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Health care policy in Palestine: challenges and opportunities Motasem Hamdan, Ph.D. School of Public Health, Al-Quds University, Jerusalem

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Presentation on theme: "Health care policy in Palestine: challenges and opportunities Motasem Hamdan, Ph.D. School of Public Health, Al-Quds University, Jerusalem"— Presentation transcript:

1 Health care policy in Palestine: challenges and opportunities Motasem Hamdan, Ph.D. School of Public Health, Al-Quds University, Jerusalem

2 Health care policy in Palestine 2 Outline Introduction Overview about the Palestinian health care system Recent policy changes: –financing –provision of services Public policies on private for-profit health sector –Characteristics –Factors affecting emergence and growth –Role in provision of health care –Impact on availability and accessibility Conclusions

3 Health care policy in Palestine 3 Introduction: historical background 1993 the Oslo peace agreement and the transitional context the Oslo peace agreement and the transitional context the establishment of the Palestinian Ministry of Health (MOH) and the changeover of authority on the health sector the establishment of the Palestinian Ministry of Health (MOH) and the changeover of authority on the health sector. Earlier a division of the Israeli Ministry of Defense administered the public PHC clinics and hospitals. Earlier a division of the Israeli Ministry of Defense administered the public PHC clinics and hospitals. Reform in the health care system has focused on financing and provision of health care. Reform in the health care system has focused on financing and provision of health care.

4 4 PROVISION* The public sector: the MOH and the security forces medical services. United Nation Relief and Working Agency (UNRWA) NGOs Private for-profit FINANCING Private: out of pocket spending (37%). Public: general taxation, GHI premiums, services charges (32%). External funds: including UNRWAs financing (24%). NGOs (7%). [World Bank, 1997] SOCIETY /PATIENTS 38.6% covered by the Governmental Health Insurance scheme, (MoH, 2003) 14.8% covered by UNRWA, registered refugees (PCBS, 2004) 7. 8% covered by private insurance schemes, and (PCBS, 2004) About 40% without any insurance coverage (PCBS, 2004). * Some overseas providers are contracted for tertiary care. Health care services relationship e.g. supplies, coverage and entitlement. Monetary relationships, e.g. remuneration of providers, user fees/ patient contributions, premiums, and services revenues. The Palestinian health care triangle (Hamdan et al, 2002)

5 Health care policy in Palestine 5 Major public policy change: financing health care 1. Increasing the governmental or public spending on healthcare. Governmental Health Insurance ( 2. Shift in the sources of public financing from Governmental Health Insurance (GHI) revenues to more based on general tax revenues; GHI premiums were 19% of public spending in 1991 to be 8% in

6 Health care policy in Palestine 6 Major public policy change: financing health care of Governmental Health Insurance scheme, by opening the scheme for voluntary enrolment by those who were not required to participate and reducing premiums. 3. Expanding the coverage of Governmental Health Insurance scheme, by opening the scheme for voluntary enrolment by those who were not required to participate and reducing premiums. (Source of data: MoH, 2000; MoH 2003)

7 Health care policy in Palestine 7 PROVISION* The public sector: the MOH and the security forces medical services. United Nation Relief and Working Agency (UNRWA) NGOs Private for-profit FINANCING Private: out of pocket spending (37%). Public: general taxation, GHI premiums, services charges (32%). External funds: including UNRWAs financing (24%). NGOs (7%). [World Bank, 1997] SOCIETY /PATIENTS 38.6% covered by the Governmental Health Insurance scheme, (MoH, 2003) 14.8% covered by UNRWA, registered refugees (PCBS, 2004) 7. 8% covered by private insurance schemes, (PCBS, 2004) About 40% without any insurance coverage (PCBS, 2004). * Some overseas providers are contracted for tertiary care. Health care services relationship e.g. supplies, coverage and entitlement. Monetary relationships, e.g. remuneration of providers, user fees/ patient contributions, premiums, and services revenues. The Palestinian health care triangle (Hamdan et al, 2002)

8 Health care policy in Palestine 8 Public policy: strengthening provision of health care –Strengthening the public sector capacity in the health care delivery –Promoting the private sector role in health care delivery

9 Health care policy in Palestine 9 Consistent public policy toward enhancing the public provision of health care since 1994

10 Health care policy in Palestine 10 Provision of health care: the role of the private health sector Private health sector is all individuals and organisations working outside the direct control of the government, including for-profit and not-for-profit initiatives e.g. NGOs. Private for-profit practices, accessibility to is determined by the ability and willingness to pay. The focus here is on the for-profit private sector.

