Transcript Slide 1
Progress towards universal health-care
coverage in Asia and the Pacific
Fourth Technical Review Meeting of the Health Policy
and Health Finance Knowledge Hub
Nossal Institute, Melbourne, 10-12 October 2011
Marco Roncarati, UNESCAP
ESCAP region
Universal health-care coverage
The financing and provision of health-care services
so that all are covered
Those of all income levels have equal use of services
Individuals and households do not incur
impoverishing expenditure in order to receive a
socially-acceptable minimum level of services
Equity in use in relation to need exists, in the case of
higher income economies
Equality and Equity
Laws are needed to protect those who are
most excluded
Effective policies and programmes need
to be directed to specific groups of people
Hence equity is an issue of fairness
related to need, and needs are not equal
ESCAP Objective:
Inclusive & Sustainable
Development in Asia-Pacific
MDGs
UN Resolutions & Mandates
Building an Inclusive Society for All
Through Social Integration
Persons
with
disabilities
Older
persons
People living
with
HIV/AIDS
Young
people
Equality
Migrants
The poor
Women
Policies, Interventions and Institutional Change
Cross-cutting: gender mainstreaming, rights-based approach, good governance
Social Protection
Formal
Social insurance
Social assistance
Social services
Labour market
policies
Local funds
Informal/traditional
Societal norms & traditions
Community-based
protection
Family-based protection
Empowerment
Advocacy/awareness raising
Education and capacity-development
Economic, legal & political empowerment
measures
Labour market policies
Access to basic services
Networking
ESCAP SDD Conceptual Framework and Thematic Focus
Social Protection, including Health
The recent economic and financial
crisis… vulnerability and the need for
social protection
UN GA resolution 65/1 of 22 Sep. 2010
… united to achieve the MDGs
Heads of State/Government committed
to promoting comprehensive systems
of social protection that provide a
minimum level of social security and
health care for all
Social Protection, including Health, cont.
Social protection should:
Be integrated into broader economic and social strategies to
guarantee all a minimum level of security
Move from interventions addressing symptoms of
vulnerability to systemic transformations eliminating
underlying causes of persistent poverty and inequality
Be accorded political commitment at the highest level
Have policies formulated and implemented by participation
of multiple actors
Social Protection including Health, cont.
It is affordable and achievable
It is an investment with many long-term benefits
It can bring about more equitable and robust
economic growth through:
Greater domestic consumption
Higher levels of human development
Greater shared opportunity
Annual cost of basic social protection package,
selected Asia-Pacific countries (as % of GNI)
What is good governance?
Governance in the health-care
sector, cont.
Enabling conditions
Political stability
Strong institutional and policy
environment
Commitment to equity
Good evidence-based decision making
Strong stakeholder support
Legal approaches to resolve
matters
Many countries have legislation to protect the
most vulnerable
Some have laws or constitutions that entitle
every citizen to benefit from health protection
In some cases anti-discrimination laws exist
In others cash transfers are conditional on
health-care issues related to children and
mothers
However, progress has been relatively slow in
Asia and the Pacific
Health Protection; Proportion of the
Population Covered by Law (%)
Country examples
China
From 1980s, growth (Socialism with Chinese characteristics) led
to dramatic poverty reduction; yet, inequality rose (Western
Regions remain poor)
Rising out-of-pocket medical expenditure led to a decline in
equity and access to health services as well as impoverishment
of families
In 2003, China launched the New Cooperative Medical System
(NCMS); as of 2008, over 90% of the rural population, over 800
million people, had joined NCMS
Urban Resident Basic Medical Insurance was launched in 2007,
targeting mainly urban residents without formal employment
Country examples, cont.
Sri Lanka
Success in MDG achievement and poverty reduction. Emphasis
on physical access to free government health and education
services
High-density but low-cost network of rural facilities
Focus on minimizing price barriers; no user fees in government
facilities, but also active measures to minimize illegal fees
charged by staff (good governance)
Emphasis on risk protection in budget allocations over cost-
effectiveness; thus the poor have a full range of services
instead of a restricted range and this has encouraged public
support and confidence in the system
In sum, effective targeting of the poor with tax subsidised
services
Country examples, cont.
Thailand
Long-term commitment (40 years to UC in 2002) to providing
affordable health-care services to the population, especially
those in greatest need
From providing free health care to the poor, step-by-step,
coverage expanded over the years to the entire population
Within Health Ministry, a long history of reformers and
advocates pushing hard for UC
In the health sector, the building of technical capacity has been
critical in achieving UC, so too have been coalitions, such as
those including the government, civil society and academia
Management is the key to sustainability
Use of Public-Private In-patient
Services by Income Quintile
India
Bangladesh
50
40
Public
Private
30
20
10
Indonesia
60
60
50
50
40
40
30
30
20
20
10
10
0
Q1
Q2
Q3
Q4
0
Q5
0
Q1
Q2
Sri Lanka
Q3
Q4
Q5
Q1
Q2
Malaysia
Q3
Q4
Q5
Q4
Q5
Hong Kong
50
60
50
40
50
40
40
30
30
30
20
20
20
10
10
10
0
0
0
Q1
Q2
Q3
Q4
Q5
Q1
Q2
Q3
Q4
Q5
Q1
Q2
Q3
In conclusion
Redistributive polices (tax, pricing, access to credit)
Political will and good governance
Macroeconomic stabilization
Investments in social protection, including health
Multi-sectoral approaches and stakeholder
involvement
Effective legislation and good data/evidence
Awareness raising and capacity building in health,
related sectors and the public at large
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Thank You