1. Health Financing Reforms in Countries of EMR – What Lessons for Sudan
Universal Health Coverage Conference
22-24 JANUARY 2017, Khartoum-Sudan

3. Health Financing for UHC Framework

4. Health Financing Challenges in EMR
Lack of a clear vision for Health Financing Reform for UHC
Insufficient and unsustainable (public) resources for health in many countries
Fragmented health (financing) system, with large uncovered population (informal and other vulnerable)
Limited capacity in rational use of health resources, compromising efficiency and equity
Complex emergencies prevailing in several Member States
Governance
Revenue Raising
Pooling
Purchasing
Geopolitical Context
UHC Conference, Khartoum/Sudan, Jan 2017

5. Around 2% of world health spending for almost 9% of world population
Revenue Raising in EMR
Around 2% of world health spending for almost 9% of world population
UHC Conference, Khartoum/Sudan, Jan 2017

6. UHC Conference, Khartoum/Sudan, 22-24 Jan 2017
Revenue Raising: Per capita Total and “General Government” Expenditure on Health by Country Group, 2013
Group 1
US$ 678–2,043
Group 2
US$ 43–631
Group 1
US$ 519–1,714
Group 3
US$ 37–137
Group 2
US$ 20–320
Group 3
US$ 12–82
UHC Conference, Khartoum/Sudan, Jan 2017

7. Share of OOP in THE by Country Group, 2013
Pooling: Out-of-Pocket Payments Limits the Pooling and Compromises the Financial Protection Objective
Group 3
40–76%
Group 2
24–58%
Group 1
8–20%
In EMR, it is estimated that up to 16.5 million people face financial catastrophe and 7.5 million become poor due to out-of-pocket payments annually
Share of OOP in THE by Country Group, 2013
UHC Conference, Khartoum/Sudan, Jan 2017

8. Purchasing: Interface between Financing and Provision
Who: MoH and SHI organizations
What: EHSP has been developed in some countries but is mostly implicit in many others
For whom: Discrepancy in coverage between insured and non-insured, with high potential for double coverage
From Whom: Mainly from public sector but modalities for private sector involvement exist and are expanding
How Paid: Providers are mainly paid on fee-for-service basis with some forms of capitation and case-based payments
UHC Conference, Khartoum/Sudan, Jan 2017

9. Revenue Raising in Egypt
Challenges and underlying causes:
Limited access to good quality care
Low public investment for health: GGHE%GDP – 1.6%
Outdated/unrealistic low contribution rates (multiple laws)
Low revenue collection rates
Strategic Response:
Constitutional amendment (Public funds at least 3% of GDP)
Political dialogue between MOHP and MOF
New revenue raising mechanisms: e.g. tobacco tax
Revision of current rates of contribution (actuarial study)
Establish effective revenue collection system
UHC Conference, Khartoum/Sudan, Jan 2017

10. UHC Conference, Khartoum/Sudan, 22-24 Jan 2017
Pooling in Morocco
Challenges and underlying causes :
Significant catastrophic and impoverishment (3-4%; 2010)
High out-of-pocket payment (54%; 2010)
Large uncovered population (poor/vulnerable and non-poor informal sector “les indépendents”)
Strategic Response:
RAMED to cover the poor/vulnerable (8.5 million)
Ongoing discussion to extend coverage to the remaining uncovered population to reduce OOP
UHC Conference, Khartoum/Sudan, Jan 2017

11. Purchasing in I.R. of Iran
Challenges and underlying causes :
High OOP (>50%) and low financial protection (3%)
Low tariffs leading to under-table payment (high OOP on medicines and hospital care)
Diversity in benefit package across schemes
Strategic Response:
High Council of Health Insurance
Defining a Benefit Package for all coverage schemes
More money for health and increased tariffs for hospital care
UHC Conference, Khartoum/Sudan, Jan 2017

12. Three Broad Trends in Health Financing Reforms in EMR
Move towards predominant reliance on compulsory (i.e. public) funding sources
Reduce fragmentation to enhance redistributional capacity and reduce administrative duplication (more prepayment and fewer prepayment schemes)
Shift towards strategic purchasing to align funding and incentives with promised services: promote efficiency and accountability
UHC Conference, Khartoum/Sudan, Jan 2017

13. Thank You!