Towards universal coverage''' key emerging themes and challenges

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Towards universal coverage...key emerging themes
and challenges
Joseph Kutzin WHO/EURO Regional Advisor, Health
Systems Financing Visiting Fellow, Imperial
College Centre for Health Management

• General Health Insurance in Financing of Health
  Services in Turkey and Restructuring of the
  Ministry of Health
• 1 April 2006
• Istanbul, Turkey

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1) Many paths to universal coverage, but

• Key challenge reaching the informal sector
• Lessons emerging from experience
• Universality requires budget subsidy cant rely
  solely on employer/employee contributions
• Not just a matter of providing a budget subsidy
  means of subsidizing is critical
• Shift from subsidizing supply to subsidizing
  demand
• Contributory (MEX, HUN, SVN) vs. non-contributory
  (THAI) approaches
• But even contributory countries are
  diversifying funding sources and reducing link
  between insurance coverage and labor-related
  contributions

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2) Reduce fragmentation

• Moving towards unified insurance pool is message
  from other countrys experience and is at the
  core of Turkeys reform plans
• Challenge putting those with currently more
  generous package in same pool as those with
  currently less generous packages
• Thai stopped short of national single pool
  because of resistance from civil servants
• Turkey scaling up to most generous package
• How to balance expanded benefits with available
  resources?

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3) From a right to health to an explicit
benefit package

• Package must be cost-able as a basis for
  financial projections, and guided by policy
  priorities
• Highly relevant in all other countries and
  reflected in the work done to date in Turkey as
  well
• Not just for initial planning tool continuous
  monitoring, updating, and refinement is needed as
  a routine process

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4) Prepare for change as a way of life monitor,
analyze, adapt

• Health reform a chronic condition that can be
  managed but not cured
• Monitor implementation and effects on objectives
  critical for developing an adaptable system
• Achieving universal coverage is not the end
• Assess financial protection and equitable burden
  (room for improvement even with 100 coverage)
• Monitor this (and not just expansion of insurance
  coverage) to learn, change, adapt over time

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5) Efficiency gain is essential (and is a shared
responsibility)

• Getting the most/best results from available
  resources (more health for the money) to lessen
  severity of sustainability tradeoffs
• Not only the job of the purchaser (GHI)
• Requires close coordination with MOH, combining
  planned system design with an implementation
  push from financial incentives
• Institutional relationships that orient the
  actions of the purchaser to the policy priorities
  of the MOH

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6) Towards an evidence-based health financing
reform process

• Need for technical adjustments to implementation
  over time
• Need for public accountability and building
  public consensus to sustain the reform process
  over time (analysis for advocacy)
• Absolutely essential, as this will be a long
  march