Financial Sustainability and Social Franchises for Health

Government as Purchaser of Health Services

SOCIAL HEALTH INSURANCEPHILIPPINES

Social Health Insurance

• Medicare in the early 70s – Formal sector scheme– Mostly hospitalization benefits– Deliveries were considered “non-insurable” and

only first deliveries were paid for as “episiorrhaphy”

– Private sector health care providers were always part of the scheme

Philippine Health Insurance Corporation (PhilHealth)

• 1995 – Medicare to PhilHealth

• Beyond the formal sector– (local + national ) government were to subsidize the poor

• In 2012, national government fully subsidized the poor identified by the Department (Ministry) of Social Welfare and Development

• Beyond inpatient care – Comprehensive benefits from primary care, outpatient

medicines to complex inpatient care• Beyond doctors

– Providers can include other health professionals

Continuing journey

• 2001 – coverage of 1st and 2nd normal deliveries done by doctors and other health professionals in non-hospital facilities– Paid by case payment

• 2002 – rationalization of coverage of ambulatory/day surgeries/procedures

• 2006 – coverage of newborn care in non-hospital facilities

• 2007 – facility-based deliveries became national policy

• Later - 3rd and 4th normal delivery – increased case rates levels

But….

• Be careful with constrained thinking– “2nd normal delivery in midwife run clinics”

• Missed opportunities– System accreditation was approved in 2006 by the Board

but not fully implemented

– Global payment implementation was suspended in 2013

– Consolidation of primary care benefits and maternity care package benefits + other outpatient benefits still ongoing• 5 in 1 contracting as a temporary measure

CENTRAL GOVERNMENTBANGLADESH

Urban Primary Care Project

• Local Government Division of the Ministry of Local Government, Rural Development and Cooperation

• Funding from the Government, ADB, UNFPA and Nordic Development Fund

• Partnership agreements with 9 local NGOs, 2 national affiliates of international NGOs (and the Chittagong City Corporation) for the provision of primary care services

• Paid per capita to deliver a basic package of services– Contracts can be terminated for poor performance– Bonus system

EMERGING TRENDS IN ASIA AND THE PACIFIC

• Expansion of social health insurance systems by subsidizing the poor and (the non-poor) informal sector

• Central government (National/Federal Ministries) becoming purchasers of health services

• Inclusion of private sector health care providers in Universal Health Coverage (UHC) strategies