Info Service on Health Issues (Jun14/03)
Dear friends and colleagues,
On the sidelines of the 67th World Health Assembly 19 – 24 May 2014, ASEAN plus Three Countries jointly organized a meeting on Universal Health Coverage. See below a write up on the meeting.
Health Coverage for 2.1 Billion Populations: Lessons Learned
from ASEAN Plus Three Countries”
Following introductions, the Chairperson of ASEAN Plus Three UHC Network, Dr Winai Sawasdivorn, informed the audience that of the countries represented in the panel, China, Japan and Malaysia had achieved up to 95% UHC coverage while Indonesia and Viet Nam are at different stages but moving towards full coverage. The audience would first hear the experiences of countries that are moving towards full coverage following which panelists from China, Japan and Malaysia, which had almost full coverage, would relate their do’s and don’ts.
Amongst the lessons learnt was that it was necessary to identify and specify informal groups so that these did not fall through the cracks. Local government must play a lead role in ensuring that as many people as possible come on board the health insurance scheme. The shift from individual health insurance to family based schemes was another important learning.
The Ministry has set itself the highly ambitious target of full coverage by 2019. People would have the options of selecting between government paid or worker premium schemes.
The country faced many challenges on the implementation front in view of large health care inequities between rural and urban areas. Although 30% of the rural population is covered, between 20 – 30 million people remain uncovered. This is in fact the most difficult challenge for the government.
In her brief address to the meeting, Dr Margaret Chen, DG of WHO, informed that when Member States (MS) first introduced the resolution on UHC many years ago, country focus at the time was on health financing. She added that feedback showed that countries did not object to the important principle of equity in UHC.
“WHO is clear in its support of UHC because it is equitable. How countries structure and finance coverage has to be context specific. For example Brazil staunchly supports that service provision should be public sector driven. In other countries, there may be a sharing between public and private sector providers. WHO plays the role of knowledge collector and sharer with MS. It is up to the country to determine whether it wants coverage to be totally public, totally private or a mix of both. WHO does not take any position on this,” she reiterated.
She asserted that WHO does not give priority to private sector health insurance but leaves each individual country to decide which system works best for it. “Nobody should be denied access to care because they are poor, rural, female or indigenous. Lend your support to UHC. It is your decision on how the post 2015 Sustainable Agenda should be developed.”
As a result, every Malaysian has access to a health facility within a 5km radius of the home. Infant mortality rate had decreased to 6.6 in 2011; life expectancy which was less than 60 years is now 77 years for women. Malaysians have a high level of risk protection – up to 97% - and catastrophic health expenditure is extremely low.
“Our main challenge is tertiary care, which has become very expensive and techno-centric. The public expects high quality care and our problem is difficulty in meeting those expectations,” stated Dr Subramaniam.
The country is seeing a rapid increase in the aged; Non-communicable diseases are rising as are problems associated with these. “The public health system is state funded while private health care is employer subsidized. The rate of out-of-pocket payments is rising, reaching 77% in some instances. The government’s ability to fund this type of system is becoming burdensome,” he added.
In view of these challenges, there is now a renewed emphasis on preventive primary care which the government is actively and aggressively promoting. The push to maximize the utilization of manpower through re-engineering processes based on existing infrastructure is one strategy that is being pursued.
“Cost co-sharing is being explored but this is an explosive issue politically- there is strong public opposition to this and the government is trying to get the public to buy-in to this. Government health expenditure on health stands at RM50 billion and clearly the private sector has the capacity to assist. We are trying to build bridges between the public and private sectors,” he concluded.
He indicated that preventive health must take priority over treatment. In Japan, the long term care system is vital in view of the rapidly aging population.
The National Health System in Japan was initiated in 1922 and covered only the employed. Currently the country has two schemes: for the employed and the non-employed.
He agreed that Japan’s health insurance scheme was quite similar to Malaysia and Vietnam. However comparatively in Japan there was a very large middle income population and almost all its population could presently be classified as middle class. Medical care in Japan is free and most of the hospitals are occupied mainly by the aged. As a result long term care facilities for the aged have been set up and concurrently there has been the introduction of a long term care insurance system. Because long term care to the ages is generally very expensive, the preference was to provide this, through community care.
The main health issues faced by the aged are dementia and loneliness; suicide is an associated factor.
delivery of PHC is being strengthened through the government’s recruitment
of qualified health care workers. China had benefitted from
the experiences of various countries on what works and what does not,
during this process of health systems reform. The following
principles were clear:
In spite of its achievements, the country continues to face many challenges including a rapidly ageing population, Non-Communicable Diseases, lifestyle related expectation. She stressed that evidence-based health policy makes a big difference to UHC.
the lessons learnt in the process were:
In her summing up WHO’s Dr Marie-Paul Kieny reiterated that availability, affordability and good quality were the basis for UHC. She indicated that even the richer countries struggle to meet changing health needs and demands. For example Japan is taking action to provide more community based health care in view of its rapidly aging population.
She asserted that UHC is not a vague concept; it was clearly defined. ASEAN countries had shown that UHC was feasible and that all countries can make measurable progress.
by: Shila Kaur