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
Ka Karl rl Th Theo eodore dore HE HEU, U, Ce Centre ntre fo for r He Heal alth th Ec Econ
Jamaica…..April 23 - 25 25, 201 2018
HE HEAL 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
➢ Review
view of C
s of
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
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
1. 1.
In In a s a stud tudy y on
diab abet etes es in n th the e Ba Baha hamas, mas, Ba Barba bados, dos, Gu Guyan ana, a, 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 th that: at:
a) a)
Di Direc ect t (tr trea eatm tment) ent) an and d ind ndire irect t (fo foreg egone
earni nings) ngs) cos
ts fo for th these ese cou
ntries am amount
ed to to US US$1 Bi Billi llion
GDP
b) b)
Per Per ca capi pita ta di direc ect t cos
t wa was US US$687 or
more tha e than n tw twice e to tota tal 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
tudy on
the e ec econ
burden den 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
ts sto tood
at US US$1.4 .4 bi billion, lion, or
.2% % GDP GDP
In a W a Wor
ld Ba Bank nk stud tudy y on
the EC e EC cou
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.
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.
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$742 pe per cap apita ta
heal alth th bi bills ls vs vs av aver erage age po popula pulati tion
spendi ending ng of US$
200
➢ In
In St St Lu Lucia, a, 36% of
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
t In Inte tellige ligence nce Un Unit it (2009) 9) stud tudy of
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
ectal tal, , pr pros
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
ts of
ange ged d fr from
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
12% of % of th the e country’s GDP that year!
4
A.
Publi blic c Measure easures:
➢ Bu
Budget dget all lloca
tions
to Mi Mini nistries stries of
Heal alth th for for pr prog
rams in incl cl. . NCD NCDs s
➢ Prescri
Prescripti ption
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
go (2 (2003); 3); the the Ba Bahamas hamas (2 (2010) 0) B.
Private vate Measure easures:
➢ Di
Direc rect t Ou Out-of
pocket cket sp spendi ending ng
➢ Pri
Private vate in insurance surance pa payment yments—general and ‘critical illness’ in insurance surance C.
Commun munit ity y Measure easures: : NGO NGOs, s, na nati tional
nd re regio gional nal D. . Regi gional
Subregio gional nal Ag Agenc encies ies :C :CAR ARPHA, PHA, CAR CARICOM COM
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Th Three dime ree dimensions to pr nsions to present c esent context
Resourc source-constrained Ca constrained Cari ribbean bbean eco economies nomies—
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);
general eral do double uble-digit digit unemploy unemployment ment and nd pov poverty le erty levels vels
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’
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
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
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
propo
sed d st stra rate tegy gy for for fi fina nanc ncing ing th the N e NCD CD re resp spon
se –
1.
Modi difica ficati tion
rren ent t me meas asur ures es an and pr d prio iorit rities ies, , ma main inly ly st stre rengt ngthe heni ning ng th the pr e prim imar ary lev y level el of
care re
2.
Adopt
ion of
new fu fund nding ing me meas asur ures es for for the h the hea ealt lth h sy syste stem
3.
Impr prove
d ef efficie ficiency ncy of cu
rren ent t fi fisca scal spen l spendi ding, ng, in incl cluding re uding real allocat location ion of pu
blic ic re reso sour urce ces s (f (fis iscal cal pr prio iorit rity y for for heal health th)
4.
Meas asur ures es ai aime med at d at im impr prov
ed revenu nue col e collect lection ion
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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
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
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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
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There are many high OOP countries in the region, but to date, a
number of countries in the region have already responded to the WHO/PAHO call and the plea today is for all countries of the region to adopt a health financing system which supports a package of health services which emphasizes the prevention and control of NCDs
In other words we do NOT want a financing system that gives pride
problem.
In the face of the NCD epidemic what the region needs to put in a
place is a social insurance system that will ensure that everyone will have access to the care that will keep them out of hospital!
What we have in mind is a financing system that focusses on the
public health and the primary care services that will keep people healthy even into old age
National Health Insurance is a cradle to grave
financing system which does precisely this
12
There are eleven
leven Caribbean countries which have already adopted a social health insurance system in the form of Na Nati tional
Heal alth th Insurance.
CARICOM member state and four are Associate members.
There are also ni
nine ne other countries, all CARICOM member states, which are, at present, either in the process of setting up a National Health Insurance or have initiated serious discussions on this matter
13
Un Univers iversal al Cover Coverage; Br age; Broad
Package age CU CURRE RENT NT NH NHI P PROPO POSED SED NH NHI Aru ruba ba Gre renada nada Anguilla nguilla St
. Kit itts/Nevis /Nevis Belize lize Antigua tigua/B /Barbud arbuda Bonaire
Bahama ahamas BVI St St Lucia ucia Cu Cura racao cao S St Vin incent cent Su Surinam rinam Do Dominica minica Turk rks & & Ca Caic icos
T Tri rinidad nidad & & Tobago bago Bermud rmuda a Jamai maica ca Ca Cayman man Is St St Maart rten en
➢ NHI is the engine that drives the pursuit of Un
Univ iversal ersal He Heal alth th Cov Coverage rage
➢ Provides equity in access to package of services, in public &
private sectors, for every citizen or resident
➢ Facilitates equity in cost sharing - the need for out of pocket
spending will be significantly reduced.
➢ Improves quality and efficiency – Primary Care based; better
integrated patient-centred chronic care; end to unreasonable waiting times for proper diagnostics and treatment
➢ Facilitates better performance accountability
➢ Identify package of health services which will be made
accessible to all eligible participants, one that addresses the NCD epidemic
➢ Estimate the cost of the package which is incorporated in an
actuarial model to ensure financial viability of the system.
➢ NHI will be a social insurance system that includes
government revenues and employer/employee contributions, pooling the resources required for payment to the public and private providers of care.
➢ NHI is supported by a modern He
Heal alth th Inf Informa
tion
Syste tem m which keeps track of every patient transaction and the resources used in providing care
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Re Reco cogni gnizing that zing that NC NCDs Ds ha have ve de deep ep roo roots ts in in soci social al de dete termi rminan nants ts (l (life ifest style yles-beh behav aviour iour) ) th the i e imp mper erati ative ve no now is to fi w is to find nd a f a fin inan ancing sys cing syste tem th m that w at wil ill
a) a) En
Ensu sure re th that at ev ever eryon yone has e has ac acce cess ss to good to good heal health th care care, , an and d
b) b) Su
Suppo pport rt mo more re pr prev even enti tion
and ma d main inte tena nanc nce e app appro roac ache hes s wh which emp ich empowe
r an and d in incen centivis tivise e in indiv dividual iduals, s, fam famil ilies ies and and com communitie munities to s to tak take t e the he ri right ght ac acti tion
c) c) Fa
Faci cilita litate te ef effi ficiency ciency in in the h the hea ealt lth sys h syste tem Si Sinc nce, e, as as a an i n ins nstr trume ument nt of UHC
and UH UHA, A, th this is is is what what th the N e Nati ation
al He Heal alth th In Insu sura ranc nce e is is des design igned ed to d to do,
it st stan ands ds out
as th the pr e pref efer erre red d he heal alth th fina financi ncing ng sy syst stem em if if
r inten enti tion
is to pre to preve vent nt and and to c to con
trol
NCDs Ds
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