• Health policy and health systems financing

Health policy and health systems financing

This paper examines to what extent health services in Asia are meeting the relevant Millennium Development Goals (MDGs) and looks at the options for scaling up delivery and for financing health service expansion. The paper concludes with a suggested action plan for Asian countries and their development partners.

Many Asian countries remain unlikely to meet several of the MDGs, including those relating to maternal and child mortality, and to disease control, particularly with respect to HIV, malaria and TB. A major reason for failure to meet these goals is inadequate expenditure on health but this is compounded by poor health systems efficiency. In addition, there are disparities between social groups and between regions in access to health services. tries, regions, governments and other agencies.

In all countries there is a mix of private and public health service provision. Some private provision may be of poor quality, including the supply of ineffective or even harmful counterfeit drugs. Public funding may not be directed as effectively as it might be, and consumers are often inadequately informed and empowered. Achievement of the health MDGs will rely on an intricate interplay of funding and management mechanisms and on collaboration between regions and agents

Three broad strategies are identified for scaling up health service delivery:

• the expansion of public provision
• extension of the ‘mixed economy’ in health service provision, building on the strengths of different types of providers and deploying a range of mechanisms
• a shift to funding arrangements where public financing remains crucial but the non-state sector takes the lead in service delivery.

Whichever strategy the country chooses to pursue, Governments need to carry out key functions of regulation of health and drug markets, as well as funding of public health activities such as communicable disease control.

Similarly, there is a range of strategies available for improving health service funding including:

• social health insurance
• tax funding
• user fees
• medical savings accounts
• aid funding
• mechanisms designed to improve access for the poor and other excluded groups.

Each has a different impact on the objectives of ensuring access to services for all, protecting people from heavy medical expenses and encouraging an efficient health system. Most countries use a mix of these strategies. Governments and their partners need to develop a long-term view of how their health financing arrangements will evolve.

Consumers need to be better informed about health issues, both to improve their own health and as a way to improve accountability. There is a need to improve the information base for planning and monitoring progress. And globally, there must be better coordination of efforts and more information exchange between counties

[This paper was prepared for the Asia 2015 Conference, held in London, 6 and 7 March 2006]

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