Professional Documents
Culture Documents
Lessons for Low and Middle Income Countries in Asia Presented by: Dr. Eduardo Banzon
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
Outcomes Coverage of interventions Coverage with a method of financial risk protection Risk factors
Social Determinants
70
60 50 40 30
20
10 0
DOTS coverage
(anti-TB services)
Births by SBA
(Maternal Health services)
CPR
(contraceptive services)
98100
9199
100
NA
13-56
98100
66100
98100
74100
2437
3860
100
6488
47100
9-35
(data from 6 countries)
1779
1987
438
DOTS Directly observed therapy for tuberculosis; ART Antiretroviral therapy; SBA Skilled birth attendants; CPR Contraceptive prevalence rate
Social health insurance Private health schemes (SHI) insurance schemes (PHI)
Nationals are subsidized into SHI schemes in some countries Mandatory for expatriate population in some countries
High Income
Middle Income
Formal sector employees, Primary and/or para-statal organizations, supplementary health vulnerable population but insurance for formal covered services are private sector variable employees
Employees of Large employers- through directly provided services Limited community health insurance schemes
Low Income
Formal private sector Formal sector employees employees but limited in some countries in scope
LESSONS
Annual premium
Family pays 4 LE Government pays 12 LE per student Earmarks of 0.10 LE per cigarette pack as supplemental funding
Benefits/Providers
HIO benefits + preventive care funded by Ministry of Health HIO runs around 6000 school clinics
All Expatriates
Total Population and estimated migrants in GCC countries 2010
Mandatory health insurance in UAE, Saudi Arabia and Qatar for all expatriates
PRE-PAYMENT EMPOWERS the POOR and VULNERABLE POINT of CARE COVERAGE FAVORS the NON-POOR
CONVERGE MoH-funded PRIMARY HEALTH CARE and HEALTH INSURANCEfinanced FAMILY PRACTICE
Different approaches
Pooled procurement
Turkey Jordan
3.10%
3.08%
2.66%
2.26% 2.09%
2.00%
1.50% 1.00% 0.50% 0.00% 2007 2008 2009 2010 2011
35.8% 31.6%
30.0%
25.0% 20.0% 15.0% 10.0% 5.0% 0.0%
22.7%
22.4%
22.6%
2007
2008
2009
2010
2011
Public Pharmaceutical Expenditure (2012 Prices - million TL) 1994 6.244 2002 14.624 2012 14.484
Tunisias CNAM
Government provider choice (70% of members)
Services provided by MOH health facilities + CNSS polyclinics and
military hospitals No co-payments for members
Different Approaches
Moroccos Obligatory Health Insurance law (AMO)
Created a government agency (AMAN) to supervise all health
insurance CNSS (for private sector) and CNOR (for government) benefits are based on AMO. AMAN manages the RAMED scheme
Amendments to Social Security and UHI Law adopted by the Grand National Assembly and signed by the President
Family medicine implemented in Elazig, Isparta, Samsun, and Izmir provinces.
Green Card holders to receive same benefits as enrollees in other health insurance schemes under UHI
Decree in Force of Law no. 663 on the Organization and Duties of the Ministry of Health and Its Affiliates passed establishing the Public Health Institution and Public Hospitals Union and moving the MoH into a stewardship role and away from provision and financing. Decree also establishes positive incentives for NCD prevention and control in family medicine.
2006 2007
2008 2009
2010 2011
2012
Health payments of civil servants and their dependents relocated to SSI Family Medicine implemented countrywide, including Ankara and Istanbul
Performance-based payments piloted in ten MoH hospitals Global budget implemented for MoH hospitals Implementation of Law 5502 (integration of social security institutions) begins Family medicine implemented in Eskisehir, Edirne, Denizli, Adiyaman and Gumushane provinces
Family Medicine implemented in the provinces of Rize, Trabzon, Tunceli, Uak and Bursa
By 2012 in TURKEY
FINANCE
General Government Budget (MoF)
Primary Health Care
SERVICE PROVISION
MoH
Emergency Transport Public hospitals / Dent. Clinics
Private Hospitals Regulation And Small Centers PUBLIC Private Physician Offices
Pharmacies
29 25
50
25
1998
1998
2003
2005
2003