GNHE » December 7, 2015

Daily Archives: December 7, 2015

Low-income countries South-East Asia

Achieving universal health coverage in Bangladesh

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Ahmed Mustafa and Tahmina Begum from Bangladesh wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ concluding points are:

  • Bangladesh faces a number of challenges from a financial protection perspective:
    • the country relies heavily on out-of-pocket payments that account for almost two-thirds of total health expenditure
    • there is evidence of a high incidence of catastrophic payments and impoverishment due to out-of-pocket spending
  • In Bangladesh, the better off:
    • pay more out of pocket for health care
    • spend proportionally more of their household resources on health care
    • receive more and better care
  • The poor pay less and receive less health care
  • The poorest of the poor simply cannot afford to pay and hence do not seek treatment
  • In most cases hospital care is pro-rich while non-hospital care is pro-poor
  • The pro-poor utilisation of outpatient services probably reflects the reliance of the poor on unqualified private informal providers
  • With the aim of achieving universal coverage, Bangladesh’s Ministry of Health and Family Welfare has developed a new 20-year health care financing strategy: the goal is to strengthen financial risk protection and extend health services and population coverage
  • The intention is to halve out-of-pocket payments for health care at the point of service delivery
  • The new strategy will combine funds from tax-based budgets, existing community-based and other prepayment schemes, and donor funding
  • Current low levels of health financing could be addressed through an increase in the level and efficiency of the government’s budget allocation as well as by creating a compulsory Social Health Protection Scheme
  • In order to increase access, tax-funded primary and preventive care services will remain free for all groups of the population.
  • The strategy envisages starting its health protection coverage with the poor and the formal sector. Then it will extend its coverage and benefit package to include the informal sector in order to achieve universal coverage

 

Read more in: Mustafa A, Begum T. 2014. Universal health coverage assessment: Bangladesh. Global Network for Health Equity (GNHE). Available at: http://gnhe.org.

Upper-middle-income countries

Achieving universal health coverage in Peru

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Janice Seinfeld and Nicolas Besich, of Videnza Consultores in Peru, wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ concluding points are:

  • The health sector in Peru is fragmented, consisting of a non-integrated set of sub-systems aimed at serving different segments of the population.
  • Over a third of the population remains uncovered and out-of-pocket payments account for over a third of health care financing.
  • More than 75,000 households are impoverished annually as a result of health care payments.
  • One of the most neglected segments of the population in terms of health insurance is the one including lower-middle and low-income individuals. This segment is not classified as poor and thus cannot access subsidized insurance through the publicly financed SIS. At the same time, they mostly work in the informal sector and therefore are not able to access the mandatory insurance scheme for formal sector workers, EsSalud.
  • There are several problems that account for this state of affairs:
    • the large informal labour market
    • the fragmentation of the health system
    • fragmented and inadequate funding for the public sector
    • the poor responsiveness of health services (especially in the public sector)
    • bottlenecks associated with the integration of the purchasing and provision functions of EsSalud
    • difficulties in implementing strategic purchasing
    • the absence of a risk-pooling mechanism for different insurance plans
    • the inefficient and inequitable distribution of human resources
  • In response to these problems, in 2013 the Ministry of Health announced a comprehensive reform of the public health sector:
    • reorganisation of the sector and public agencies
    • strengthening the funding of SIS and EsSalud
    • the modernisation of the management of public investments in the sector
    • the modernisation of the national health system (e.g. to shift the focus to promotion, prevention and early detection)
    • a comprehensive reimbursement policy
  • The impact of these reforms is not yet known.
  • Some important areas that need attention with respect to promoting financial protection are:
    • the definition of an explicit benefit package and actuarial projections about its costs
    • improving the efficiency of available resource use
  • Any budgetary increase must be justified by the increased ability of the government to attain its health objectives.

 

Read more in: Seinfeld J, Besich N. 2014. Universal health coverage assessment: Peru. Global Network for Health Equity (GNHE). Available at: http://gnhe.org.