Evolution of CBHI towards Universal Health Coverage (UHC) – Achievement and Challenges
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The document discusses community-based health insurance (CBHI) and its evolution towards achieving universal health coverage (UHC) in low-income countries, highlighting the historical context and different models of CBHI. It outlines three CBHI models: generic, enhanced, and nationwide, each with specific characteristics and examples from various countries. Key messages emphasize the importance of sustainable CBHI schemes and suggest strategies for expansion, particularly for poorer and informal sector populations.
Evolution of CBHI towards Universal Health Coverage (UHC) – Achievement and Challenges
- 1. FINANCIAL PROTECTION AND IMPROVED ACCESS TO HEALTH CARE: PEER-TO-PEER LEARNING WORKSHOP FINDING SOLUTIONS TO COMMON CHALLENGES FEBRUARY 15-19, 2016 ACCRA, GHANA Day 1V, Session III.
- 2. Evolution of CBHI towards Universal Health Coverage (UHC) - Achievement and Challenges - Hong Wang, MD, PhD (BMGF) Financial Protection and Improved Access to Health Care Accra, Ghana February 15-19, 2016
- 3. Universal coverage of health care • Universal health coverage (UHC): is defined as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost. • Pro-poor UHC: There is a determination to include poor people in service provision from the outset (Lancet Commission on Investing in Health(CIH), July 2015)
- 4. Community-based health insurance: • Applying the principles of health insurance at the community level for social protection purpose. • 19th Century: developed in Germany, Japan, UK • 20th Century: Introduced to low-income countries to provide financial risk protection to the people in the informal sector • More than 30 years experience gradually reveals the potential pathways/challenges of CBHI towards UHC in low-income countries
- 5. Objective of this presentation • Discuss the possibility of using CBHI to achieve UHC based on existing evidence by extending tax-based/social insurance characteristics into CBHI scheme. • Three types of CBHI schemes: – Generic model – Enhanced model – Nationwide model
- 6. Table 1. The key characteristics of a generic model of CBHI Community supports Community itself, defined by geographic, professional, or ethnic characteristics Health Financing functions Revenue collection Participation Voluntary Source of revenue Membership prepayment Risk pooling Risk pooling Within a community Fund management Managed by community committee or local health provider Service purchasing Service coverage Outpatient, inpatient, or both at local level Purchase mechanism FFS, Capitation Country cases Philippines, China (before 2002), Uganda, Kenya, Tanzania, and etc.
- 7. Table 3. The key characteristics of a enhanced model of CBHI Community supports At multi-community/ regional level with local government political endorsement Health Financing functions Revenue collection Participation Poor are covered through government subsidy Source of revenue Government subsidy (for the poor, or for catastrophic, or re- insurance) Risk pooling Risk pooling Re-insurance within the network of communities Fund management Managed by community with network of technical support Service purchasing Service coverage Strengthening the links with provider network Purchase mechanism Capitation, case-based payment Country cases Rwanda, Uganda, Mali, Senegal etc.
- 8. Table 5. The key characteristics of a nationwide model of CBHI Community supports Political commitment and stewardship at national level with legislation backup Health Financing functions Revenue collection Participation Majority targeted population at national level Source of revenue Government subsidy (administration and premium) Risk pooling Risk pooling Cross-subsidy among communities with Risk- equalization mechanism Fund management Professional management with community participatory roles Service purchasing Service coverage Standardized, comprehensive benefit package Purchase mechanism Capitation, case-based payment. Global budget, and PBP Country cases Rwanda, Ghana, China, etc.
- 9. Generic model Enhanced model Nationwide model •Community initiation and operation •Voluntary participation •Membership contribution •Government political endorsement •Government subsidy to the poor and to catastrophic risk •Network for management and service delivery •Government political commitment, stewardship, legislation, and funding support •Regional level professional management •Community level mobilization, abuse and fraud control Evolution of CBHI schemes toward UHC in LMICs SupporttoCommunity Tax-based/social insurance characteristics
- 10. Key messages and questions • If your country already has sustainable CBHI schemes, they can be a good platform for expanding coverage to the poor, rural, and informal sector, with further potential improvements – Public financing supports – Risk pooling at higher level – Potential pathways to integrate CBHI with other prepaid schemes • If your country does not have CBHI, don’t begin with generic model – skip to national model (pro-poor UHC scheme from beginning) • Ethiopia, Rwanda, Senegal, and Nigeria: – What model is each country? Generic, enhanced, national? – What are they doing to mitigate the challenges of CBHI?