This document provides an overview of key concepts in health financing for universal health coverage. It discusses UHC goals and objectives, important contextual factors that influence health policy, methods for analyzing health expenditures, reviewing financing arrangements, and assessing progress toward UHC. The document outlines a framework for conducting an integrated assessment of a country's health system to identify challenges and priorities for reform in order to make progress on achieving universal access to needed health services of sufficient quality.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
National Health Policy 2017 and its historic perspectiveDr Sanket Nandekar
Presentation aims to describe National health policy 2017 & its historic perspective in the simplest possible way. Highlights of past two health polices are also covered in the discussion.
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
National Health Policy 2017 and its historic perspectiveDr Sanket Nandekar
Presentation aims to describe National health policy 2017 & its historic perspective in the simplest possible way. Highlights of past two health polices are also covered in the discussion.
India being a developing country with growing population has been traditionally vulnerable to natural and man made disasters.
Development cannot be sustainable unless disaster mitigation is built into developmental process.
Disaster could be a nature calamity, outbreak of disease, bioterrorism, etc.
New Delhi, Feb 23. The health ministry has proposed a bill that seeks to empower state and local authorities to take appropriate actions to tackle public health emergencies like epidemics and bio-terrorism.
this presentation takes you through the concept of association observed between variables in a study and how could it become a causative association in step-wise manner.Exemplify using Bradford hill criteria. slides after references are extra slides not covered in the presentation.
Global health is the health of populations in the global context;
It has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide".Health is a state of physical, mental, and social well-being in which disease and infirmity are absent. Global health practices can respond to some of the major health responsibilities such as non-communicable diseases (heart disease, diabetes, cancer, and chronic respiratory diseases) or injuries that occur in varying degrees in many countries, no matter how advanced.
The guidelines set out the principles and practices that government can look at when making laws and regulating food programs. Inequality affects the health of the world.
The future of global health is at risk and needs urgent strategies. Also, technology is contributing at a vast pace to overcome the various health challenges all over the world.
For prevention of non-communicable diseases(NCD):
Ban all forms of tobacco advertising, promotion, and sponsorship.
Restrictions on the availability of retailed alcohol.
Replacement of trans fats with polyunsaturated fats.
Scale-up early detection and coverage starting with very cost-effective, high-impact interventions.
Globalization, Global Health and Public Health.
Changing Concepts of Public Health.
Causes, Aspects and Types of Globalization.
Social Changes due to Globalization.
How Globalization affects Public Health.
Globalization of Public Health.
Threats to Global Health.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
Toca opinar sobre una cuestión sensible en estos días: los arreglos institucionales y los efectos jurídicos del acuerdo con los holdouts (fondos buitres). Es una cuestión sensible, pero no nueva para la fiscalía que interviene en todos los eslabones que se han transformado en causas judiciales derivadas del endeudamiento externo desde 1976. Desde la causa iniciada por Alejandro Olmos hasta la hora presente.
India being a developing country with growing population has been traditionally vulnerable to natural and man made disasters.
Development cannot be sustainable unless disaster mitigation is built into developmental process.
Disaster could be a nature calamity, outbreak of disease, bioterrorism, etc.
New Delhi, Feb 23. The health ministry has proposed a bill that seeks to empower state and local authorities to take appropriate actions to tackle public health emergencies like epidemics and bio-terrorism.
this presentation takes you through the concept of association observed between variables in a study and how could it become a causative association in step-wise manner.Exemplify using Bradford hill criteria. slides after references are extra slides not covered in the presentation.
Global health is the health of populations in the global context;
It has been defined as "the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide".Health is a state of physical, mental, and social well-being in which disease and infirmity are absent. Global health practices can respond to some of the major health responsibilities such as non-communicable diseases (heart disease, diabetes, cancer, and chronic respiratory diseases) or injuries that occur in varying degrees in many countries, no matter how advanced.
The guidelines set out the principles and practices that government can look at when making laws and regulating food programs. Inequality affects the health of the world.
The future of global health is at risk and needs urgent strategies. Also, technology is contributing at a vast pace to overcome the various health challenges all over the world.
For prevention of non-communicable diseases(NCD):
Ban all forms of tobacco advertising, promotion, and sponsorship.
Restrictions on the availability of retailed alcohol.
Replacement of trans fats with polyunsaturated fats.
Scale-up early detection and coverage starting with very cost-effective, high-impact interventions.
Globalization, Global Health and Public Health.
Changing Concepts of Public Health.
Causes, Aspects and Types of Globalization.
Social Changes due to Globalization.
