Health Care Financing in Pakistan: Trends and Issues

1
Health Care Financing in Pakistan Trends and
Issues

• Dr. Rashid Jooma
• Director General
• Ministry of Health, Pakistan

2
Purpose of a Sound Health Care Financing Policy

• Beyond how much should we spend
• A sound HCF policy should look at
• The Overall need and Available funds
• How money flows to ensure the system reaches its
  objectives
• Creating incentives to enhance health care
  delivery
• Provide social protection against routine and
  catastrophic health care expenses

3
The Current Government Setup
Federal
Policy Budget Surveillance ME
Reporting
Funds
Oversight
Direct Oversight ME
Provincial
Reporting
Funds
Oversight
Direct Implementation ME
District
4
Current Health Care Spending

• Total Rs 152 billion (2 of GDP)
• Or about USD 17 per capita
• Government contribution is about a quarter
• Reflects only about a 50 increase over the past
  15 years (when adjusted for inflation and
  population growth)

5
Where it goes

• Government prevention, curative care and
  infrastructure
• Private sector and NGOs mostly curative care

6
Some current restraints

• Limited revenue collection (lt15 of GDP)
• Limited revenue collection by provincial or
  district governments
• Distinction between recurrent and development
  budgets, sometimes with management of each with
  different depts
• Within sub-units (eg hospitals) different things
  are paid from different funding sources
• Under utilization of allocated funds

7
Is increased funding needed

• Absolutely!
• However, this is not the final answer
• Health outcomes are not well correlated with
  health spending
• In fact setting a total as a target may not be
  very helpful
• Equally important to
• prioritize funding
• design technically sound interventions and
• monitor results that are geared towards effective
  and equitable targets

8
General Suggestions

• Need an overarching plan that looks at the
  overall health needs to establish the funding
  envelope (and also assigns deliverables and
  responsibilities for different stakeholders)
• Making sub-units (for e.g. districts or even
  clinics) accountable for their budgets and their
  deliverables
• Definition of minimum essential packages
• Assign accountability and responsibility for
  services
• Financial and budgetary implications (rewards or
  otherwise) tied to quality of services provided
• ME framework including results and finances

9
Raising Adequate funds

• Taxation
• Earmarking
• Approach external donors
• Allowing provincial or local revenues to go
  directly to health locally
• User fees

10
Pooling Risk

• Catastrophic health insurance is being provided
  in Pakistan via the Rural Support Networks
• Government leverages expenses related to natural
  disasters
• Government increases coverage and payments for
  expensive healthcare such as hospitalization, esp
  when these payments are pro-rated acc to incomes

11
Equitable Provision of Services

• Pro-rate user fees and other expenses acc to
  income of clients
• Conditional Cash Transfers (CCT) to attract
  clients to prevention services and as social
  support for the poorest
• Support funds for indigent care (zakat)
• NGO and philanthropic support

12
Efficient Provision of Services

• Adequate funding for what is planned
• Timely and efficient disbursement of funds
• A results monitoring system
• Pilot trials of Results based financing
• Delegate control over budgets, implementation as
  well as responsibility to local implementers
• Local community involvement in planning and then
  monitoring services

13
Role of non-state actors

• Providers of quality care (Rural Support
  Networks, charitable hospitals/ clinics)
• Providers of essential services (Edhi)
• Providers of social safety nets (Edhi, other
  NGOs)
• Providers of employment or employment/ income
  generation (include micro credit, vocational
  training)
• Piloting new health care models (AKHS)
• Funding some care