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HIP Study Update and Progress

HIP Study Update and Progress HIP Platform meeting 7 October 2010. Agenda. Aim & Objectives HIP Study Literature Review Stocktaking ‘Dutch Organization’s Policies and Interventions’ Progress

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HIP Study Update and Progress

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  1. HIP Study Update and Progress HIP Platform meeting 7 October 2010

  2. Agenda • Aim & Objectives HIP Study • Literature Review • Stocktaking ‘Dutch Organization’s Policies and Interventions’ • Progress • Monitoring & Evaluation Model • Country Case Studies Amsterdam, The Netherlands www.kit.nl

  3. Objective HIP Study • Overall objective • To document the existing evidence-base on the performance of different health insurance arrangements in low income countries and linking the evidence to existing and future policies of Dutch stakeholders and their partners • Literature review • Stocktaking Dutch organization’s policies and practices • Development of M&E tool • Testing M&E tool with Southern partners (Country case studies) Amsterdam, The Netherlands www.kit.nl

  4. Criteria • Resource mobilization • Financial protection • Utilization • Performance of health services (e.g. quality of care) • Social inclusion • Community empowerment Amsterdam, The Netherlands www.kit.nl

  5. Literature review • Progress • Literature review has been completed • Writing articles in process • Presentations • 8th European Conference on Health Economics, July 2010, Helsinki • 1st Global Symposium on Health Systems Research, November 2010, Montreux Amsterdam, The Netherlands www.kit.nl

  6. Literature review • Main findings • Overall, the evidence on impact of health insurance in low income countries in Africa and Asia is fragmented • Positive impact on utilization (SHI, CBHI), financial protection (SHI, CBHI) and resource mobilization (CBHI). • The impact of health insurance (SHI, CBHI) on social inclusion is inconclusive • The number of observations for PHI is too limited to draw solid conclusions • The impact of health insurance on community empowerment, quality of care and resource mobilization are under researched based on the limited number of observations Amsterdam, The Netherlands www.kit.nl

  7. Literature review • Conclusions and recommendations • No sound scientific evidence • However evidence suggests early indications of positive contributions to utilization and financial protection • Diverging research methods, perspectives and a lack of longitudinal data hamper the comparability of studies • Longitudinal studies will increase the robustness of evidence • Broader set of impact criteria are required for a comprehensive assessment Amsterdam, The Netherlands www.kit.nl

  8. Stocktaking policies and practices • Research questions • What are existing policies and interventions? • What are existing policies regarding M&E? • Methodology • Questionnaire: 40 organizations invited  28 respondents working for 26 organizations • 7 In depth interviews Amsterdam, The Netherlands www.kit.nl

  9. Types of organizations working on health insurance • NGOs working in the field of development cooperation • Karuna Foundation • Prisma • HealthNet TPO • Cordaid (3 respondents) • Intervolve • ICCO & Kerk in Actie • STOP AIDS NOW! • AIDS Fonds • Oxfam Novib • Tear • LEPRAZending • SNV Ghana, Cameroun, Mali, Burkina Faso, Niger • NGO working on micro health insurance • Micro Insurance Academy • University • Erasmus University Rotterdam • Radboud University Nijmegen MC • Nijenrode Business University • University of Twente • Knowledge/Research Institute • Royal Tropical Institute (KIT) • African Studies Centre Leiden • Consultancy Firm • Ecorys • ETC Crystal • Insurance Company • Agis – Stichting De Ziekenfondsbode Amsterdam, The Netherlands www.kit.nl

  10. Organization’s motives to work on health insurance Health insurance is our core business Increase accessibility for poor and vulnerable Increase utilization for poor and vulnerable Stimulate resource mobilization Protection catastrophic health expenditures Increase performance (quality,efficiency,coverage) To empower the community To achieve a provider/purchaser split Best price/quality mix through a contracting approach To foster a public-private mix for health Strengthen the business function for sustainability Amsterdam, The Netherlands www.kit.nl

  11. Type of health insurance schemes Amsterdam, The Netherlands www.kit.nl

  12. Geographical area and magnitude Amsterdam, The Netherlands www.kit.nl

  13. Monitoring & Evaluation - responsibility Amsterdam, The Netherlands www.kit.nl

  14. Monitoring & Evaluation – focus • Focus monitoring • Input and process - financial • - managerial, organizational • Focus evaluation • Output – membership rates, renewal rates • Initial outcome - utilization rates, perceived quality of care • Medium-term outcomes – rarely considered • (catastrophic health care expenditures, risk-coping strategies, resource mobilization and empowerment of community) • Long-term impact – rarely considered • (socio-economic status, health status) Amsterdam, The Netherlands www.kit.nl

  15. Monitoring & Evaluation – focus Amsterdam, The Netherlands www.kit.nl

  16. Conclusion Amsterdam, The Netherlands www.kit.nl

  17. Recommendations • M&E performed at the moment is narrow and could gain more value by including indicators to measure medium-term outcome of the health insurance scheme • Invest in the development of an M&E system that allows a continuous monitoring of the process of establishment and implementation of the health insurance arrangement and for the evaluation of the output, short- and medium-term outcomes of the schemes • M&E should be undertaken systematically on an ongoing basis, based on the six key criteria Amsterdam, The Netherlands www.kit.nl

  18. Further steps… • Development Monitoring & Evaluation Model • (April 2010 – Feb 2011) • Country case studies (Nov 2010 – Jan 2011) • Dissemination (March 2011) Amsterdam, The Netherlands www.kit.nl

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