Health Care Financing and Access to Health Care: MSH at Health Systems Research Symposium

Health Care Financing and Access to Health Care: MSH at Health Systems Research Symposium

 {Photo credit: MSH}Colin Gilmartin, Dr. San San Aye, Uzaib Saya, and David Collins present at HSR 2014.Photo credit: MSH

This post originally appeared on the MSH at the Third Global Symposium on Health Systems Research conference blog.

On September 30 – October 3, 2014, nearly 3,000 researchers, program managers, and policy makers convened in Cape Town, South Africa for the Third Health Systems Research Symposium (HSR2014) to review evidence and research focused on improving people-centered health systems and service delivery. A key component to strengthening health systems and improving health outcomes is through health care financing mechanisms.

To explore this issue, three Management Sciences for Health (MSH) staff members participated in a panel entitled the Role of Financing in Improving Access to Health Care: Experiences from Indonesia, Myanmar, Rwanda and other countries. Moderated by Michael Myers, managing director at the Rockefeller Foundation, the panel featured presentations from David Collins, MSH senior principal technical advisor of health care financing, Uzaib Saya, MSH senior technical officer of health care financing, Dr. San San Aye, director of the Department of Planning at the Ministry of Health of the Republic of the Union of Myanmar, and Colin Gilmartin, MSH technical officer of health care financing.

The four presentations highlighted experiences across countries and the impact of health financing strategies on improving access to health care.

Presenting on the economic burden of tuberculosis in Indonesia, David Collins demonstrated how 25-year tuberculosis (TB) case projections can be used to advocate for long-term financing and investment into the health system. Despite increased external financing for TB case detection and treatment in Indonesia, there remains a significant gap in TB services for which the cost of inaction is high. Collins cited the high productivity loss and out-of-pocket spending associated with undetected cases and explained that TB treatment and prevention go hand-in-hand:

The more TB cases that can be treated, the more cases we can prevent.

According to Collins, assuming a TB case treatment rate of about 70 percent, a per capita $0.33 investment in medical costs for TB case detection and treatment can result in per capita $9 of savings to the health system and society as a result of improved productivity.

[David Collins describes the projected financing required to effectively limit the gap in TB services in Indonesia.] {Photo credit: MSH}David Collins describes the projected financing required to effectively limit the gap in TB services in Indonesia.Photo credit: MSH

Presenting on the Government of Rwanda’s community-based health insurance (CBHI) social protection scheme, MSH’s Uzaib Saya cited preliminary research conducted in partnership with the Ministry of Health and the University of Rwanda’s School of Public Health. Findings showed that CBHI has afforded individuals lowered costs of health services and better access to medications. According to Saya, Rwanda’s CBHI scheme, which in 2013 initiated a sliding scale premium structure based on household-level income categories, increased financial protection to the poorest groups. Data from 1,300 households indicate that financial catastrophe was only observed in 0.38 percent of households and impoverishment rates as a result of out-of-pocket health payments have reduced considerably. Nevertheless, according to Saya:

These findings demonstrate that more efforts need to be undertaken to reduce the burden of inequalities related to out-of-pocket payments and CBHI premiums especially for poorer households.

[Uzaib Saya presents on the impact of Rwanda’s Community-Based Health Insurance (CBHI) Scheme.] {Photo credit: MSH}Uzaib Saya presents on the impact of Rwanda’s Community-Based Health Insurance (CBHI) Scheme.Photo credit: MSH

Recognizing the unique health challenges of Myanmar’s 330 townships, Dr. San San Aye presented on the importance of health planning at the township levels and financing in population health, and in achieving a pathway toward universal health coverage. According to Dr. San San Aye, while tax-based financing has increased government health expenditure in recent years, out-of-pocket payments must be reduced and social assistance programs must be increased at the township levels to ensure financial protection of Myanmar’s people.

[San San Aye presents on the unique challenges of Myanmar’s townships and financial investments required to achieve universal health coverage.] {Photo credit: MSH}San San Aye presents on the unique challenges of Myanmar’s townships and financial investments required to achieve universal health coverage.Photo credit: MSH

Colin Gilmartin presented on the costs and cost-effectiveness of integrated community case management (iCCM) programs in seven countries in Sub-Saharan Africa. While iCCM programs are often considered to be a relatively cheap and low-cost intervention for treating childhood illnesses in hard-to-reach areas, results of MSH-led costing analyses indicate that high program costs and low utilization can reduce the cost-effectiveness of such programs. According to Gilmartin, a comprehensive understanding of the costs and financing involved in iCCM programs allows countries, program managers, and policy makers to examine key cost-drivers (e.g. management, supervision, supply chain, and program overhead costs) and to advocate and plan for the efficient use of scarce resources:

Community health worker programs and services must be well-utilized in order to be cost-effective.

[Colin Gilmartin presents pictures of three CHWs from Senegal, Cameroon, and Sierra Leone to illustrate similarities of job functions but also how differences in environments can affect cost of community-based health services.] {Photo credit: MSH}Colin Gilmartin presents pictures of three CHWs from Senegal, Cameroon, and Sierra Leone to illustrate similarities of job functions but also how differences in environments can affect cost of community-based health services.Photo credit: MSH

Learn more about MSH’s role at the Health Systems Research Symposium and about MSH’s other activities related to Health Care Financing.

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