SlideShare a Scribd company logo
1 of 30
UNIVERSAL HEALTH COVERAGE:
THE HOLY GRAIL?
Professor Anne Mills
London School of Hygiene and Tropical Medicine
Office of Health Economics Annual Lecture
London • 9 June 2014
Improving health worldwide
www.lshtm.ac.uk
Growth in development assistance for health
(data from IHME)
Year
Billionsof2010USdollars
*2011 and 2012 are preliminary estimates
Year
Billionsof2010USdollars
Disease focus of development assistance for health
(data from IHME)
Neglect of health system infrastructure
• Recognition that selective support has
hampered achievement of long term health
gains: eg
– Competition for health workers and for health
workers’ and managers’ time
– Lack of support for cross-cutting systems issues –
eg primary care and district infrastructure; general
training programmes; drug supply systems
– Lack of attention to long term development of
sustainable financing system
Per capita expenditure, 2011
Indicator /
Income Group
Per capita
total health
expenditure
(US$)
Per capita
government
health
expenditure
(US$)
Per capita
private health
expenditure
(US$)
Out-of-pocket
as % private
health
expenditure
Low-income 31 12 19 76.8
Lower-middle income 80 29 51 87.1
Upper-middle income 417 230 187 72.0
High-income 4575 2811 1764 36.4
Global 1011 604 407 44.6
PPP: Purchasing Power Parity
Source: WHO Global Health Expenditure Atlas. Geneva: WHO. Available at: http://www.who.int/nha/atlas.pdf
accessed 24/01/14
Significance of out-of-pocket payment: rural
South Africa(Goudge et al 2009)
• Poor rural area in South Africa with free public
primary care and hospital fee exemptions for poor
• Survey of 280 households (1446 individuals)
• 70% of households had one or more members with
health problem
• On average, households paying for health care spent
4.5% of monthly household expenditure
• 20% of households spent more than 10%
• 15% of households spent more than 15%
The goal of universal health coverage
• Growing momentum behind universal health
coverage as a key global goal
– World Health Report 2010 on universal coverage of health
care
– Declaration of the World Health Assembly urged member
states to ‘aim for affordable universal coverage and access
for all citizens on the basis of equity and solidarity’
– 2012 declaration by UN General Assembly
– Strong lobby to have universal health coverage as goal in
post 2015 MDGs: endorsed by WHO DG at 2014 WHA
Key issues
• What does universal coverage mean in
low/middle income country context?
• What can be learnt from the experiences
of countries tackling the key challenges in
making progress towards universal health
coverage?
• What are priorities for countries on the
path towards universal coverage?
The health system
B
PROVIDERS OF
SERVICES
GOVERNMENT/
PROFESSIONAL
BODY
A
POPULATION/
PATIENTS
C
FINANCIAL
INTERMEDIARIES
DIRECT PAYMENTS
HEALTH SERVICES
INSURANCE
COVERAGE
MONEY
(TAXES OR
PREMIUMS)
REGULATION
REGULATIONCLAIMS
MONEY
PAYMENT
(FEES, GLOBAL
BUDGET)
What is universal health coverage?
• ‘ensuring that all people can use the promotive, preventive,
curative, rehabilitative and palliative health services they need,
of sufficient quality to be effective, while also ensuring that the
use of these services does not expose the user to financial
hardship’ (WHO)
• Ie three related objectives:
– Equity in access to health services – those who need the services
should get them, not only those who can pay for them
– Sufficient quality of health services – enough to improve the health of
those receiving services
– Financial-risk protection – the cost of using care should not put people
at risk of financial hardship.
Key components of a system of
universal coverage
1. Sources of finance
2. Financial intermediaries
3. Service providers
The health system
B
PROVIDERS OF
SERVICES
GOVERNMENT/
PROFESSIONAL
BODY
A
POPULATION/
PATIENTS
C
FINANCIAL
INTERMEDIARIES
DIRECT PAYMENTS
HEALTH SERVICES
INSURANCE
COVERAGE
MONEY
(TAXES OR
PREMIUMS)
REGULATION
REGULATIONCLAIMS
MONEY
PAYMENT
(FEES, GLOBAL
BUDGET)
Sources of finance
• Mix of sources common:
• General tax, payroll tax, other earmarked tax
(Philippines, Thailand, Ghana)
• Plus Medical Savings Accounts (Singapore, China)
• Plus voluntary contributions, copayments (Korea,
China, Philippines, Ghana)
• Core mandatory financing mechanism needed: social
health insurance and/or general tax revenues
Sources of finance
• Population in formal (employed) sector
(public and private) relatively easy to cover
• Social health insurance usually the chosen
main route
• Challenges are:
– Low income workers and self employed in
informal sector
– Those outside the workforce: young, old,
disabled, and unemployed
Extending financial protection
to the informal sector
• Via compulsory social health insurance
• Social insurance scheme cross-subsidises low income worker
premiums (Mexico)
• Public funds subsidise compulsory health insurance premiums
(all Thailand; targeted Korea, Singapore)
• Premiums kept low by continuing some supply side subsidies
(Colombia scheme for poor households)
• Via ‘voluntary’ insurance schemes (Ghana, Rwanda,
Philippines, Thailand, China) eg through partial or full
subsidies for premiums from tax funding
• Via universal entitlement and general tax funding to
health services (Thailand)
Extending financial protection to
non-working population
• Dependants (elderly, children) covered
within compulsory social insurance
schemes
• General tax used to pay for insurance card
for poorest and sometimes elderly
(Rwanda, Ghana, India – RSBY)
