HEAL HE ALTHY THY CAR CARIB IBBEAN EAN CO COAL ALITION ITION - PowerPoint PPT Presentation

HEAL HE ALTHY THY CAR CARIB IBBEAN EAN CO COAL ALITION ITION HC HCC C Ca Cari ribb bbea ean NC n NCD For D Forum um Ka Karl rl Th Theo eodore dore HE HEU, U, Ce Centre ntre fo for r He Heal alth th Ec Econ onomics, UW omics, UWI Jamaica…..April 23 - 25 25, 201 2018

➢ Review view of C of Cost osts s of of NCD NCDs in the s in the Ca Carib ribbean bean ➢ Cur Current rent Fun Fundi ding ng Ar Arrange rangements ments ➢ Con Conte text xt and nd Fi Fina nancin ncing g Stra Strategy tegy ➢ The he Fi Fina nancin ncing/Effi g/Effici ciency ncy Li Link nk ➢ Un Univ iversal ersal He Heal alth th Cov Coverage/ rage/Uni Universa versal l He Heal alth th Acc Access ss ➢ Na Nati tional onal He Heal alth th Insurance nsurance to to the the re rescue: scue: how how doe does s it it wor work? k? ➢ Con Concl clud udin ing g Com Comme ments nts 2

In In a s a stud tudy y on on di diab abet etes es in n th the e Ba Baha hamas, mas, Ba Barba bados, dos, Gu Guyan ana, a, 1. 1. Jam amai aica a an and Tr d Trinida inidad d an and To d Toba bago, go, Ba Barcelo elo et et al al. . (2003) 3) fo found und that: th at: Di Direc ect t (tr trea eatm tment) ent) an and d ind ndire irect t (fo foreg egone one ea earni nings) ngs) cos osts ts fo for a) a) th these ese cou ountries ntries am amount ounted ed to to US US$1 Bi Billi llion on or or 3% GDP GDP Per Per ca capi pita ta di direc ect t cos ost t wa was US US$687 or or mo more tha e than n tw twice e to tota tal b) b) he heal alth th spe pending nding pe per cap apita ta (US US$302) 02) at at th the e ti time me. . 2. . Si Simil milar arly ly in n a r a reg egional onal stud tudy on on th the e ec econ onomic omic bu burden den of of di diab abet etes es an and d hy hype pertension, tension, Abd bdulka ulkadri dri et et.a .al (2009) ) fo found und th that: at: Di Direc ect t an and in d indire direct t cos osts ts sto tood od at at US US$1.4 .4 bi billion, lion, or or 5.2 .2% % GDP GDP

3. In In a W a Wor orld ld Ba Bank nk stud tudy y on on th the EC e EC cou ountrie ntries s (2011) 1) an and on d on Jam amai aica a (2012) 2) it was t was fo found und th that at ➢ In In EC EC St Stat ates, es, av aver erag age pe e per cap ap. . he heal alth th ex expe pend. nd. on on di diab abet etics ics (US US$53 536) 6) wa was 1.3 .3 ti time mes s to tota tal pe per cap ap. . he heal alth th ex expe pend. nd. (US US$435) 35) ➢ In In Jam amai aica ca, , ho households useholds wi with th NC NCD D pa pati tients ents spe pent nt US US$742 pe per cap apita ta on on he heal alth th bi bills ls vs vs av aver erage age po popula pulati tion on sp spendi ending ng of US$ of US$20 200 ➢ In In St St Lu Lucia, a, 36% of of out out of of po pocket et he heal alth th spe pending nding by by ho househol useholds ds wa was inc ncurre urred d fo for NC NCDs Ds tr trea eatm tment ent 4. . In In an an Ec Economis onomist t In Inte tellige ligence nce Un Unit it (2009) 9) stud tudy of of 8 co 8 countr untries ies it t wa was see een n th that at fo for 5 lea eadi ding ng can ancer ers s (lung, lung, br brea east, t, col olor orec ectal tal, , pr pros osta tate te an and d cer ervi vical al) ) to tota tal l di direc ect t an and in d indire direct t cos osts ts of of ran ange ged d fr from om US US$1.4 .4 mi million lion in n Guy Guyan ana a to to US US$1 $17. 7.6 6 mi million lion in n Tr Trinidad nidad an and d To Tobag bago o or or 12 12% of % of th the e country’s GDP that year! 4