How Globalization affects Public Health.
Globalization of Public Health.
Threats to Global Health.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
Toca opinar sobre una cuestión sensible en estos días: los arreglos institucionales y los efectos jurídicos del acuerdo con los holdouts (fondos buitres). Es una cuestión sensible, pero no nueva para la fiscalía que interviene en todos los eslabones que se han transformado en causas judiciales derivadas del endeudamiento externo desde 1976. Desde la causa iniciada por Alejandro Olmos hasta la hora presente.
Aquí te presento algunos de los riesgos o peligros a los que se expone un niño o un adolescente al chatear con personas a las cuales no conoce y enviar imágenes que pueden dañar su vida.
Health Economics In Clinical Trials - Pubricapubrica101
Pubrica specializes in Health Economics in Clinical Trials, offering comprehensive support to ensure the economic aspects of your trial are effectively managed. From cost-effectiveness analysis to budgeting and reimbursement strategies, we help you optimize the economic outcomes of your trial. With Pubrica's expertise, you can navigate the complex landscape of health economics in clinical trials with confidence.
For more information, please refer to our service- https://pubrica.com/blog/research/health-economics-in-clinical-trials/ & Order now - https://pubrica.com/order-now/
Contact Our UK Medical Author’s;
Our email id – sales@pubrica.com
Contact No. +91 9884350006
mHealth Israel_US Health Insurance Overview- An Insider's PerspectiveLevi Shapiro
Presentation about the US Health Insurance Sector by Lori Rund, VP, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System, with 650,000 lives. Lori is responsible for the identification, concept building, researching and business case developments for new products, services and markets. She develops and leads comprehensive market intelligence functions to help the organization better understand industry trends and identify business opportunities.
Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Clinic Association, also in Illinois.
OHE Lecturing for Professional Training at International Centre of Parliament...Office of Health Economics
On 7th November 2018, Bernarda Zamora delivered a pro bono lecture to professionals from diverse countries enrolled at the Professional Certificate in Strategic Planning organised by the International Centre of Parliamentary Studies.
Author(s) and affiliation(s): Bernarda Zamora, Office of Health Economics
Conference/meeting: Professional Certificate in Strategic Planning organised by the International Centre of Parliamentary Studies
Location: Conference Centre, London
Date: Conference Centre, London
2. OUTLINE
• An introduction to health financing for universal health coverage: key
concepts and terms
• Key contextual factors that influence health financing policy and
attainment of policy goals
• Overview of health expenditure
• Review of health financing arrangements
• Analysis of the UHC goals and intermediate objectives
• Overall assessment: setting priorities for health financing reforms
• Summary
• References
3. HEALTH FINANCING FOR UNIVERSAL HEALTH
COVERAGE: KEY CONCEPTS AND TERMS
• UHC:
Provision of financial protection from the cost of using health services for
all people of a country, enabling them to access the sufficient quality of
health services to be effective that they need
• Specific policy goals of UHC
Equity in the use of health services
Quality of care
Financial protection
4. HEALTH FINANCING FOR UNIVERSAL HEALTH
COVERAGE: KEY CONCEPTS AND TERMS
• UHC intermediate objectives:
Equity in resource distribution
Efficiency
Transparency and accountability
• Health financing: generation, allocation and use of financial resources in
health systems, focusing on how to move closer to UHC. An important
building block of the health system
• Health financing functions:
1. Revenue raising
2. Pooling
3. Purchasing
5. HEALTH FINANCING FOR UNIVERSAL HEALTH
COVERAGE: KEY CONCEPTS AND TERMS
• Equity in finance: distribution of the burden of financing the health
system across socio demographic groups
7. KEY CONTEXTUAL FACTORS THAT INFLUENCE
HEALTH FINANCING POLICY AND ATTAINMENT OF
POLICY GOALS
• What is a contextual factor?
Something outside the direct control of health sector decision makers
but has an important influence on the attainment of UHC goals or what
health financial reforms can be implemented, or both.
• 3 major contextual factors:
1. Fiscal context
2. Public administrative structure
3. Public sector financial management
8. Fiscal Context
• Fiscal envelope: overall level of government spending
• Fiscal capacity: government’s ability and willingness to mobilise public
revenues which in turn allows it to spend money on public services and
programs including health
↑fiscal capacity → ↑potential for spending on health
↑public spending on health → ↓dependence on OOPS for funding health
services → ↓financial barriers to the use of health services
• Fiscal space: ability of the government to devote more resources to the
health sector without distorting the sustainability of its financial position.
‘Does the government have the needed revenue to increase health
spending?’
