Transforming Healthcare Funding in a Dynamic World
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.
- Healthcare funding
- Medical funds
- Health governance
- Universal Health Coverage
- Progressive health policies
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Presentation Transcript
MEDICAL FUNDS IN A CHANGING WORLD Rajesh Patel BHF July 2018 NAMAF Trustee Training
Outline Business of health fund Health Governance Progressive health policy Standardised benefits Resources
Business of Medical Fund Purpose of MF Why do employers plough millions for staff? Business of Health!
Health Governance Health needs Health benefits/services Interventions Problems identified Health priorities M&E Progressive health policies
<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
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
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
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
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
Standard benefits structure for Social Solidarity Revised PMB Benefits Top-up C Top-up B Top-Up A
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
Regulatory reform Supply side reform Co-ordinated care & Group practices Quality and outcomes improvement ARMs Funder side reform Voluntary changes Regulatory changes
Resources: penny wise and pound foolish Medical advisors Public Health expertise Health economists HTA Health promotion expertise Ethical leadership
