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Financing of health services for workers

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Presentation by Adrienne Chattoe-Brown, Lead Specialist- Health Systems and Service Delivery, HLSP, at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

Presentation by Adrienne Chattoe-Brown, Lead Specialist- Health Systems and Service Delivery, HLSP, at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012


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  • 1. Financing of health services for workersAdrienne Chattoe-BrownLead Specialist - Health Systems and Service DeliveryHLSP
  • 2. Introduction • What mechanisms are available to countries and social groups for financingPrivate insurance &user fees health services for workers?Taxation • How can financing mechanisms stimulate the integration of basic services forSocial insurance occupational health in primary healthCommunity based care?insurance
  • 3. Introduction • The principle of integration applies to financing as well as deliveryPrivate insurance &user fees • Vertical funding is an option but thereTaxation are problems:Social insurance – Poor allocation across programmes – Inefficiency and duplicationCommunity basedinsurance – Problems in getting funding for training and operational costs down to service delivery level
  • 4. Five main mechanismsIntroduction • Private health insurancePrivate insurance & • User feesuser fees • TaxationTaxation • Social insuranceSocial insurance • Community based insuranceCommunity basedinsurance
  • 5. Inclusion of OHSIntroduction • Depends on how the mechanism is implementedPrivate insurance &user fees • Effective coverage of OH through PHCTaxation may depend on a cocktail of mechanismsSocial insurance • In reality – different starting pointsCommunity basedinsurance • Which approaches are showing the most promise to stimulate the integration of OSH into PHC?
  • 6. Private health insuranceIntroduction • Can deliver good quality, and choice for beneficiariesPrivate insurance &user fees But . . .Taxation • Little risk poolingSocial insurance • Poor for promotion and preventionCommunity based Suitable for OH?insurance • Expensive • Dependent on insurance premiums
  • 7. User feesIntroduction • Raise revenuePrivate insurance & • Deter inappropriate use of servicesuser fees But . . .Taxation • Barrier to usageSocial insurance • Waivers / exemptions problematicCommunity basedinsurance • Weak at supporting promotion and prevention Suitable for OH? • Likely to exclude poorest
  • 8. TaxationIntroduction • Inexpensive mechanismPrivate insurance & • Progressiveuser fees • Good for prevention and health promotionTaxation But . . . .Social insurance • UnpredictableCommunity basedinsurance • Sometimes regressive Suitable for OHS? • Competition with other demands • Difficult to implement incentives
  • 9. Example: IndonesiaIntroduction • PHC + OSHPrivate insurance & • Integrated delivery through OH Postsuser fees • Co-funded by central and localTaxation governmentSocial insurance • 8,000 OHPs by 2008Community based But . . .insurance • OHS not yet in basic PHC package • Support and financing patchy
  • 10. Social insuranceIntroduction • Risk pooling promotes social solidarity • Clear link between payments and benefitsPrivate insurance &user fees • Can enable universal coverageTaxation • Responsive • Can include promotion and preventionSocial insurance But . . .Community basedinsurance • Usually requires subsidies for poor Suitable for OHS? • May exclude catastrophes • Must be financed from employment
  • 11. Example: Ba’oan, ChinaIntroduction • Cost shared by employer and governmentPrivate insurance & • 3 levels of service provider (district anduser fees below)Taxation • Targeted at workers.Social insurance • Cost effective to provide services in comparison to funding days lostCommunity basedinsurance But . . . • Only covers workers in formal employment • Problems with mobile workforce
  • 12. Community based health insuranceIntroduction • Addresses financing and service provisionPrivate insurance &user fees • Can improve value for moneyTaxation • Can include primary and secondarySocial insurance • Can include promotion and preventionCommunity based But . . .insurance • Dependent on subsidies, community participation and willingness to pay Suitable for OH? • Difficult to scale up
  • 13. Example: SEWA, IndiaIntroduction • Trade union for workersPrivate insurance & • Community based health insuranceuser fees expanded to include occupationalTaxation insuranceSocial insurance • Health workers deliver basic OHS e.g. TB screening for at risk groups,Community basedinsurance outreach to remote workers • Very integrated with PHC
  • 14. www.hlsp.org