A. A. Pu Publi blic c Measure easures: ➢ Bu Budget dget all lloca ocati tions ons to to Mi Mini nistries stries of of He Heal alth th for for pr prog ograms rams in incl cl. . NCD NCDs s ➢ Prescri Prescripti ption on dr drug ug pl plans ns in in Barbados Barbados (1 (1980); 0); Ja Jamaica maica (2 (2003); 3); Tri rini nidad dad and nd Tob obago go (2 (2003); 3); the the Ba Bahamas hamas (2 (2010) 0) B. B. Pri Private vate Measure easures: ➢ Di Direc rect t Ou Out-of of-po pocket cket sp spendi ending ng ➢ Pri Private vate in insurance surance pa payment yments —general and ‘critical illness’ in insurance surance C. C. Com Commun munit ity y Measure easures: : NGO NGOs, s, na nati tional onal and nd re regio gional nal D. . Regi gional onal-Subre Subregio gional nal Ag Agenc encies ies :C :CAR ARPHA, PHA, CAR CARICOM COM 5

Th Three dime ree dimensions to pr nsions to present c esent context ontext :- 1. Re Resourc source-constrained Ca constrained Cari ribbean bbean eco economies nomies — • fis fiscal sp cal space cons ace constra traints (l ints (low w or ne r negat gative ive gr growth; wth; hig high h de debt); bt); • gen general eral do double uble-digit digit unemploy unemployment ment and nd pov poverty le erty levels vels • Re Reduced duced acc ccess to co ess to concessionar ncessionary y fu funds: nds: so some countr me countries ies classified by the World Bank as ‘high - income’ • Co Competition mpetition fo for r re resourc sources, es, int inter er-mi minister nisterial an ial and d int intra ra- he health alth 2. Adopt Adoption ion of f go goals o als of f Un Univers iversal Healt al Health Access h Access and nd Co Coverage verage ➢ 3. In Intr troduction oduction of f Na National Stra tional Strategi tegic c Ac Action tion Pl Plans for ns for NC NCDs Ds 6

Th Ther ere are e are four four key ey asp aspec ects ts of any of any pr propo opose sed d st stra rate tegy gy for for fi fina nanc ncing ing th the N e NCD CD re resp spon onse se – 1. Mo Modi difica ficati tion on of cu of curr rren ent t me meas asur ures es an and pr d prio iorit rities ies, , 1. ma main inly ly st stre rengt ngthe heni ning ng th the pr e prim imar ary lev y level el of of ca care re 2. Ad Adopt option ion of of new new fu fund nding ing me meas asur ures es for for the h the hea ealt lth h 2. sy syste stem 3. Im Impr prove oved d ef efficie ficiency ncy of cu of curr rren ent t fi fisca scal spen l spendi ding, ng, 3. in incl cluding re uding real allocat location ion of pu of publ blic ic re reso sour urce ces s (f (fis iscal cal pr prio iorit rity y for for heal health th) 4. Me Meas asur ures es ai aime med at d at im impr prov oved reve ed revenu nue col e collect lection ion 4. 7

 Although we can lobby for greater fiscal efficiency and for improved revenue collection in the different countries, our main focus will remain with the first two aspects of the financing strategy – the strengthening of primary care and new financing arrangements for the health sector  There is international evidence which shows that bolstering the capacity of the nation’s primary care system actually reduces the long term growth in health care costs. 8

 We also have USAID-supported work on the Eastern Caribbean showing that the health systems in the different countries will be much stronger if more emphasis is placed on primary care because a strong primary care system seems to go hand in hand with making the health system more efficient.  WH WHO e O esti stimat mate e of of was waste in healt te in health spe h spending: nding: 20 20 – 40 40 % %  9

 When we pull together the NCD financing context, the aspects of the financing strategy and the link between financing and efficiency we come to one conclusion:  FIN INANC ANCIN ING G NC NCD D PR PREV EVENTION ENTION AND ND CONTROL ONTROL IS IS IN INEXORABLY EXORABLY LI LINK NKED ED TO O HOW HOW THE HE HE HEALT ALTH H SY SYST STEM EM IS IS FINANCED INANCED  The connecting force is the WHO call for Universal Health Coverage (UHC) and PAHO’s Universal Health Access (UHA).  In a situation where NCDs have become the main health challenge in all our countries we have to take UHC and UHA very seriously  For UHC and UHA point us to having ACCESS to health care available for everyone, regardless of income and ensuring that no one is FINANCIALLY DISTRESSED because of health 10

 Since ACCESS and FINANCIAL DISTRESS are precisely the risks that are exacerbated by ch chronic ronic co condi nditio tions ns, the time for moving to a different way of financing our health system is opportune.  This is the message that WHO and PAHO have sending out when countries are encouraged to opt for a SO SOCIA IAL L IN INSU SURAN ANCE CE approach to health financing.  The evidence shows that countries that minimize out of pocket expenditure(OOP) and emphasize social health insurance are the ones where the health system seems to be working better 11