9. Fiscal Context
• Key fiscal indicators to consider:
Government expenditure to GDP ratio
Government revenue to GDP ratio
Government debt to GDP ratio
Budget deficit
• Gross Domestic Product (GDP): broadest quantitative measure of a
nation’s total economic activity
10. Public Administrative Structure
• Extent of decentralization of the government and decision making
responsibilities at different levels
• Level at which public spending on health is made
11. Public Sector Financial Management (PFM)
• Comprises of the rules that govern the processes of:
Public sector budget formation
Distribution
Financial control
Expenditure reporting
• Has important implications on the decision making autonomy of the
health sector managers for both the objectives of the health system
and the ability to implement some reforms
12. OVERVIEW OF HEALTH EXPENDITURE
• Revolves around the National Health Account (NHA)
• NHA: systematic, comprehensive and consistent monitoring of
resource flows in a country’s health system
• NHA indicators on health expenditures and sources of finance:
1. Total Health Expenditure (THE) as a % of GDP
2. General Government Health Expenditure (GGHE) as a % of GDP
3. Per capita government expenditure on health, US $ adjusted for
purchasing power aka ‘purchasing power parity’
13. NHA indicators cont’d
4. GGHE as a % to the total General Government Expenditure (GGE)
Abuja target – 15%
5. GGHE as a % to THE
6. Private Health Expenditure (PHE) as a % of THE
7. External sources for health (EXT) as a % to THE
8. Out of Pocket Spending (OOPS) as a % of THE
9. Private prepaid plans (VHI) to the THE
14. REVIEW OF HEALTH FINANCING ARRANGEMENTS
• Revenue Raising Mechanisms
1. Compulsory prepayment
a. General revenues of central and local government: direct taxes, indirect
taxes and revenues from government owned assets
b. Revenue specifically earmarked for the health system: alcohol/tobacco
taxes
c. Social health insurance schemes
2. Voluntary prepayment
3. Household OOPS
4. Foreign sources
15. Fund Pooling Mechanisms
• Main aim is to maximize the redistribution capacity of prepaid funds
• 3 characteristics of pools that influence redistribution:
1. Size: the larger the pool, the greater the capacity to provide cross
subsidies to support those with greater health needs
2. Diversity: increased diversity would mean having individuals with a mix
of health risks and this facilitates cross subsidizing from the healthy to
the sick
3. Compulsory or voluntary participation: compulsory inclusion of
populations in pool is much more effective. Sicker people tend to join
voluntary schemes
• Fragmentation: major challenge which means barriers to redistribution of
available prepaid funds, leads to a lower potential for cross subsidies to
flow across the health system
16. Purchasing
• Transfer of pooled funds to the providers
• Analysis of purchasing functions:
1. What services?: benefit entitlement policies
2. How are the providers paid?: provider payment mechanisms and
incentives
3. Who are the purchasers?: organizational structure and governance
of purchasers
17. Policies for Benefit Design and Rationing
Coverage cube:
• Section of the population
covered
• Services covered for which
population group
• Proportion of the cost covered
18. Passive and Strategic Purchasing
• Passive purchasing: follows a predetermined budget or simply paying
bills when presented
• Strategic purchasing: continuous search for the best way to maximize
health system performance by deciding which interventions should
be purchased, how and from whom
19. Key Issues in Purchasing
• What is the nature of the purchasing organization?
• What is the market source of the provider?
• Is there a selection process for providers?
• Is there a contract agreement specifying expectations from the providers?
• What provider payment mechanisms are used? Does it provide incentives to
promote efficient delivery? Are they constraints e.g. PFM?
• Is the purchaser able to influence payment rates?
• Is there an information system used to support provider payment?
• Does the purchaser have effective mechanisms to identify fraud and ensure
expenditure does not exceed resources?
• Are there mechanisms to hold the purchasers accountable?
20. ANALYSIS OF THE UHC GOALS AND INTERMEDIATE
OBJECTIVES
• UHC perspective considers the overall performance of the health
system
• Analysis is conducted at the system level
21. Financial Protection and Equity in Finance
2 indicators are used for financial protection:
1. Proportion of households that incur catastrophic spending on health services:
calculated using health spending as a % of capacity to pay (total income/total
consumption expenditures/non-subsistence expenditures e.g. spending beyond
basic food items) and comparing to a specific threshold.
