Cheryl Cashin

Moving towards universal health coverage: lessons from 11 country studies

In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls--but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.

Implementing pro-poor universal health coverage.

Universal health coverage (UHC) - the availability of quality affordable health services for all when needed without financial impoverishment - can be a vehicle for improving equity health outcomes and financial wellbeing. It can also contribute to economic development. In its Global Health 2035 report the Lancet Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and financial protection to poor people from the beginning and that include people with low income in the design and development of UHC health financing and service provision mechanisms.

A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam

Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

Provider payment arrangements are currently a core concern for Vietnams health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnams health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnams health system objectives.

Costing of commune health station visits for provider payment reform in Vietnam

Expanding effective coverage in Vietnam will require better use of available resources and placing higher priority on primary care. The way providers are currently paid does not give priority to primary care and does not reflect the costs of delivering services. This paper aims to estimate the unit costs of primary care visits at commune health stations (CHS) in selected areas in Vietnam. Seventy-six CHS from two provinces in northern Vietnam were studied. Costs were calculated from the perspective of the CHS using the top-down costing using the step-down cost accounting technique in order to estimate the full cost of delivering services. On average, the cost of one outpatient visit in mountainous, rural and urban CHSs was VND 49,521 (US

Health financing policy : the macroeconomic, fiscal, and public finance context

2.40), VND 41,375 (US

Une couverture sanitaire universelle pour un développement durable inclusive : une synthèse de 11 études de cas pays

2.01) and VND 39,794 (US

Health system research in Vietnam: Generating policy-relevant knowledge

1.93), respectively. Personnel costs accounted for the highest share of total costs followed by medicines. The share of operating costs was minimal. On average, CHSs recover 18.9% of their total cost for an outpatient visit from social insurance payments or fees that can be charged patients. The results provide valuable information for policy-makers as they revise the provider payment methods to better reflect the costs of services and give greater priority to primary care.

Universal health coverage for inclusive and sustainable development : a synthesis of 11 country case studies

Universal health coverage (UHC) requires adequate financial resources to pay for necessary health services. These resources must be able to be both pooled (to provide financial protection) and redistributed (to maintain equity), and should be raised efficiently and equitably. The World Bank and the World Health Organization (WHO) have long supported analysis and policy dialogue for stronger health financing systems that can achieve health system goals, including reaching and sustaining universal health coverage. The main objective of this guidance note is to outline the key components of the macroeconomic, fiscal, and public financial management (PFM) context that need to be considered for an informed health financing discussion at the country level. The guidance note is organized as follows: chapter one gives introduction. Chapter two presents the objectives for health financing policy dialogue and baseline indicators that can form the starting point for discussion. Chapter three discusses the key aspects of the macroeconomic and fiscal environment that will determine realistic government health spending scenarios, as well as aspects of the government budgeting practices that will influence allocation decisions. Chapter four discusses the different options for sources of revenue for the health sector, and how to assess their feasibility and potential adverse consequences. Chapter five discusses options and constraints in resource flows and PFM systems for better alignment of health funding with priorities through better pooling of health revenues and purchasing. Chapter six discusses how to assess the fiscal sustainability of health expenditure and identify opportunities for efficiency gains and for getting more value for money in health spending.

Cobertura universal de salud para el desarrollo inclusivo y sostenible : una síntesis de 11 estudios de caso de país

The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.