Current challenges in delivering social health insurance in Asia and the Pacific

1. ISSA Meeting of Directors of Social Security Organizations in Asia and the Pacific, Seoul, Republic of Korea, 9-11 October 2005 Current challenges in delivering social health insurance in Asia and the Pacific Dorjsuren Bayarsaikhan Regional Adviser in Health Care Financing WPRO, Manila, Philippines

2. Outline • Increasing need and emphasis • Issues and challenges • Recent and future reforms • Conclusion

3. I. Increasing needs and emphasis All countries need additional financial resources. There is an increasing interest in Social Health Insurance (SHI). SHI is regarded as a reliable funding source for financing and providing a predefined package of health services SHI allows to raise predictable and sustainable revenues in equitable and affordable ways SHI ensures access to needed health services and provides financial protection Thus, SHI affects the main goals of health system financing such as adequacy, sustainability, equity, access, efficiency and protection

4. WHO global and regional policy actions • 57th World Health Assembly (May 2005): • Social health insurance and universal coverage • Regional Committees-SEAR and WPR (Sep 04-05): • Policy briefs for social health insurance • Strategy on health care financing

5. WHO Policy directions To provide large population access to basic health care through prepayment financing arrangement, in particular SHI To increase the capacity to respond efficiently to the rising demand in developing SHI To broaden international collaboration with bilateral and multilateral agencies to support SHI

7. OECD

8. Private out of pocket spending Total HE, % Private HE,% Public HE, % Cambodia India Viet Nam Indonesia China Philippines Sri Lanka Thailand 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 82.9 78.7 70.8 64.0 66.3 60.9 51.3 30.3 17.1 21.3 29.2 36.0 33.7 39.1 48.7 69.7 Source: WHO/NHA 2005

10. Poverty and ill health • Poor people more likely to become sick. • Ill health contributes to poverty: • - loss of earning, and employment • - low chances of productive life • - high financial burden

11. Facts • Medical costs rise far faster than incomes in developing countries, creating heavy burden n individual families. • Out of pocket payment for health care became a major reason for poverty among rural population. • Increasing number of people borrow money or sell family assets to cover cost of health care.

12. Low financial protection The rapid increase in health care expenditure has not been accompanied by a similar trend in financial protection for everyone against health care costs.

14. II. Issues and challenges • Majority of the population in Asia and the Pacific inadequately covered by social safety nets such as SHI. • Few countries achieved near universal SHI coverage. • HI coverage in many developing countries is still low. • Excluded population: • rural and self-employed population • poor and vulnerable • family defendants

15. What does the low coverage mean? • Heavy financial burden on individuals • Undesirable financial barrier in seeking care • Unmet health needs and demand affecting health • Increasing incidence of poverty • Inefficient and ineffective use of resources • Impeding economic and social development

16. Challenges in extending coverage • Socioeconomic factors • Policy consensus and political commitment • Policy and strategy development and plans • Supporting legislation and regulations • Technical and administrative capacity • Health service and system infrastructure

17. Main causes • Low awareness about social health insurance • Lack of political commitment • Limited evidence, data and information • Vested interest versus needs • Weak human resource development and management • Poor coordination among partners

18. III. Recent and future reforms Recent and future reforms aimed to enhance SHI coverage in Asia and the Pacific need to answer: 1. Whether SHI is feasible in low-income developing countries? 2. Whether universal coverage is achievable if labour force has a large informal sector? 3. Whether specific provider payment methods have any impact on increasing coverage?

19. Is SHI is feasible for low-income countries? Regional experiences show that social health insurance is feasible with given policy consensus, political commitment and funding support for the poor and vulnerable. http://www.wpro.who.int/sites/hcf/documents/

20. Is universal coverage achievable ? Regional experiences show that universal coverage is achievable with appropriately developed policy and design that covers both formal and informal sectors through a single or well coordinated multiple schemes, such as cooperative and community based health insurance (Thailand, China, Philippines)

21. Does payment methods have impact on coverage? Regional experience and pilot projects show that provider payment methods such as capitation and case mix payments have some positive impacts on extension of coverage versus fee for service methods. (Mongolia, Lao DPR, Philippines)

22. Important features of successful reform • Political commitment • Affordable premiums • Comprehensive benefits • Family coverage • Risk shared payment such as capitation • Separate administration

23. IV. Conclusion • Stable and equitable health care financing is needed for all countries. • Paying for health care has become an issue for equity, access and family impoverishment. • Problems may seem similar but solutions will be country specific. • Social health insurance is one feasible option. • Challenges in delivering SHI exist but solvable.

24. Regional strategy on health financing To provide operational and practical guidance to the Member States in improving overall health financing arrangements that will • mobilize adequate, and stable revenues • provide effective financial protection, and • ensure equitable access by all, to good quality health services.

25. Sharing experiences in SHI Asia and the Pacific have a wide range of experience on SHI development. Opportunities in sharing these experiences were limited for some reasons, but there is now increasing interest and demand in SHI. In collaboration with MOHW and NHIC of the R.O.Korea, a regional SHI training course was launched in 2004, Seoul. SHI development experience examined in 12 countries in Asia and the Pacific and lessons learnt published in a book.

26. Thank you