• Via universal entitlement and general tax
funding to health services
Role of co-payments
• Permits contribution rate to be set
at a level that is affordable and/or
acceptable (Korea, Philippines)
• May help to constrain demand in
the early (or later) years of
extension of coverage (Korea,
Philippines)
• May be symbol of family
responsibilities (Korea, Singapore)
• But regressive – weighs most
heavily on poorer groups – and
discourages use
Kakwani
indices for
financing
sources
Tanzania,
South
Africa,
Ghana
(Mills et al 2012)
Financial intermediaries
• Historical legacy of segmented funds: should
aim be single payer system? (Korea merged;
Thailand not yet)
• Public or private agencies?
• One or more public bodies (traditional for social
health insurance)
• Government regulates competing private insurers
within social health insurance arrangements (eg
Colombia, discussed in South Africa)
• Government contracts with insurance companies
to manage schemes (eg RSBY in India)
Rashtriya Swasthya Bima Yojana (RSBY)
• Targeted at families below the poverty line
• Premium of max Rs750 (£7.50) per family: shared
75%/25% by central/local government; beneficiary
family pays Rs 30 pa for registration
• Insurance companies bid for contract to insure
families in each district
• Hospitalisation benefits up to ceiling of Rs 30,000
per family pa (max of 5 beneficiaries per family)
• Insurance company contracts a third party
administrator to manage the smart card system
• Currently 31m active smart cards (families)
Service providers
• Public only or public and private? (Thailand SHI, India
RSBY)
• Benefit package?
• List what is included (eg RSBY) or excluded (eg Thailand)?
• Ensuring continuum across primary and hospital care problematic
• Payment method (avoid fee for service unless within
strong global budget)
• Encourage strong primary care role:
• Primary care gatekeeper (Korea)
• Bypass fees (Thailand)
• Primary care budget holder (Thailand, sort of)
• Extend services first to poorer areas (eg Brazil Family
Health Programme)
Development of Thai health system from 1970s
(Balabanova et al 2013)
Thai universal health coverage arrangements
• Universal coverage via 3 schemes:
– Social health insurance for formal sector employees (with
public subsidy)
– Non-contributory scheme (so, tax funded) for civil servants
– Universal coverage scheme (from 2001) for rest of
population, general-tax funded
• Gradual progress in harmonising benefit package,
payment methods, service provision arrangements
• Performance:
– Relatively equitable: pro poor benefits; financing becoming
less regressive; reduction in catastrophic payments
– Inequities remain between schemes in benefit package and
level of expenditure
– Good cost containment in SHI and UC
0.050
0.075
0.100
0.125
0.150
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2003 2004 2005 2006 2007 2008 2009 2010
OPvisitsperyear
Year
Outpatient visits
inpatient addmissions
IPadmissionspercapitaperyear
-0.50
-0.40
-0.30
-0.20
-0.10
0.00
0.10
0.20
0.30
0.40
0.50
2001
2003
2004
2005
Health Centre District Provincial Private Overall
Hospital Hospital Hospital
Pro-poorPro-rich
Catastrophic health expenditure refers to household spending on health care >10%
of total household consumption expenditure
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
1996 1998 2000 2002 2004 2006 2007 2008 2009
Year
Q1 (Poorest) Q5 (Richest) All
%ofhouseholdsineachquintile
Incurringcatastrophichealthexpenditure
%
6.8%
2.9%
6.1% 4.7%
Performance concerns with UHC
• Concern about rising costs: increased
utilisation, expansion of benefit package (eg
renal dialysis in Thailand)
• Lack of evidence on link between increased
coverage and health outcomes
• Lack of evidence on relationship of
performance to numerous design options
• What is best way to make progress in low
income countries?
Learning lessons to apply elsewhere
• ‘Technical’ assessment – evaluation of performance
and explaining it by reference to design features
• Performance criteria, eg
– Efficiency (allocative, technical)
– Equity of financing (who pays?)
– Equity of access to care (who benefits?)
– Extent of catastrophic payments
– Responsiveness
• ‘Institutional’ assessment: what political, economic,
social and cultural institutions enable governments to
pursue universal health coverage?
Key institutional aspects
• Existence of a civil service which has the capability to
implement programmes and policies: eg merit based
recruitment, tenure in office not linked to personal or political
patron, hierarchical structures with impersonal application of
rules
• Existence of institutions which allow the voice of the less-well-
off to be expressed in policy debates and decisions
• Relative importance of exercise of ‘voice’ and ‘exit’ as influence
on performance (do the richer groups work inside the system
to improve it or exit to private sector?)
• Whether there is the social solidarity needed for merger of
funds and universalist approaches (eg South Africa)
Trajectory and priorities
• Universal health coverage is process over time, not a
fixed point that can be achieved
• Critical to put the necessary elements in place early:
– Combination of financing sources
– Strong purchasing role encompassing both public and
private providers and including emphasis on health
promotion and prevention
– Payment systems with appropriate incentives for cost
containment and quality of care
– Strong primary care and ‘district’ level infrastructure with
good geographical access

