1. Ministry’s Vision for Universal Health Coverage Dr San San Aye Director (Planning) Department of Health Planning Ministry of Health National Dialogue on Social Protection Policy Options and Scenarios, Nay Pyi Taw, June 2014

2. Universal Health Coverage without excessive financial burden All people have access to a full range of needed personal and preventive health services of adequate quality, without excessive financial burden goodquality affordable costs Ensuring good quality health care to every citizen at affordable costs Universal Health Coverage ≠ Free Health Care Universal Health Coverage ≠ Free Health Care

3. Vision UHC is crucial to enhancing - health social cohesion sustainable human and economic development

4. Mission and Goals To strengthen the health systems towards the provision of equitable universal coverage through: (1) Improving health outcomes; (2) Enhancing financial protection, and (3) Ensuring consumer satisfaction.

5. UHC Indicators WHO target indicators OOP spending should not exceed 30-40 % of THE THE should be at least 4-5 % of GDP Over 90 % of the population is covered by prepayment and risk- pooling scheme Close to 100 % coverage of vulnerable populations with social assistance and safety-net program Myanmar’s situations OOP Expenditure as % of THE: >80% THE as % of GDP: 2% GGHE : 20 % SSB: <1% Supply Side Financing ??? Demand Side Financing ???

6. Level and Mix of Health Expenditure Source: WHO, Health Financing Strategy in Asia and the Pacific (2010-2015), 2009 6

7. Myanmar: Health Sector Investment Financial YearMOHE as % of GGEMOHE as % of GDP 2010-20111.030.20 2011-20121.050.21 2012-20132.820.72 2013-20143.150.89 2014-20153.380.99

8. Health Expenditures among WHO SEA Region Country THE as % of GDPGGHE as % of THEGGHE as % of GGE 2000201020002010 Bangladesh2.83.739.036.57.6 Bhutan6.94.379.384.612.2 DPR Korea4.57.148.658.2- India4.33.726.028.26.8 Indonesia2.02.836.1 6.2 Maldives7.06.258.060.89.3 Myanmar2.12.013.512.11.0 Nepal5.45.124.637.49.5 Srilanka3.73.548.445.676.9 Thailand3.43.956.175.014.3 Timor8.05.778.974.75.0 Source: World Health Statistics, 2013

11. Poverty impact of health OOPs

12. UHC journey far away

13. Proposed Plan for UHC Population Coverage SSB 2% Civil Service 3 % Service Coverage Basis Essential Package (Public Health Services, Out Patient Services, Inpatient Services) Exclusion list Supply Side Readiness Quality Services Decentralization and Autonomy HRH Financial Coverage Revenue Collection - GGHE (SSR to Ministries) - GGHE (Full Premium subsidization for Poor & near poor and Half Premium subsidization for Informal Sector to Autonomous Body) - Pooled external assistance - CBOs/ NGOs, CSR - Premium from private insurance Pooling - Single large pool (ideal) - Fragmented pool (worse) Rich 10 % Defense 5% Informal Sector 50 % Poor and Near Poor 30 % Purchasing -Provider-Purchaser split - Autonomous Body for financing function Purchasing -Provider-Purchaser split - Autonomous Body for financing function

14. Assumptions/ Proposed actions Based on expert opinion and evidence based information: Population group - percentage Per capita health care expenditure (average): 30,000 Kyat Rich gp: per capita health expenditure (average): 100,000 K Political control knob (Huge reform!!!) Political control knob (Huge reform!!!) - Full premium subsidization to poor and near poor gp - Half premium subsidization to the middle group National Health Insurance Board - Autonomous body Provider-purchaser split Community has a chance to make choice for providers

15. Comparing existing situation and proposed plan Financing AgentNational Health Account (2011-2012) Proposed Plan Ministry of Health11.67 %4.18 % Other Ministries3.78 %1.35 % SSB0.48 %0.17 % NHIB - Poor & Near Poor (30%) - Middle Class (50%) - Govt Staff (3%) 23.83 % 19.86 % 2.38 % Out-of -Pocket - Middle Class (50%) - Rich (10%) 78.79 % 19.86 % 26.48 % Non-profit5.28 %1.9 % THE as % of GDP1.75 %4.88 % OOP as % of THE78.79 %46.34 %

16. Health as an input into Economic Development Economic Policies and Institutions Governance Provision of public Goods Technology including scientific knowledge relevant for production Enterprise Capital – ability to attract labor and capital Health Economic Development Human capital: education, on-the- job training, physical and cognitive development

17. 2010 2020 2030 2040 Goals and targets towards universal coverage: Myanmar Case Reduce out-of-pocket payments and increase prepayment Absence of financial protection Universal Coverage <5 % 20 % 50 % 75 % -Increased tax based financing - Expansion of SSS -Other prepayment schemes Mixes of prepayment, social assistance and safety nets schemes developed -Increased tax based financing (2012 – 3 fold higher) - 330 township -Social Assistance and Social safety nets scheme (Poor Identification) - Interest of the Trust Fund - 330 Tsp - Interest of the Trust Fund - 330 Tsp - MCH Voucher Scheme - 20 Tsp - MCH Voucher Scheme - 20 Tsp - Health Equity Fund - 180 Tsp - Health Equity Fund - 180 Tsp - Social Assistances given by CBOs - Social Assistances given by CBOs - National Health Insurance - Expansion of social health insurance under SSS