Health-financing reforms in southeast Asia: challenges in achieving universal coverage

Health-financing reforms in seven south-east-Asian countries are reviewed in this study. Those countries have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service, stepping towards universal coverage.

The document introduces these concerned facts: 

• Laos and Cambodia have mostly relied on donor-supported-health equity funds to reach the poor.
  
• thus, reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion in these two countries.
• for Thailand, the Philippines, Indonesia, and Vietnam,social health insurance financed by pay-roll tax is commonly used for formal sector employees.
• this produces varying outcomes in terms of financial protection in these countries.
• consequently, there are great opportunities to share experiences among south-east Asian countries in the movement towards universal coverage for improved health care.
  

The author underlines that expanding coverage of good-quality services and ensuring adequate human resources are important to achieve universal coverage.

Key messages include: 

• the extension of functioning and affordable primary health-care services is an initial priority for governments as geographical access to services is still a major problem.
• this extension needs to be matched with financial risk protection for the poor, including effective identification of the poor, user fee exemption, and adequate levels of subsidy.
• social health insurance can make an important contribution to insurance coverage—although general tax funding might be preferable in the long run.
• introducing partial subsidy for the informal sector can be an appropriate choice in some cases.
• governments need to move towards harmonisation of benefit packages, levels, and methods of provider payment across these schemes as members move from one scheme to another.
• act on evidence about cost-effective interventions are needed, yet institutional capacity to generate evidence and inform policy is essential and should be strengthened.