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Progress towards universal health care coverage in Asia and the

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					Progress towards universal health-care
    coverage in Asia and the Pacific

Fourth Technical Review Meeting of the Health Policy
         and Health Finance Knowledge Hub

       Nossal Institute, Melbourne, 10-12 October 2011


                                   Marco Roncarati, UNESCAP
ESCAP region
 Universal health-care coverage


  The financing and provision of health-care services
  so that all are covered
 Those of all income levels have equal use of services
 Individuals and households do not incur
  impoverishing expenditure in order to receive a
  socially-acceptable minimum level of services
 Equity in use in relation to need exists, in the case of
  higher income economies
Equality and Equity


  Laws are needed to protect those who are
   most excluded
  Effective policies and programmes need
   to be directed to specific groups of people
  Hence equity is an issue of fairness
   related to need, and needs are not equal
             ESCAP Objective:
                                                                        MDGs
           Inclusive & Sustainable
                                                             UN Resolutions & Mandates
          Development in Asia-Pacific




         Building an Inclusive Society for All
                             Through Social Integration


                                        Young          Older
                                        people        persons
                      Persons                                People living
                        with
                     disabilities   Equality                    with
                                                              HIV/AIDS
                            Migrants       The poor         Women



     Policies, Interventions and Institutional Change
       Cross-cutting: gender mainstreaming, rights-based approach, good governance

               Social Protection                                 Empowerment
      Formal             Informal/traditional      Advocacy/awareness raising
                                                   Education and capacity-development
 Social insurance                                  Economic, legal & political empowerment
                     Societal norms & traditions
 Social assistance                                 measures
                     Community-based
 Social services                                   Labour market policies
                       protection
 Labour market                                     Access to basic services
                     Family-based protection
 policies                                          Networking
 Local funds


ESCAP SDD Conceptual Framework and Thematic Focus
  Social Protection, including Health

 The recent economic and financial
  crisis… vulnerability and the need for
  social protection
 UN GA resolution 65/1 of 22 Sep. 2010
  … united to achieve the MDGs
 Heads of State/Government committed
  to promoting comprehensive systems
  of social protection that provide a
  minimum level of social security and
  health care for all
Social Protection, including Health, cont.

Social protection should:


 Be integrated into broader economic and social strategies to
  guarantee all a minimum level of security
 Move from interventions addressing symptoms of
  vulnerability to systemic transformations eliminating
  underlying causes of persistent poverty and inequality
 Be accorded political commitment at the highest level

 Have policies formulated and implemented by participation
  of multiple actors
Social Protection including Health, cont.


  It is affordable and achievable
  It is an investment with many long-term benefits
  It can bring about more equitable and robust
   economic growth through:
       Greater domestic consumption
       Higher levels of human development
       Greater shared opportunity
Annual cost of basic social protection package,
selected Asia-Pacific countries (as % of GNI)
What is good governance?
Governance in the health-care
sector, cont.
 Enabling conditions
  Political stability
  Strong institutional and policy
   environment
  Commitment to equity
  Good evidence-based decision making
  Strong stakeholder support
Legal approaches to resolve
matters

 Many countries have legislation to protect the
  most vulnerable
 Some have laws or constitutions that entitle
  every citizen to benefit from health protection
 In some cases anti-discrimination laws exist
 In others cash transfers are conditional on
  health-care issues related to children and
  mothers
 However, progress has been relatively slow in
  Asia and the Pacific
Health Protection; Proportion of the
Population Covered by Law (%)
 Country examples
    China
 From 1980s, growth (Socialism with Chinese characteristics) led
  to dramatic poverty reduction; yet, inequality rose (Western
  Regions remain poor)
 Rising out-of-pocket medical expenditure led to a decline in
  equity and access to health services as well as impoverishment
  of families
 In 2003, China launched the New Cooperative Medical System
  (NCMS); as of 2008, over 90% of the rural population, over 800
  million people, had joined NCMS
 Urban Resident Basic Medical Insurance was launched in 2007,
  targeting mainly urban residents without formal employment
 Country examples, cont.
        Sri Lanka
 Success in MDG achievement and poverty reduction. Emphasis
   on physical access to free government health and education
   services
 High-density but low-cost network of rural facilities
 Focus on minimizing price barriers; no user fees in government
   facilities, but also active measures to minimize illegal fees
   charged by staff (good governance)
 Emphasis on risk protection in budget allocations over cost-
   effectiveness; thus the poor have a full range of services
   instead of a restricted range and this has encouraged public
   support and confidence in the system
 In sum, effective targeting of the poor with tax subsidised
   services
Country examples, cont.
       Thailand
 Long-term commitment (40 years to UC in 2002) to providing
  affordable health-care services to the population, especially
  those in greatest need
 From providing free health care to the poor, step-by-step,
  coverage expanded over the years to the entire population
 Within Health Ministry, a long history of reformers and
  advocates pushing hard for UC
 In the health sector, the building of technical capacity has been
  critical in achieving UC, so too have been coalitions, such as
  those including the government, civil society and academia
 Management is the key to sustainability
     Use of Public-Private In-patient
     Services by Income Quintile
                    Bangladesh                                       India                              Indonesia
50                                                   60                                  60

40    Public         Private                         50                                  50

30                                                   40                                  40

                                                     30                                  30
20
                                                     20                                  20
10
                                                     10                                  10
 0
     Q1    Q2           Q3       Q4        Q5         0                                   0
                                                          Q1   Q2       Q3     Q4   Q5        Q1   Q2        Q3     Q4   Q5



                    Sri Lanka                                       Malaysia                            Hong Kong
50                                                   60                                  50

40                                                   50                                  40
                                                     40
30                                                                                       30
                                                     30
20                                                                                       20
                                                     20
10                                                   10                                  10

 0                                                    0                                   0
     Q1        Q2        Q3           Q4        Q5        Q1   Q2       Q3     Q4   Q5        Q1   Q2        Q3     Q4   Q5
In conclusion

 Redistributive polices (tax, pricing, access to credit)
 Political will and good governance
 Macroeconomic stabilization
 Investments in social protection, including health
 Multi-sectoral approaches and stakeholder
  involvement
 Effective legislation and good data/evidence
 Awareness raising and capacity building in health,
  related sectors and the public at large
  roncarati@un.org




Thank You

				
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