs. regional
development
• Collaboration in infrastructure planning
• Collaboration in sharing technical expertise
• Sharing financing mechanisms (?)
• Innovations in sharing and utilization
resources (some examples)
Priorities in Health Care
• Easy access to quality care
• Quality of health care: advanced technology
equipment, skilled health professionals
• Equitable coverage
• Choices of care
• Risk sharing and protection
• Sustainability
Future health care in small island
nations will be expensive
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Island populations are increasingly heavier;
NCDs are growing
Populations are aging
Financing resources are not necessarily
predictable
• Unmet expectations can be high
Institute for Health Metrics and Evaluation, Human Development Network, The World Bank. The Global Burden of Disease: Generating Evidence, Guiding Policy –
Latin America and Caribbean Regional Edition. Seattle, WA: IHME, 2013
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Changing of Burden of Diseases
in Latin America and the Caribbean
1. In 1990 Diarrheal
Diseases ranked No. 1
and in 2010, it ranks
No. 20.
2. In 1990 Forces of
nature ranked No. 174
and in 2010, it ranks
No. 2
Top 5 burden of diseases
In 2010
1. Heat diseases
2. Forces of Nature
3. Violence
4. Road injury
5. Major depressive
disorder
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An example of understanding burden of diseases
Diabetes a particularly severe problem
Source: WDI, 2014
Treating NCD is Costly
Two Priorities for Dutch Caribbean
Health Systems
• Improve efficiency (quality
results with lower costs)
• Contain Costs (managing
increased demand with in
resources available)
Options for efficiency improvement
• Managed care model:
– controlled and limited choices of service providers
– Referral system
– Managed competition
• Strategic purchasing
– Provider payment methods: per case, DRGs
– Defined benefit packages
On cost control
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Knowing the costs and efficiency
improving prevention efforts
Strengthening primary health care
Developing self-management programs –keeping
patients out of hospitals
• Developing new approaches
Possible Future development
• Tele-medicine,
Telementoring,
Telesurgery;
Telepsychiatry;
Telenursing,
Telepaediatrics;
Home Health
• Medical Tourism: Can your
country take a share?
The global medical tourism industry is growing by 2023% annually
(in US$ Billion)
140
120
100
80
60
40
20
0
2004
2006
2010
2012
2015
“Medical Practice in the Caribbean will be
marginalized in the medium term as
competition now involves e—health solutions
overseas such as online pharmacies, therapies
…”
Professor Davidson Head of School of Public
Health and Health Technology in Jamaica
Key Messages
• More resources do not necessarily produce
desired health results
• New direction for cost-effective care:
– Patients play a central role in health management
– Take advantages of the communication and
technology advancement
• Improving sustainability requires do more
with less, seeking for better solutions at lower
costs
Thank You!
[email protected]