More Related Content

What's hot

INDIA : TOWARDS UNIVERSAL HEALTH COVERAGE
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGEINDIA : TOWARDS UNIVERSAL HEALTH COVERAGE
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGEDevesh Shukla
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverageAsmaa Ghanem
 
Universal Healthcare - Dr. Srinath Reddy Report to Planning Commision
Universal Healthcare -  Dr. Srinath Reddy Report to Planning CommisionUniversal Healthcare -  Dr. Srinath Reddy Report to Planning Commision
Universal Healthcare - Dr. Srinath Reddy Report to Planning CommisionAnup Soans
 
Universal health coverage concept and vision for india
Universal health coverage   concept and vision for indiaUniversal health coverage   concept and vision for india
Universal health coverage concept and vision for indiaVikash Keshri
 
Health financing strategies uhc 27 09 12
Health financing strategies   uhc 27 09 12Health financing strategies   uhc 27 09 12
Health financing strategies uhc 27 09 12Vikash Keshri
 
Researching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health CoverageResearching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health Coverageresyst
 
Universal health coverage final
Universal health coverage finalUniversal health coverage final
Universal health coverage finalSnehlata Parashar
 
Universal Health Care: Perceptions, Values, and Issues
Universal Health Care: Perceptions, Values, and IssuesUniversal Health Care: Perceptions, Values, and Issues
Universal Health Care: Perceptions, Values, and IssuesRenzo Guinto
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverageAkshay Minhas
 
Universal Health Coverage
Universal Health Coverage Universal Health Coverage
Universal Health Coverage sourav goswami
 
Universal Health Coverage and Health Insurance - India
Universal Health Coverage and Health Insurance - IndiaUniversal Health Coverage and Health Insurance - India
Universal Health Coverage and Health Insurance - IndiaDr Chetan C P
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverageVineetha K
 
Universal Health Care - the Philippine journey towards accessing quality heal...
Universal Health Care - the Philippine journey towards accessing quality heal...Universal Health Care - the Philippine journey towards accessing quality heal...
Universal Health Care - the Philippine journey towards accessing quality heal...Albert Domingo
 
Where is Nigeria on Universal Health Coverage (UHC)?
Where is Nigeria on Universal Health Coverage (UHC)?Where is Nigeria on Universal Health Coverage (UHC)?
Where is Nigeria on Universal Health Coverage (UHC)?HFG Project
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverageIla Singh
 
Universal Health Coverage
Universal Health CoverageUniversal Health Coverage
Universal Health CoverageNursing Path
 

What's hot (20)

INDIA : TOWARDS UNIVERSAL HEALTH COVERAGE
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGEINDIA : TOWARDS UNIVERSAL HEALTH COVERAGE
INDIA : TOWARDS UNIVERSAL HEALTH COVERAGE
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Universal Health Care (UHC) and the right to health
Universal Health Care (UHC) and the right to healthUniversal Health Care (UHC) and the right to health
Universal Health Care (UHC) and the right to health
 
Universal Healthcare - Dr. Srinath Reddy Report to Planning Commision
Universal Healthcare -  Dr. Srinath Reddy Report to Planning CommisionUniversal Healthcare -  Dr. Srinath Reddy Report to Planning Commision
Universal Healthcare - Dr. Srinath Reddy Report to Planning Commision
 
Universal health coverage concept and vision for india
Universal health coverage   concept and vision for indiaUniversal health coverage   concept and vision for india
Universal health coverage concept and vision for india
 
Health financing strategies uhc 27 09 12
Health financing strategies   uhc 27 09 12Health financing strategies   uhc 27 09 12
Health financing strategies uhc 27 09 12
 
Researching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health CoverageResearching Purchasing to achieve the promise of Universal Health Coverage
Researching Purchasing to achieve the promise of Universal Health Coverage
 
Universal health coverage final
Universal health coverage finalUniversal health coverage final
Universal health coverage final
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Universal health care
Universal health care Universal health care
Universal health care
 
Universal Health Care: Perceptions, Values, and Issues
Universal Health Care: Perceptions, Values, and IssuesUniversal Health Care: Perceptions, Values, and Issues
Universal Health Care: Perceptions, Values, and Issues
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Universal Health Coverage
Universal Health Coverage Universal Health Coverage
Universal Health Coverage
 
Universal Health Coverage and Health Insurance - India
Universal Health Coverage and Health Insurance - IndiaUniversal Health Coverage and Health Insurance - India
Universal Health Coverage and Health Insurance - India
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Universal Health Care - the Philippine journey towards accessing quality heal...
Universal Health Care - the Philippine journey towards accessing quality heal...Universal Health Care - the Philippine journey towards accessing quality heal...
Universal Health Care - the Philippine journey towards accessing quality heal...
 
