Overview of Pathways project, key concepts of UHC and translation into an Irish context Steve Thomas Principal Investigator Pathways Project Director, Centre for Health Policy and Management

Context Commitment to Universalisation – st time ever Compulsory Private Health Insurance (UHI) and Free GP Care… Questions about appropriate road from UHI to UHC Ireland emerging from prolonged austerity Squeezed resources and morale, cost-shifting Governance capacity strained European countries with UHC mandates Many feel unable to access care (low income, unemployed) (Cylus and Papanicolas 2015)

Mapping the Pathway to Universal Health Care in Ireland Health Research Award from HRB Centre for Health Policy and Management, Trinity College Dublin WHO Barcelona Office for Health Systems Strengthening European Observatory for Health Policy and Systems First of three Annual Workshops Website - Twitter

Scope Aim: to provide an excellent evidence base that will inform strategic direction and implementation of universal healthcare in Ireland 1.Assessing the gap between current Irish health system performance and universal healthcare 2.Evaluating the strengths and weaknesses of different models of universal healthcare and assessing their feasibility of implementation 3.Assessing the organisational challenges of moving to universal healthcare by reviewing the experience of other countries & exploring the current capacity & constraints facing decision makers throughout the system

Component 1 – Mind the Gap! What is UHC? Identification of indicators to measure progress Actual Progress towards UHC and remaining Gap Year 1 workshop National policy vs UHC Analysis of Financial Protection

Components 2 and 3: Moving forward Which Pathway? Identify possible distinct options Assessing their feasibility of translation and implementation Resource requirements of different models Organisational Challenges Systematic review of the experience of other countries moving to UHC Surveying health managers on current capacity constraints Case studies and problem solving with managers

Workshop Programme 9.00Overview of project, key concepts of UHC, translation of dimensions of UHC to an Irish context Dr Steve Thomas, Centre for Health Policy and Management, TCD 9.20Indicators of UHC dimensionsDr Sara Burke, Centre for Health Policy and Management, TCD 9.45DiscussionOpen to the floor 10.00Key findings from WHO Europe Financial Protection Research Jon Cylus, LSE and WHO Barcelona Office for Health Systems Strengthening 10.15Irish findings on Financial ProtectionBridget Johnston, Centre for Health Policy and Management, TCD 10.30Early findings from UHC – Organisational Outcomes Systematic Review Dr Sarah Barry, Centre for Health Policy and Management, TCD 10.55DiscussionOpen to the floor 11.25Coffee 11.55The gap between the intent of universalism in Irish health policy and what has happened Dr Sara Burke, Centre for Health Policy and Management, TCD 12.15Reflections on the seminar & international lessons on introducing and sustaining UHC Dr Sarah Thomson, WHO Barcelona Office for Health Systems Strengthening 12.45DiscussionOpen to the floor 1.00Close and lunch

Deconstructing Universal Healthcare (UHC) Steve Thomas, Sara Burke and Sarah Barry Centre for Health Policy and Management

Universal what? Universal… Health Insurance Healthcare vs Health coverage High vs low income countries Health Commitment 1978 Declaration of Alma Ata 2005 all WHO member states including Ireland signed up to UHC 2012 UN Resolution on Universal Health Coverage Health Confusion

Definitions of universal health coverage the goals of universal health coverage are to ensure that all people can access quality health services, to safe guard all people from public health risk, and to protect all people from impoverishment due to illness, whether from out-of- pocket payments for healthcare or loss of income when a household member falls sick… UHC consists of three inter-related components: i) the full spectrum of quality health services according to need; ii) financial protection from direct payment for health services when consumed; and iii) coverage for the entire population (WHO/World Bank, 2013: 1/10)

The Cubist representation: WHO

Deconstructi ng UHC 1. How do we get access? Financial Protection Free at the point of contact Affordable at the point of contact Affordable and progressive Income Protection Coverage/ Entitlement Altogether - no differentiation, no tiering

Deconstructi ng UHC 2. Access to what? Full Package Needs based Sufficiently Resourced ThresholdEfficiency Quality Best practice TimelyIntegrated

5 Dimensions of UHC Quality Timely Integrated - Continuity Appropriate - Best Practice Clinical Full Package Community, Acute, Long Term Care Needs based Financial Protection Free Care (at point of contact) Affordable care (Progressive, avoid Catastrophic Payment and Risk of Impoverishment) Coverage for all Universal means everyone Resources Sufficiency (Threshold) Efficiency (Allocative, Technical – Right mix)

4D and 5D!

quality financial protection package of care coverage resources outcomes enablers Dimensions of Universal healthcare in relation to the WHO ‘cube’

Are we nearly there yet? Destination or Direction? Good enough – 80%? Thresholds Free care at the point of contact One tier system Moving Target Technology Resource Envelope Purposive

The End Thank You