2 commonly used thresholds for international comparison that may be considered
catastrophic:
a. Out of pocket expenditure on health care that is ≥ 25% of total household
expenditure
b. Out of pocket expenditure on health care that is ≥ 40% of non food household
expenditure
2. Number of households that are impoverished due to health care expenditure
22. Financial Protection and Equity in Finance
• For interpretation of national data, it is important to have information at least
2 points in time for comparison on the level of OOPS and health service
utilization
• Equity in finance: Kakwani index is used
• Kakwani Index: compares the distribution of health payments across
households, ordered according to their socio economic status.
• Financing incidences can be
1. Progressive: +ve Kakwani index
2. Proportional: Zero Kakwani index
3. Regressive: -ve Kakwani index
23. Equity in Service Use and Distribution of
Resources
• 2 utilization incidences:
1. Pro rich utilization: +ve concentration index
2. Pro poor utilization: -ve concentration index
• Utilization rates: calculated using analysis on distribution of service across
socioeconomic groups, household survey and routine health information system
• Could be compared with proxy indicators of need (population size and
demographic composition) or relative deprivation (per capita income, poverty
rates) across geographic area
• It is the distribution of financial resources that influences the distribution of other
resources- human resources, drugs and medical supplies, infrastructure
24. Health Service Quality
• Input related indicators:
1. Availability of staff and staff workload
2. Availability of functional equipment
3. Routine availability of essential drugs
• Process indicators:
1. Extent to which treatment is appropriate for diagnosis
2. Assessment of the rational use of drugs
25. Health Service Quality
• Outcome related indicators:
1. % cure rates for diseases
2. % of patients with chronic illnesses that are appropriately controlled
3. Post-surgical infection rates
4. Hospital mortality rates
• Others:
1. Patient satisfaction with services
2. Presence of an incentive promoting environment for providers to give
high quality services
26. Health System Efficiency
• Efficient use of limited resources is essential for achieving UHC
• Indicators for assessing possible sources of inefficiency:
1. Medicines:
• Underuse of generics
• Higher than necessary prices
• Substandard and counterfeit medicines
• Inappropriate and ineffective use
2. Health care products and services
• Overuse or supply of equipment, investigations and procedures
• Inappropriate hospital admission and length of stay
• Inappropriate hospital size
• Medical errors and sub optimal quality of care
27. Health System Efficiency
3. Health care workers
• Inappropriate or costly staff mix and unmotivated workers
4. Health system leakages
• Waste, corruption and fraud
5. Health interventions
• Inefficient mix/inappropriate level of strategies
6. Passive purchasing
28. Transparency and Accountability
• Transparency- ensuring entitlements and obligations are well understood by
everyone
• Sources of data on transparency:
oPatient exit interview
oHousehold survey data
oCommon knowledge on whether or not under table payments are
widespread
• Accountability – regular public reporting on key performance indicators by
health financing institutions or individual managers
29. OVERALL ASSESSMENT: SETTING PRIORITIES FOR
HEALTH FINANCING REFORMS
• Help to reach the conclusions on the likely causes of under performance of the
system
• For an integrated assessment, the following should be made clear:
1. How the system is organized and how it functions
2. How the system is doing in terms of policy objectives and attaining UHC
3. Key contextual factors
30. Assessing Universal Financial Protection
• Extent of catastrophic health expenditure and impoverishment
• OOPS as a share of THE
• Mandatory prepayment funding in THE
• Equity in health financing
• Fiscal, labour force and demographic context
• Pooling arrangement
• Purchasing function and benefit entitlement
• Efficient use of resources
• Transparency, accountability and governance
31. Assessing Universal Access to Needed Health
Services of Sufficient Quality to be Effective
• Equity in health service utilization relative to need
• Mandatory prepayment funding mechanism as a % of THE
• Pooling arrangement
• Purchasing and benefit entitlements
• Revenue raising and fiscal context
• Political administration and financial management context
• Transparency, accountability and governance
32. OVERALL ASSESSMENT: SETTING PRIORITIES
FOR HEALTH FINANCING REFORMS
• Analysis of the financial protection and access to sufficient and
effective health services helps to identify:
1. The main causes of inadequate financial protection
2. The main contributory factors to inadequate/inequitable access to
quality health care based on need
3. The challenges that need to be addressed to make progress towards
UHC
• Priority is given to challenges that are most subjective to health policy
action by the health sector decision makers
33. SUMMARY
• An in-depth study of a country’s situational analysis of it’s health
financing system and an assessment of it’s existing system is vital in
achieving the goals and intermediate objectives relative to the goal of
UHC
34. REFERENCES
• Health Financing Country Diagnostic (Health Financing Diagnostics
and Guidance) : a foundation for national strategy development /
Diane McIntyre and Joseph Kutzin.