Universal Health Care
Universal Health CareUniversal Health Care
Universal Health Care
 
Where is Nigeria on Universal Health Coverage (UHC)?
Where is Nigeria on Universal Health Coverage (UHC)?Where is Nigeria on Universal Health Coverage (UHC)?
Where is Nigeria on Universal Health Coverage (UHC)?
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Universal Health Coverage
Universal Health CoverageUniversal Health Coverage
Universal Health Coverage
 

Viewers also liked

Chapter 2 Identifying a Research Problem
Chapter 2 Identifying a Research ProblemChapter 2 Identifying a Research Problem
Chapter 2 Identifying a Research ProblemJairo Gomez
 
Chapter 13 national health information system
Chapter 13 national health information systemChapter 13 national health information system
Chapter 13 national health information systemnaranbatn
 
Integrating Financing Schemes to Achieve Universal Coverage in Thailand: Anal...
Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...
Integrating Financing Schemes to Achieve Universal Coverage in Thailand: Anal...CREHS
 
Healthcare sector in India
Healthcare sector in IndiaHealthcare sector in India
Healthcare sector in IndiaGoI Monitor
 
UHealth in Korea for Health and Wellness by Jongtae Park
UHealth in Korea for Health and Wellness by Jongtae ParkUHealth in Korea for Health and Wellness by Jongtae Park
UHealth in Korea for Health and Wellness by Jongtae Park3GDR
 
Lecture1 Basic Economic Concepts (1)
Lecture1  Basic Economic Concepts (1)Lecture1  Basic Economic Concepts (1)
Lecture1 Basic Economic Concepts (1)katerinamailru
 
Time to Manage | How to Manage Your Time Instead of Letting it Managing You
Time to Manage | How to Manage Your Time Instead of Letting it Managing YouTime to Manage | How to Manage Your Time Instead of Letting it Managing You
Time to Manage | How to Manage Your Time Instead of Letting it Managing YouChandler Warrick
 

Viewers also liked (10)

Recognising the need for whole system change: Towards PHC renewal and univers...
Recognising the need for whole system change: Towards PHC renewal and univers...Recognising the need for whole system change: Towards PHC renewal and univers...
Recognising the need for whole system change: Towards PHC renewal and univers...
 
Chapter 2 Identifying a Research Problem
Chapter 2 Identifying a Research ProblemChapter 2 Identifying a Research Problem
Chapter 2 Identifying a Research Problem
 
Chapter 13 national health information system
Chapter 13 national health information systemChapter 13 national health information system
Chapter 13 national health information system
 
Integrating Financing Schemes to Achieve Universal Coverage in Thailand: Anal...
Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...Integrating Financing Schemes to Achieve Universal Coverage in Thailand:Anal...
Integrating Financing Schemes to Achieve Universal Coverage in Thailand: Anal...
 
Healthcare sector in India
Healthcare sector in IndiaHealthcare sector in India
Healthcare sector in India
 
[Public Lecture Slides] Jennifer Friedman: Health care in Japan's aged society
[Public Lecture Slides] Jennifer Friedman: Health care in Japan's aged society[Public Lecture Slides] Jennifer Friedman: Health care in Japan's aged society
[Public Lecture Slides] Jennifer Friedman: Health care in Japan's aged society
 
UHealth in Korea for Health and Wellness by Jongtae Park
UHealth in Korea for Health and Wellness by Jongtae ParkUHealth in Korea for Health and Wellness by Jongtae Park
UHealth in Korea for Health and Wellness by Jongtae Park
 
Lecture1 Basic Economic Concepts (1)
Lecture1  Basic Economic Concepts (1)Lecture1  Basic Economic Concepts (1)
Lecture1 Basic Economic Concepts (1)
 
Time to Manage | How to Manage Your Time Instead of Letting it Managing You
Time to Manage | How to Manage Your Time Instead of Letting it Managing YouTime to Manage | How to Manage Your Time Instead of Letting it Managing You
Time to Manage | How to Manage Your Time Instead of Letting it Managing You
 
Types of Research
Types of ResearchTypes of Research
Types of Research
 

Similar to Universal Health Coverage: The Holy Grail?

Solution to unlock financial opportunities in sierra leone ida psw
Solution to unlock financial opportunities in sierra leone ida pswSolution to unlock financial opportunities in sierra leone ida psw
Solution to unlock financial opportunities in sierra leone ida pswPeter Kamunyo
 
Health_Care_Financing.pptx
Health_Care_Financing.pptxHealth_Care_Financing.pptx
Health_Care_Financing.pptxRanjit90
 
Health system and financing
Health system and financingHealth system and financing
Health system and financingAnkita Kunwar
 
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMY
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMYProgress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMY
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMYachapkenya
 
Health carefinancing2010 common module phd 26 feb
Health carefinancing2010 common module phd 26 febHealth carefinancing2010 common module phd 26 feb
Health carefinancing2010 common module phd 26 febThurein Naywinaung
 
health services.pptx ecology and health care
health services.pptx ecology and health carehealth services.pptx ecology and health care
health services.pptx ecology and health careSumaiyaJabin5
 
Financing_Kenya-1.pptx
Financing_Kenya-1.pptxFinancing_Kenya-1.pptx
Financing_Kenya-1.pptxboscokiuria
 
Health care financing
Health care financingHealth care financing
Health care financingdev224224
 
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...The Devil is in the Details: Designing and Implementing UHC Policies that Rea...
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...HFG Project
 
Week 3 - Fiscal Sustainability of Ontario's Health Care System
Week 3 - Fiscal Sustainability of Ontario's Health Care SystemWeek 3 - Fiscal Sustainability of Ontario's Health Care System
Week 3 - Fiscal Sustainability of Ontario's Health Care SystemAlexandre Mayer
 