11 Health care policy in Palestine 11 Provision of health care: Characteristics of the private for-profit practices Important role in providing ambulatory medical care. Significant growth in private for profit practices after Significant growth in private for profit practices after Prevalence of private practices in the West Bank more than in Gaza Strip due to economic reasons. Concentration in the urban areas. Mainly focus on curative medical care.

12 12 MoH, NGOs and UNRWAs sector consists of PHC clinics of different level. Private for-profit sector consists of self-employed GP, specialists physicians and dental clinics Role of the private for profit sector in the provision of health care in Palestine

13 Health care policy in Palestine 13 Role of the private for profit sector in provision of health care in Palestine: recent growth

14 Health care policy in Palestine 14 Role of private sector in the provision of hospital services

15 Health care policy in Palestine 15 Role of private sector in the provision of hospital services: recent growth

16 Health care policy in Palestine 16 Reasons behind the growth of the private sector A public policy towards promoting private health provision seems evident. –Lack of proper regulating processes e.g. accreditation and licensing of private facilities is very weak. –Shortages of the governmental capacity in providing health care e.g. contracting out the private sector for providing tertiary health care. Other factors – Prospects of political stability and economic security in the post- Oslo period –Donor driven policies towards promoting the private sector, decrease state involvement in health care provision.

17 Health care policy in Palestine 17 (Source: MoH) Impact on the availability of health services

18 Health care policy in Palestine 18 Private for-profit practices: Impact on the accessibility Accessibility to private for-profit practices is determined by the ability and willingness to pay for services. However, 65% of population are living below the poverty line (2US$ per day) as of 2003.

19 Health care policy in Palestine 19 Private for-profit practices: Impact on the accessibility Health insurance schemes and coverage of private services: 1.Governmental Health Scheme (GHI) about 38% of the Palestinian households enrolled, but covers only public providers unless they referred for care not available by the MoH. 2. UNRWA system serve registered refugees, about 15% of the Palestinian households. UNRWA also covers services available at its clinics, yet outsource some limited services from private providers. Patients have to contribute to the cost. 3.Private insurance schemes, covers about 7. 8% of the households and covers specific packages of services. 4.About 40% without any health insurance coverage.

20 Health care policy in Palestine 20 Conclusions Weakness of the public capacity to provide health care has contributed to the flourishing of the private health sector. Policies of promoting the private sector have had positive impact on the availability of services, but created inequitable patterns of accessibility between different socio-economic groups. Integration and complementarity policies accompanied with appropriate regulation and monitoring by the government (the Ministry of Health) are necessary.

21 21 Demographic Population (million)3.73 Population growth rate2.4% Population under 15 years46% Dependency ratio97 Median age16.7 Life expectancy at birth72.3 Literacy rate is among individuals aged 15+91% Health Crude birth rate per 1000 population27.2 Crude death rate per 1000 population2.7 Infant mortality rate per 1000 live births24 Neonatal mortality rate per 1000 live births11 Child < 5 mortality rate 1000 live births21 Deliveries at health institutions95% Maternal mortality ration births12.7 Population covered by the GHI scheme38% Population is living under poverty line (less than US$2 per day) (%) 65%

22 22 Health Crude birth rate per 1000 population27.2 Crude death rate per 1000 population2.7 Infant mortality rate per 1000 live births24 Neonatal mortality rate per 1000 live births11 Child < 5 mortality rate 1000 live births21 Deliveries at health institutions95% Maternal mortality ration births12.7 Population covered by the GHI scheme38% Resources Hospital beds per population12.5 Population per physicians1200 Population per dentists12750 Population per nurse762 Percent of GDP spent on health7.4% Economic GDP per capita US$895 Unemployment rated31% Population is living under poverty line (less than US$2 per day) (%) 65%

23 Health care policy in Palestine 23 Main causes of death all age groups, Heart disease 20.1% 2.Cardiovascular disease 11% 3.Conditions in prenatal period 9.7% 4.Malignant neoplasm 9% 5.Transport accidents 7.5% 6.Other accidents 7.5% 7.Senility 5.7% 8.Pneumonia 4.8% 9.Diabetes mellitus 4% 10.Renal failure 3.4 % 11.Infectious diseases 2.9%

24 Health care policy in Palestine 24 Main cases of child (0-4 age) death: Conditions in prenatal period 48.4% Congenital malformations 14.4% Septicaemia 5.4% Peunomia 5.1% Accidents 4.6% Sudden infant death syndrome 4.8% Malformation metabolic disorders 2% Heart disorders 1.7% Cerebral Palasy 1.6% Malignant neoplasm 1.1%

25 Health care policy in Palestine 25


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