Financial Sustainability and Social Franchises for Health

SOCIAL HEALTH INSURANCE PHILIPPINES

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 1 st and 2 nd 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 - 3 rd and 4 th normal delivery – increased case rates levels

But…. Be careful with constrained thinking – “2 nd 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 GOVERNMENT BANGLADESH

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