Health system development & National health policy
Health system development & National health policyHealth system development & National health policy
Health system development & National health policyAccra School of Hygiene
 
pdf_20221007_125356_0000.pdf
pdf_20221007_125356_0000.pdfpdf_20221007_125356_0000.pdf
pdf_20221007_125356_0000.pdfZeyneptatl
 
HEALTHCARE FINANCING lecture.pptx
HEALTHCARE FINANCING lecture.pptxHEALTHCARE FINANCING lecture.pptx
HEALTHCARE FINANCING lecture.pptxFeniksRetails
 
Chapter 3 - Managing Healthcare in Singapore
Chapter 3 - Managing Healthcare in SingaporeChapter 3 - Managing Healthcare in Singapore
Chapter 3 - Managing Healthcare in SingaporeGoh Bang Rui
 
Week 4 - Fiscal Sustainability & Interprofessional Collaboration
Week 4 - Fiscal Sustainability & Interprofessional Collaboration Week 4 - Fiscal Sustainability & Interprofessional Collaboration
Week 4 - Fiscal Sustainability & Interprofessional Collaboration Alexandre Mayer
 
1362574283 economic burden dm sl
1362574283 economic burden dm sl1362574283 economic burden dm sl
1362574283 economic burden dm sldfsimedia
 

Similar to Universal Health Coverage: The Holy Grail? (20)

Solution to unlock financial opportunities in sierra leone ida psw
Solution to unlock financial opportunities in sierra leone ida pswSolution to unlock financial opportunities in sierra leone ida psw
Solution to unlock financial opportunities in sierra leone ida psw
 
Health_Care_Financing.pptx
Health_Care_Financing.pptxHealth_Care_Financing.pptx
Health_Care_Financing.pptx
 
Health system and financing
Health system and financingHealth system and financing
Health system and financing
 
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMY
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMYProgress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMY
Progress towards universal health coverage in Ethiopia, Dr Girma Borishie, EECMY
 
Health carefinancing2010 common module phd 26 feb
Health carefinancing2010 common module phd 26 febHealth carefinancing2010 common module phd 26 feb
Health carefinancing2010 common module phd 26 feb
 
health services.pptx ecology and health care
health services.pptx ecology and health carehealth services.pptx ecology and health care
health services.pptx ecology and health care
 
Financing_Kenya-1.pptx
Financing_Kenya-1.pptxFinancing_Kenya-1.pptx
Financing_Kenya-1.pptx
 
Health care financing
Health care financingHealth care financing
Health care financing
 
3.4.1 dr gwendolyn gray
3.4.1 dr gwendolyn gray3.4.1 dr gwendolyn gray
3.4.1 dr gwendolyn gray
 
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...The Devil is in the Details: Designing and Implementing UHC Policies that Rea...
The Devil is in the Details: Designing and Implementing UHC Policies that Rea...
 
Week 3 - Fiscal Sustainability of Ontario's Health Care System
Week 3 - Fiscal Sustainability of Ontario's Health Care SystemWeek 3 - Fiscal Sustainability of Ontario's Health Care System
Week 3 - Fiscal Sustainability of Ontario's Health Care System
 
UHC lesson learn Thailand
UHC lesson learn ThailandUHC lesson learn Thailand
UHC lesson learn Thailand
 
Health system development & National health policy
Health system development & National health policyHealth system development & National health policy
Health system development & National health policy
 
20150428 LTCI scheme
20150428 LTCI scheme 20150428 LTCI scheme
20150428 LTCI scheme
 
pdf_20221007_125356_0000.pdf
pdf_20221007_125356_0000.pdfpdf_20221007_125356_0000.pdf
pdf_20221007_125356_0000.pdf
 
Health Insurance in Nepal
Health Insurance in NepalHealth Insurance in Nepal
Health Insurance in Nepal
 
HEALTHCARE FINANCING lecture.pptx
HEALTHCARE FINANCING lecture.pptxHEALTHCARE FINANCING lecture.pptx
HEALTHCARE FINANCING lecture.pptx
 
Chapter 3 - Managing Healthcare in Singapore
Chapter 3 - Managing Healthcare in SingaporeChapter 3 - Managing Healthcare in Singapore
Chapter 3 - Managing Healthcare in Singapore
 
Week 4 - Fiscal Sustainability & Interprofessional Collaboration
Week 4 - Fiscal Sustainability & Interprofessional Collaboration Week 4 - Fiscal Sustainability & Interprofessional Collaboration
Week 4 - Fiscal Sustainability & Interprofessional Collaboration
 
1362574283 economic burden dm sl
1362574283 economic burden dm sl1362574283 economic burden dm sl
1362574283 economic burden dm sl
 

More from Office of Health Economics

OHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
OHE presents at G20 AMR-R&D meeting in Paris - Adrian TowseOHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
OHE presents at G20 AMR-R&D meeting in Paris - Adrian TowseOffice of Health Economics
 
Pricing in emerging markets: options to get value for money - Adrian Towse
Pricing in emerging markets: options to get value for money - Adrian TowsePricing in emerging markets: options to get value for money - Adrian Towse
Pricing in emerging markets: options to get value for money - Adrian TowseOffice of Health Economics
 
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...
% GDP spending in UK, G5 countries and OECD upper middle income countries.  W...% GDP spending in UK, G5 countries and OECD upper middle income countries.  W...
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...Office of Health Economics
 
