1. Patients Perspective on UHC and Health Benefits Plans Eva Maria Ruiz de Castilla IAPO Board Member President, ESPERANTRA December 6, 2013 Washington, DC Roundtable Discussion on Universal Health Coverage in Latin America and the Caribbean: Health Benefits Plans

2. UHC as a movement The Abuja Declaration (Nigeria 2001) is that low-income governments promoting universal access to health care should devote 15% of their total budgets to health. In 2005, the 58th World Health Assembly adopted a resolution encouraging countries to plan the transition to UHC in their health systems. In 2012 the UN resolution reaffirms WHOs leading role in supporting countries to respond to the challenges of implementing universal health coverage. The resolution, adopted on 12 December 2012, urges governments to move towards providing all people with access to affordable, quality health-care services. The resolution calls on Member States to adopt a multisectoral approach and to work on the social, environmental and economic determinants of health to reduce inequities and enable sustainable development

3. Achieving universal health coverage is a path specific to each country, and no single system or model exists to achieve it. World Bank 2013

4. Select Country Approaches Comprehensive social health insurance programs – Costa Rica, Brazil Primary care/community catchment areas Financial stress, which has led to rationing Progressive defined benefits – Chile, Mexico Plan AUGE and Seguro Popular take an incremental approach Managed competition – Colombia System broke, now being reformed to fix skewed incentives Defined populations – Argentina, Peru Maternal and child health - Plan Nacer and Programa Sumar Cancer coverage - Plan Esperanza

5. No one best-practice approach for the region… and unrealistic to ask that all systems adopt one approach… but there are common elements for success.

6. Common Elements for Success Make sure overall system architecture in place to support UHC Clearly define health governance roles and responsibilities Reorient system financing to support this architecture Define benefits Know what is currently covered Plan to progressively expand, but sustainably Manage coverage information and data Measure effectiveness thoroughly and continuously Plan ahead Multi-year plans and strategies not subject to political whims

7. What patients want to see How is my disease/condition part of the plan? Essential benefits package – what is the minimum guaranteed? What will be done if or when minimum standards do not adequately meet patient needs? How will increasing quantity affect improving quality? Is the plan maximizing a multisectoral approach? Are all sectorsincluding civil societyinvolved in the plans implementation? Is there all-of-society buy-in for the plan? Once in place, how can we guarantee benefits are never rolled-back?

8. Areas for civil society/patient engagement Reliable monitoring of coverage plan(s) impact and effectiveness Continued advocacy reliable diagnostic procedures and processes that underpin quality care multidisciplinary care and disease management approaches Public awareness and patient education programs tied to expanded care initiatives Patient navigation programs

9. Patients support very much the idea and goals of health systems oriented to achieving UHC…. as long as plans are predictable, sustainable, and maintain a focus on progressive improvements in quality care.

10. I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care. Dr Margaret Chan, WHO Director-General Eva Maria Ruiz de Castilla evamaria@esperantra.org MUCHAS GRACIAS!