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

1. Financing of health services for workers
Adrienne Chattoe-Brown
Lead Specialist - Health Systems and Service Delivery
HLSP

2. Introduction • What mechanisms are available to
countries and social groups for financing
Private insurance &
user fees health services for workers?
Taxation • How can financing mechanisms stimulate
the integration of basic services for
Social insurance
occupational health in primary health
Community based care?
insurance

3. Introduction • The principle of integration applies to
financing as well as delivery
Private insurance &
user fees
• Vertical funding is an option but there
Taxation are problems:
Social insurance
– Poor allocation across programmes
– Inefficiency and duplication
Community based
insurance
– Problems in getting funding for training and
operational costs down to service delivery
level

4. Five main mechanisms
Introduction • Private health insurance
Private insurance & • User fees
user fees
• Taxation
Taxation
• Social insurance
Social insurance
• Community based insurance
Community based
insurance

5. Inclusion of OHS
Introduction • Depends on how the mechanism is
implemented
Private insurance &
user fees
• Effective coverage of OH through PHC
Taxation may depend on a cocktail of
mechanisms
Social insurance
• In reality – different starting points
Community based
insurance
• Which approaches are showing the
most promise to stimulate the
integration of OSH into PHC?

6. Private health insurance
Introduction • Can deliver good quality, and choice for
beneficiaries
Private insurance &
user fees But . . .
Taxation • Little risk pooling
Social insurance • Poor for promotion and prevention
Community based Suitable for OH?
insurance
• Expensive
• Dependent on insurance premiums

7. User fees
Introduction • Raise revenue
Private insurance & • Deter inappropriate use of services
user fees
But . . .
Taxation
• Barrier to usage
Social insurance
• Waivers / exemptions problematic
Community based
insurance • Weak at supporting promotion and
prevention
Suitable for OH?
• Likely to exclude poorest

8. Taxation
Introduction • Inexpensive mechanism
Private insurance & • Progressive
user fees
• Good for prevention and health promotion
Taxation
But . . . .
Social insurance
• Unpredictable
Community based
insurance • Sometimes regressive
Suitable for OHS?
• Competition with other demands
• Difficult to implement incentives

9. Example: Indonesia
Introduction • PHC + OSH
Private insurance & • Integrated delivery through OH Posts
user fees
• Co-funded by central and local
Taxation government
Social insurance • 8,000 OHPs by 2008
Community based But . . .
insurance
• OHS not yet in basic PHC package
• Support and financing patchy

10. Social insurance
Introduction • Risk pooling promotes social solidarity
• Clear link between payments and benefits
Private insurance &
user fees • Can enable universal coverage
Taxation • Responsive
• Can include promotion and prevention
Social insurance
But . . .
Community based
insurance • Usually requires subsidies for poor
Suitable for OHS?
• May exclude catastrophes
• Must be financed from employment

11. Example: Ba’oan, China
Introduction • Cost shared by employer and government
Private insurance & • 3 levels of service provider (district and
user fees below)
Taxation • Targeted at workers.
Social insurance • Cost effective to provide services in
comparison to funding days lost
Community based
insurance
But . . .
• Only covers workers in formal employment
• Problems with mobile workforce

12. Community based health
insurance
Introduction • Addresses financing and service
provision
Private insurance &
user fees • Can improve value for money
Taxation • Can include primary and secondary
Social insurance • Can include promotion and prevention
Community based But . . .
insurance
• Dependent on subsidies, community
participation and willingness to pay
Suitable for OH?
• Difficult to scale up

13. Example: SEWA, India
Introduction • Trade union for workers
Private insurance & • Community based health insurance
user fees
expanded to include occupational
Taxation insurance
Social insurance • Health workers deliver basic OHS e.g.
TB screening for at risk groups,
Community based
insurance outreach to remote workers
• Very integrated with PHC

14. www.hlsp.org