The role of real world data and evidence in building a sustainable & efficien...
The role of real world data and evidence in building a sustainable & efficien...The role of real world data and evidence in building a sustainable & efficien...
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
 
ISPOR Education Symposium- Go where the money is
ISPOR Education Symposium- Go where the money isISPOR Education Symposium- Go where the money is
ISPOR Education Symposium- Go where the money isOffice of Health Economics
 
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Office of Health Economics
 
IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?
 IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY? IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?
IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?Office of Health Economics
 
Understanding what aspects of health and quality of life are important to people
Understanding what aspects of health and quality of life are important to peopleUnderstanding what aspects of health and quality of life are important to people
Understanding what aspects of health and quality of life are important to peopleOffice of Health Economics
 
Novel approaches for valuing health at the end of life
Novel approaches for valuing health at the end of lifeNovel approaches for valuing health at the end of life
Novel approaches for valuing health at the end of lifeOffice of Health Economics
 
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Office of Health Economics
 
HTA and payment mechanisms for new drugs to tackle AMR
HTA and payment mechanisms for new drugs to tackle AMRHTA and payment mechanisms for new drugs to tackle AMR
HTA and payment mechanisms for new drugs to tackle AMROffice of Health Economics
 
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Office of Health Economics
 
Pay for Performance for Specialised Care in England
Pay for Performance for Specialised Care in EnglandPay for Performance for Specialised Care in England
Pay for Performance for Specialised Care in EnglandOffice of Health Economics
 
Real option value drugs: is it really an option?
Real option value drugs: is it really an option?Real option value drugs: is it really an option?
Real option value drugs: is it really an option?Office of Health Economics
 
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
 

More from Office of Health Economics (20)

Annual lecture
Annual lecture Annual lecture
Annual lecture
 
Devlin ispor 2020 issues panel 20.05.20
Devlin ispor 2020 issues panel 20.05.20 Devlin ispor 2020 issues panel 20.05.20
Devlin ispor 2020 issues panel 20.05.20
 
Towse 2020 antimicrobials melbourne final
Towse 2020 antimicrobials melbourne finalTowse 2020 antimicrobials melbourne final
Towse 2020 antimicrobials melbourne final
 
Towse cgd price transparency seminar
Towse cgd price transparency seminarTowse cgd price transparency seminar
Towse cgd price transparency seminar
 
OHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
OHE presents at G20 AMR-R&D meeting in Paris - Adrian TowseOHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
OHE presents at G20 AMR-R&D meeting in Paris - Adrian Towse
 
Pricing in emerging markets: options to get value for money - Adrian Towse
Pricing in emerging markets: options to get value for money - Adrian TowsePricing in emerging markets: options to get value for money - Adrian Towse
Pricing in emerging markets: options to get value for money - Adrian Towse
 
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...
% GDP spending in UK, G5 countries and OECD upper middle income countries.  W...% GDP spending in UK, G5 countries and OECD upper middle income countries.  W...
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...
 
The role of real world data and evidence in building a sustainable & efficien...
The role of real world data and evidence in building a sustainable & efficien...The role of real world data and evidence in building a sustainable & efficien...
The role of real world data and evidence in building a sustainable & efficien...
 
ISPOR Education Symposium- Go where the money is
ISPOR Education Symposium- Go where the money isISPOR Education Symposium- Go where the money is
ISPOR Education Symposium- Go where the money is
 
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...
 
IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?
 IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY? IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?
IS INDICATION BASED PRICING FEASIBLE AND/OR BENEFICIAL FOR SOCIETY?
 
Ispor 2019 poster - Patricia Cubi-Molla
Ispor 2019 poster - Patricia Cubi-MollaIspor 2019 poster - Patricia Cubi-Molla
Ispor 2019 poster - Patricia Cubi-Molla
 
Understanding what aspects of health and quality of life are important to people
Understanding what aspects of health and quality of life are important to peopleUnderstanding what aspects of health and quality of life are important to people
Understanding what aspects of health and quality of life are important to people
 
Novel approaches for valuing health at the end of life
Novel approaches for valuing health at the end of lifeNovel approaches for valuing health at the end of life
Novel approaches for valuing health at the end of life
 
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...
 
HTA and payment mechanisms for new drugs to tackle AMR
HTA and payment mechanisms for new drugs to tackle AMRHTA and payment mechanisms for new drugs to tackle AMR
HTA and payment mechanisms for new drugs to tackle AMR
 
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...
 
Pay for Performance for Specialised Care in England
Pay for Performance for Specialised Care in EnglandPay for Performance for Specialised Care in England
Pay for Performance for Specialised Care in England
 
Real option value drugs: is it really an option?
Real option value drugs: is it really an option?Real option value drugs: is it really an option?
Real option value drugs: is it really an option?
 
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...
 

Recently uploaded

Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...rajnisinghkjn
 
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Me
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near MeCall Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Me
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Menarwatsonia7
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Mohamed Rizk Khodair
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...saminamagar
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Timevijaych2041
 
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...narwatsonia7
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Modelssonalikaur4
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingNehru place Escorts
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxDr. Dheeraj Kumar
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersnarwatsonia7
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowNehru place Escorts
 

Recently uploaded (20)

Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...
Noida Sector 135 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few C...
 
