Update from Malaysia conference. Universal coverage

Universal Coverage – Can we guarantee health for all?
3 – 4 October 2011, Kuala Lumpur
Nossal perspective
Symposium Overview
Monash University, Sunway campus, Malaysia and
Jeffrey Cheah Foundation
Participants: Policy makers, Academia, WHO, private health sector &
insurance companies
Countries: Australia, Bangladesh, China, Ghana, India, Indonesia, Malaysia,
Philippines, Thailand, Singapore, South Africa & Sudan
Keynote address
Scientific papers: 20
Jeffrey Cheah Global Health Oration
Panel Discussions
The Symposium discussions
Reflected on the practical implications of the
The World Health Report 2010
‘Health Systems Financing: The Path to Universal Coverage’ and
The Health Financing Strategy for the Asia Pacific Region (2010-2015)
Reviewed experiences and explored opportunities to strengthen health
system to accelerate progress towards universal coverage
Found out more about what it meant to work as part of universal coverage
Key Areas of Discussions
Diseases burden & healthcare priorities
Service infrastructure & health workforce
Measurement, monitoring and health information system
Gaps in health governance
Health financing
Experiences in universal health coverage
Key Issues
Health Financing
High out of pocket spending
Low and fragmented public financing
Resource mobilization for universal coverage is a major challenge
Social health protection schemes against catastrophic cost
Gaps in implementing the national health insurance programme
Increase the extent of population coverage: How to cover informal sector?
Types of services should be covered by universal coverage
Increasing burden of NCDs on ability to achieve and sustain UC
Benefit package design: Equity in benefit package
Readiness of the health system
Fragmented public-health care system
Private sector involvement in support of universal coverage
Coverage is a specific question in health financing terms
In the provision of adequate services and
in providing access to them specially by the poor through targeting mechanisms
Level of coverage:
How to extend coverage to those in the informal sector remains a major
challenge for universal coverage
Poverty-focused demand-side financing mechanisms as a means for
moving towards universal coverage
Health Equity Fund (HEF)
Community Based Health Insurance (CBHI)
Conditional Cash Transfer (CCT)
Country case studies: Barriers to scaling up for universal coverage
Cambodia: Scaling up of HEFs and CBHI
Lao PDR: National Health Insurance Authority
Assist the Ministry of Health and develop partners to strengthen the institutional
arrangements for the implementation of a national system for universal health
Cambodia: preliminary results
Revenue collection:
Harmonizing funding- Agreement of the donors
Pooling: Pooling would be difficult
Purchasing and provision of services:
Role of National Agency in purchasing & provision of services: Third party management
Standardization of benefit package
Provider payment mechanism
Accreditation, management and evaluation to ensure quality of care
When policy change will be implemented remains unclear
Where will National Social Security Fund (HEF+CBHI) be?
Role of Ministry of Health as an implementer (Capacity?)
Harmonizing regulations, guidelines (HEF+CBHI) & M&E plan
Revenue collection:
Subsidy needed to cover the informal sector
Simplified and computerised claim procedures
Pooling: Agreement on amounts to be pooled from social insurance and donor funds
Purchasing and provision of services:
Purchasing and provision policies
Provider payment policies
Policy related to benefit package
Fund management at the district and provincial level
Approval of the decree will take time
Location of National Health Insurance Authority undecided
Capacity needed for implementation
Free maternal health care
Implications and next steps
Key policy and implementation challenges identified
Synthesize our findings with available international evidence
Assesses issues and options for integration of social protection schemes
with respect to design factors and implementation procedures
Policy options and strategic directions regarding institutional arrangements
Based on the initial findings and recommendations, consultation meetings/
workshops will be organized with higher level officials from MOH, other relevant
government agencies and development partners