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Health Systems Reform

HCM 742: Financing and Insurance Schemes


Spring 2018 – Fourth Semester, Second Quarter – Week Ends
Isaac El-Mankabadi; BSc, MPH
Overview
• Why Health Reform?
• Definitions and Synonyms
• Types of health reforms
• Objectives of health reform
• Implementation of reform
• Health reform in Egypt

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Why Health Reform
• Healthy people are essential element in human
development
• Health population are more productive

On the Other Hand

• Continuous increase in costs of health care


services worldwide (Cost escalation)
• Scarcity of resources
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Health is Essential Element for Social
& Political Stability

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Definition
• Health Reform is:
“Better health system for better
health”
(PHRplus)

“Continuous process to improve efficiency,


effectiveness and equity of health sector”
(Langen 1993)
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Types of Health Reforms
• Limited Reform “Small R”
Concentrates on reforming specific area of
health systems through vertical programmes
(immunization, family planning, IMC, etc.)
• Comprehensive reform “Big R”
Includes all components of health system as
models of service delivery, financing, etc.
(Bermen and Bossert 2000)
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Why Health Reforms
• Insufficient financing;
• Poor quality of health care services;
• Inefficiency;
• Misuse (moral hazards) of health care system
by beneficiaries;
• Demotivation and demoralization of providers
to improve their performance due to
inappropriate remuneration system.
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Implementation of reforms
Two mechanisms
• Piloting
Through implementation of planned changes in
certain area and to role it out gradually.
• Big Bang
Immediate implementation of planned changes
everywhere at the same time.

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From piloting to universality
Rolling out reformed/modernized model
throughout the country has to start after
• Fulfillment of health needs of the population;
• Efficient – achieving best utilization of available
resources; and
• Sustainable – there are enough resources to
sustain the model

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How to start Health Reform
• Needs Assessment
Determining existing deficiencies/problems of
current system through health system research
(HSR)
• Vision for reform
Development of common vision for the
reformed/ideal system among all stakeholders

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WHO HealthCare Reform Approach
(Health System Analysis Approaches)

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How to start Health Reform
Development of a strategy for reform based on
• Needs Assessment
• Vision for reform

The Strategy may include long term and medium


term plans.

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Common challenges facing health
Systems - Financing
• Cost escalation due to
– Epidemiologic transition
– New technology
• Insufficient funding
• Improper allocation of resources
• Lack of capacities
• Inefficiency

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Common challenges facing health
Systems - HRH
• Lack of well trained HRH
• Changing mind setting and changing behavior
• Resistance to change
• Sensitivity associated with HR policies (hiring,
firing and redistribution) due to social aspect
• Linking payments with performance
• LEGAL CHANGES necessary for implementing
new HR policies and new payment mechanisms
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Common challenges facing health
Systems - Service provision
• Development of new models for service
delivery to deliver integrated health services
and to achieve universal health coverage UHC
• Including and collaborating non governmental
providers through PPP
• Continuity of care and referral system
• HIS
• District Health System as an option
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Common challenges facing health
Systems - Regulation
• Existing legal environment and issuance of
new laws;
• Establishment of new independent bodies
(e.g. for quality and economic evaluation);
• Existing conflict of interests;
• Restructuring of health care system into new
bodies;
• Regulating the non governmental providers.
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Five Control Knobs for Health Reform
HEALTH SYSTEM Target Pop.

Financing

Efficiency
Health Status
Payment E

HEAHEALTH SYSTEM
LTH SYSTEM
Organization Quality
E
Financial Risk
Protection
Regulation
Accessibility
E

Persuasion
Satisfaction
Intermediate
Control Knobs Final Outcomes
Outcomes
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Health reform in Egypt
Aims at
• Improving quality:
– Model(s) for service delivery
– Development of protocols and guidelines
– Accreditation
• Equity in:
– Financing (fair financing/income based)
– Service provision and Utilization
• Affordability
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Health reform in Egypt (Cont.)
• Universality/Accessibility:
– UHC through health insurance for all
– Package(s) of services especially on the PHC level
• Efficiency through best utilization of available
resources
• Sustainability

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Health reform in Egypt
Adopting Purchaser Provider Split PPS through
restructuring health care system into three main
components:
• Purchaser/Payer – Health Insurance Organization
(HIO) and/or Family Health Fund (FHF)
• Providers – Provider Organizations
• Regulator – MoHP and its directorates in all
governorates
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Health reform in Egypt
• Service Delivery Reform
Integrated and quality services through the
Family Health Model and referral system
• Structural Reform
To enhance efficiency through solving conflict of
interest
• Financial Reform
To achieve sustainability and efficiency

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Current Health System
MoF

Financing

Ministry of Health Service


Providers at
Financing Service Regulation Private & Non
Provision Governmental
sectors

PHC and PHC &


Surveillance Financing
Hospitals Hospitals

Citizens/Beneficiaries

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Purchaser Provider Split
MoF

Financing

Ministry of Health Service


Providers at
Financing Service Regulation Private & Non
Provision Governmental
sectors

PHC and PHC &


Surveillance Financing
Hospitals Hospitals

Citizens/Beneficiaries

HCM 742: Financing & Insurance Schemes


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Purchaser Provider Split
MoF MoH
Financing
Regulator
Financing
Surveillance

Social health ALL Service


Insurance SHI Providers
(Governmental
Financing Private & Non
Contractual Relationship Governmental)

Surveillance PHC, Hospitals,


Financing etc. Financing

Citizens/Beneficiaries
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Good Luck

HCM 742: Financing & Insurance Schemes


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