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Me
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near MeCall Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Me
Call Girls Service in Budigere - 7001305949 | 24x7 Service Available Near Me
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
call girls in Dwarka Sector 21 Metro DELHI 🔝 >༒9540349809 🔝 genuine Escort Se...
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
 
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
 
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking ModelsMumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
Mumbai Call Girls Service 9910780858 Real Russian Girls Looking Models
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
 
Epilepsy
EpilepsyEpilepsy
Epilepsy
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
 
Measurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptxMeasurement of Radiation and Dosimetric Procedure.pptx
Measurement of Radiation and Dosimetric Procedure.pptx
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 

Universal Health Coverage: The Holy Grail?

  • 1. UNIVERSAL HEALTH COVERAGE: THE HOLY GRAIL? Professor Anne Mills London School of Hygiene and Tropical Medicine Office of Health Economics Annual Lecture London • 9 June 2014 Improving health worldwide www.lshtm.ac.uk
  • 2. Growth in development assistance for health (data from IHME) Year Billionsof2010USdollars *2011 and 2012 are preliminary estimates
  • 3. Year Billionsof2010USdollars Disease focus of development assistance for health (data from IHME)
  • 4. Neglect of health system infrastructure • Recognition that selective support has hampered achievement of long term health gains: eg – Competition for health workers and for health workers’ and managers’ time – Lack of support for cross-cutting systems issues – eg primary care and district infrastructure; general training programmes; drug supply systems – Lack of attention to long term development of sustainable financing system
  • 5. Per capita expenditure, 2011 Indicator / Income Group Per capita total health expenditure (US$) Per capita government health expenditure (US$) Per capita private health expenditure (US$) Out-of-pocket as % private health expenditure Low-income 31 12 19 76.8 Lower-middle income 80 29 51 87.1 Upper-middle income 417 230 187 72.0 High-income 4575 2811 1764 36.4 Global 1011 604 407 44.6 PPP: Purchasing Power Parity Source: WHO Global Health Expenditure Atlas. Geneva: WHO. Available at: http://www.who.int/nha/atlas.pdf accessed 24/01/14
  • 6. Significance of out-of-pocket payment: rural South Africa(Goudge et al 2009) • Poor rural area in South Africa with free public primary care and hospital fee exemptions for poor • Survey of 280 households (1446 individuals) • 70% of households had one or more members with health problem • On average, households paying for health care spent 4.5% of monthly household expenditure • 20% of households spent more than 10% • 15% of households spent more than 15%
  • 7. The goal of universal health coverage • Growing momentum behind universal health coverage as a key global goal – World Health Report 2010 on universal coverage of health care – Declaration of the World Health Assembly urged member states to ‘aim for affordable universal coverage and access for all citizens on the basis of equity and solidarity’ – 2012 declaration by UN General Assembly – Strong lobby to have universal health coverage as goal in post 2015 MDGs: endorsed by WHO DG at 2014 WHA
  • 8. Key issues • What does universal coverage mean in low/middle income country context? • What can be learnt from the experiences of countries tackling the key challenges in making progress towards universal health coverage? • What are priorities for countries on the path towards universal coverage?
  • 9. The health system B PROVIDERS OF SERVICES GOVERNMENT/ PROFESSIONAL BODY A POPULATION/ PATIENTS C FINANCIAL INTERMEDIARIES DIRECT PAYMENTS HEALTH SERVICES INSURANCE COVERAGE MONEY (TAXES OR PREMIUMS) REGULATION REGULATIONCLAIMS MONEY PAYMENT (FEES, GLOBAL BUDGET)
  • 10. What is universal health coverage? • ‘ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’ (WHO) • Ie three related objectives: – Equity in access to health services – those who need the services should get them, not only those who can pay for them – Sufficient quality of health services – enough to improve the health of those receiving services – Financial-risk protection – the cost of using care should not put people at risk of financial hardship.
  • 11. Key components of a system of universal coverage 1. Sources of finance 2. Financial intermediaries 3. Service providers
  • 12. The health system B PROVIDERS OF SERVICES GOVERNMENT/ PROFESSIONAL BODY A POPULATION/ PATIENTS C FINANCIAL INTERMEDIARIES DIRECT PAYMENTS HEALTH SERVICES INSURANCE COVERAGE MONEY (TAXES OR PREMIUMS) REGULATION REGULATIONCLAIMS MONEY PAYMENT (FEES, GLOBAL BUDGET)
  • 13. Sources of finance • Mix of sources common: • General tax, payroll tax, other earmarked tax (Philippines, Thailand, Ghana) • Plus Medical Savings Accounts (Singapore, China) • Plus voluntary contributions, copayments (Korea, China, Philippines, Ghana) • Core mandatory financing mechanism needed: social health insurance and/or general tax revenues
  • 14.
  • 15. Sources of finance • Population in formal (employed) sector (public and private) relatively easy to cover • Social health insurance usually the chosen main route • Challenges are: – Low income workers and self employed in informal sector – Those outside the workforce: young, old, disabled, and unemployed
  • 16. Extending financial protection to the informal sector • Via compulsory social health insurance • Social insurance scheme cross-subsidises low income worker premiums (Mexico) • Public funds subsidise compulsory health insurance premiums (all Thailand; targeted Korea, Singapore) • Premiums kept low by continuing some supply side subsidies (Colombia scheme for poor households) • Via ‘voluntary’ insurance schemes (Ghana, Rwanda, Philippines, Thailand, China) eg through partial or full subsidies for premiums from tax funding • Via universal entitlement and general tax funding to health services (Thailand)
