Transforming Healthcare Funding in a Dynamic World

 
 
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Rajesh Patel
BHF
July 2018
NAMAF Trustee Training
 
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Business of health fund
Health Governance
Progressive health policy
Standardised benefits
Resources
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Purpose of MF
Why do employers plough millions for staff?
 
Business of Health!
 
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Health needs
Health benefits/services
Interventions
Problems identified
Health priorities
M&E
 
 
Progressive health
policies
 
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Source: HQA 2015 reports
 
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Social solidarity
Cross subsidisation
Community rating
Contribution level
Benefit level
Prescribed benefits
Prescribed pricing
Strategic purchasing
Compete on quality and
outcomes
Reduced fragmentation
UHC
 
Information asymmetry
 
Financial
Risk based capital
Anti-selection protection
 
 
 
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Assess progress towards
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http://journals.plos.org/plosmedicine/article?i
d=10.1371/journal.pmed.1001730
Presented as a percentage
 
 
Unmet need
Use (Intervention/Drug)
Quality/Outcomes
 
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 All public sector care & emergency services
Incl. Primary care
Consultation services
Evidence based preventive care
Formulary of procedures, radiology, pathology
Medicine: EDL
Essential devices
Essential dental care
Optical benefit subject to resolution of perverse pricing
 
Rare diseases & Biologics benefits (PMB)
Center of Excellence & Repricing considerations
 
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Supply side reform
Co-ordinated care & Group practices
Quality and outcomes improvement
ARMs
 
Funder side reform
Voluntary changes
Regulatory changes
 
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Medical advisors
Public Health expertise
Health economists
HTA
Health promotion expertise
 
Ethical leadership
 
V
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T
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Exploring the evolving landscape of medical funds and health governance, this presentation delves into the business aspects of health funds, the challenges in achieving access to essential medicines, and the importance of progressive health policies. It discusses the need for Universal Health Coverage (UHC) and highlights key strategies for improving access to quality care and reducing financial risk in healthcare financing.


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  1. MEDICAL FUNDS IN A CHANGING WORLD Rajesh Patel BHF July 2018 NAMAF Trustee Training

  2. Outline Business of health fund Health Governance Progressive health policy Standardised benefits Resources

  3. Business of Medical Fund Purpose of MF Why do employers plough millions for staff? Business of Health!

  4. Health Governance Health needs Health benefits/services Interventions Problems identified Health priorities M&E Progressive health policies

  5. <5year Mortality: scheme X <5year mortality 60 50 48 40 38 36 34 30 20 12 10.3 10 9.7 7.5 7.3 7.1 6.9 0 2010 2011 2012 2013 US MS SA

  6. Access to essentials medicines: Inadequate health governance throughout the value chain! Finance centric rather than health centric! 2010 2011 2012 2013 2014 IHD Aspirin Cover % 61 57 63 62 60 Statin coverage % 67 59 59 59 58 Diabetes I & II Statin coverage % 40 34 35 37 38 Cardiac Failure ACE/ARB Cover % 65 62 60 60 59 Source: HQA 2015 reports

  7. Context that informs policy! UN & WHO SDGs Social Solidarity Community Rating Mandatory membership of sorts Affordable Access to Care UHC NHI Access to meds & vaccines

  8. Progressive health policies Social solidarity Cross subsidisation Community rating Contribution level Benefit level Prescribed benefits Prescribed pricing Strategic purchasing Compete on quality and outcomes Reduced fragmentation UHC Information asymmetry Financial Risk based capital Anti-selection protection

  9. UHC

  10. Effective Coverage Assess progress towards UHC Unmet need Use (Intervention/Drug) Quality/Outcomes http://journals.plos.org/plosmedicine/article?i d=10.1371/journal.pmed.1001730 Presented as a percentage

  11. Standard benefits structure for Social Solidarity Revised PMB Benefits Top-up C Top-up B Top-Up A

  12. New PMB All public sector care & emergency services Incl. Primary care Consultation services Evidence based preventive care Formulary of procedures, radiology, pathology Medicine: EDL Essential devices Essential dental care Optical benefit subject to resolution of perverse pricing Rare diseases & Biologics benefits (PMB) Center of Excellence & Repricing considerations

  13. Regulatory reform Supply side reform Co-ordinated care & Group practices Quality and outcomes improvement ARMs Funder side reform Voluntary changes Regulatory changes

  14. Resources: penny wise and pound foolish Medical advisors Public Health expertise Health economists HTA Health promotion expertise Ethical leadership

  15. Video

  16. THANK YOU

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