Progress towards universal health-care coverage in Asia and the Pacific

1. Progress towards universal health-care coveragein Asia and the Pacific Fourth Technical Review Meeting of the Health Policy and Health Finance Knowledge Hub Nossal Institute, Melbourne, 10-12 October 2011 Marco Roncarati, UNESCAP

2. ESCAP region

3. Universal health-care coverage The financing and provision of health-care services so that all are covered • Those of all income levels have equal use of services • Individuals and households do not incur impoverishing expenditure in order to receive a socially-acceptable minimum level of services • Equity in use in relation to need exists, in the case of higher income economies

4. Equality and Equity • Laws are needed to protect those who are most excluded • Effective policies and programmes need to be directed to specific groups of people • Hence equity is an issue of fairness related to need, and needs are not equal

5. Older persons Young people Persons with disabilities People living with HIV/AIDS Equality Migrants The poor Women Policies, Interventions and Institutional Change Cross-cutting: gender mainstreaming, rights-based approach, good governance Advocacy/awareness raising Education and capacity-development Economic, legal & political empowerment measures Labour market policies Access to basic services Networking Social insurance Social assistance Social services Labour market policies Local funds Societal norms & traditions Community-based protection Family-based protection ESCAP SDD Conceptual Framework and Thematic Focus

6. Social Protection, including Health • The recent economic and financial crisis… vulnerability and the need for social protection • UN GA resolution 65/1 of 22 Sep. 2010 … united to achieve the MDGs • Heads of State/Government committed to promoting comprehensive systems of social protection that provide a minimum level of social security and health care for all

7. Social Protection, including Health, cont. Social protection should: • Be integrated into broader economic and social strategies to guarantee all a minimum level of security • Move from interventions addressing symptoms of vulnerability to systemic transformations eliminating underlying causes of persistent poverty and inequality • Be accorded political commitment at the highest level • Have policies formulated and implemented by participation of multiple actors

8. Social Protection including Health, cont. • It is affordable and achievable • It is an investment with many long-term benefits • It can bring about more equitable and robust economic growth through: • Greater domestic consumption • Higher levels of human development • Greater shared opportunity

9. Annual cost of basic social protection package, selected Asia‑Pacific countries (as % of GNI)

10. What is good governance?

11. Governance in the health-care sector, cont. Enabling conditions • Political stability • Strong institutional and policy environment • Commitment to equity • Good evidence-based decision making • Strong stakeholder support

12. Legal approaches to resolve matters • Many countries have legislation to protect the most vulnerable • Some have laws or constitutions that entitle every citizen to benefit from health protection • In some cases anti-discrimination laws exist • In others cash transfers are conditional on health-care issues related to children and mothers • However, progress has been relatively slow in Asia and the Pacific

13. Health Protection; Proportion of the Population Covered by Law (%)

14. Country examples China • From 1980s, growth (Socialism with Chinese characteristics) led to dramatic poverty reduction; yet, inequality rose (Western Regions remain poor) • Rising out-of-pocket medical expenditure led to a decline in equity and access to health services as well as impoverishment of families • In 2003, China launched the New Cooperative Medical System (NCMS); as of 2008, over 90% of the rural population, over 800 million people, had joined NCMS • Urban Resident Basic Medical Insurance was launched in 2007, targeting mainly urban residents without formal employment

15. Country examples, cont. Sri Lanka • Success in MDG achievement and poverty reduction. Emphasis on physical access to free government health and education services • High-density but low-cost network of rural facilities • Focus on minimizing price barriers; no user fees in government facilities, but also active measures to minimize illegal fees charged by staff (good governance) • Emphasis on risk protection in budget allocations over cost-effectiveness; thus the poor have a full range of services instead of a restricted range and this has encouraged public support and confidence in the system • In sum, effective targeting of the poor with tax subsidised services

16. Country examples, cont. Thailand • Long-term commitment (40 years to UC in 2002) to providing affordable health-care services to the population, especially those in greatest need • From providing free health care to the poor, step-by-step, coverage expanded over the years to the entire population • Within Health Ministry, a long history of reformers and advocates pushing hard for UC • In the health sector, the building of technical capacity has been critical in achieving UC, so too have been coalitions, such as those including the government, civil society and academia • Management is the key to sustainability

17. Use of Public-Private In-patient Services by Income Quintile

18. In conclusion • Redistributive polices (tax, pricing, access to credit) • Political will and good governance • Macroeconomic stabilization • Investments in social protection, including health • Multi-sectoral approaches and stakeholder involvement • Effective legislation and good data/evidence • Awareness raising and capacity building in health, related sectors and the public at large

19. roncarati@un.orgThank You