  • 17. Extending financial protection to non-working population • Dependants (elderly, children) covered within compulsory social insurance schemes • General tax used to pay for insurance card for poorest and sometimes elderly (Rwanda, Ghana, India – RSBY) • Via universal entitlement and general tax funding to health services
  • 18. Role of co-payments • Permits contribution rate to be set at a level that is affordable and/or acceptable (Korea, Philippines) • May help to constrain demand in the early (or later) years of extension of coverage (Korea, Philippines) • May be symbol of family responsibilities (Korea, Singapore) • But regressive – weighs most heavily on poorer groups – and discourages use
  • 20. Financial intermediaries • Historical legacy of segmented funds: should aim be single payer system? (Korea merged; Thailand not yet) • Public or private agencies? • One or more public bodies (traditional for social health insurance) • Government regulates competing private insurers within social health insurance arrangements (eg Colombia, discussed in South Africa) • Government contracts with insurance companies to manage schemes (eg RSBY in India)
  • 21. Rashtriya Swasthya Bima Yojana (RSBY) • Targeted at families below the poverty line • Premium of max Rs750 (£7.50) per family: shared 75%/25% by central/local government; beneficiary family pays Rs 30 pa for registration • Insurance companies bid for contract to insure families in each district • Hospitalisation benefits up to ceiling of Rs 30,000 per family pa (max of 5 beneficiaries per family) • Insurance company contracts a third party administrator to manage the smart card system • Currently 31m active smart cards (families)
  • 22. Service providers • Public only or public and private? (Thailand SHI, India RSBY) • Benefit package? • List what is included (eg RSBY) or excluded (eg Thailand)? • Ensuring continuum across primary and hospital care problematic • Payment method (avoid fee for service unless within strong global budget) • Encourage strong primary care role: • Primary care gatekeeper (Korea) • Bypass fees (Thailand) • Primary care budget holder (Thailand, sort of) • Extend services first to poorer areas (eg Brazil Family Health Programme)
  • 23. Development of Thai health system from 1970s (Balabanova et al 2013)
  • 24. Thai universal health coverage arrangements • Universal coverage via 3 schemes: – Social health insurance for formal sector employees (with public subsidy) – Non-contributory scheme (so, tax funded) for civil servants – Universal coverage scheme (from 2001) for rest of population, general-tax funded • Gradual progress in harmonising benefit package, payment methods, service provision arrangements • Performance: – Relatively equitable: pro poor benefits; financing becoming less regressive; reduction in catastrophic payments – Inequities remain between schemes in benefit package and level of expenditure – Good cost containment in SHI and UC
  • 25. 0.050 0.075 0.100 0.125 0.150 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 2003 2004 2005 2006 2007 2008 2009 2010 OPvisitsperyear Year Outpatient visits inpatient addmissions IPadmissionspercapitaperyear -0.50 -0.40 -0.30 -0.20 -0.10 0.00 0.10 0.20 0.30 0.40 0.50 2001 2003 2004 2005 Health Centre District Provincial Private Overall Hospital Hospital Hospital Pro-poorPro-rich
  • 26. Catastrophic health expenditure refers to household spending on health care >10% of total household consumption expenditure 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 1996 1998 2000 2002 2004 2006 2007 2008 2009 Year Q1 (Poorest) Q5 (Richest) All %ofhouseholdsineachquintile Incurringcatastrophichealthexpenditure % 6.8% 2.9% 6.1% 4.7%
  • 27. Performance concerns with UHC • Concern about rising costs: increased utilisation, expansion of benefit package (eg renal dialysis in Thailand) • Lack of evidence on link between increased coverage and health outcomes • Lack of evidence on relationship of performance to numerous design options • What is best way to make progress in low income countries?
  • 28. Learning lessons to apply elsewhere • ‘Technical’ assessment – evaluation of performance and explaining it by reference to design features • Performance criteria, eg – Efficiency (allocative, technical) – Equity of financing (who pays?) – Equity of access to care (who benefits?) – Extent of catastrophic payments – Responsiveness • ‘Institutional’ assessment: what political, economic, social and cultural institutions enable governments to pursue universal health coverage?
  • 29. Key institutional aspects • Existence of a civil service which has the capability to implement programmes and policies: eg merit based recruitment, tenure in office not linked to personal or political patron, hierarchical structures with impersonal application of rules • Existence of institutions which allow the voice of the less-well- off to be expressed in policy debates and decisions • Relative importance of exercise of ‘voice’ and ‘exit’ as influence on performance (do the richer groups work inside the system to improve it or exit to private sector?) • Whether there is the social solidarity needed for merger of funds and universalist approaches (eg South Africa)
  • 30. Trajectory and priorities • Universal health coverage is process over time, not a fixed point that can be achieved • Critical to put the necessary elements in place early: – Combination of financing sources – Strong purchasing role encompassing both public and private providers and including emphasis on health promotion and prevention – Payment systems with appropriate incentives for cost containment and quality of care – Strong primary care and ‘district’ level infrastructure with good geographical access