1. Social Assistance for Health Care Rationale & Model Bruno Meessen, ITM International Workshop Health Care and Poverty, Solutions Ahead?

2. Presentation The problem. An institutional environment in change. The model.

3. The problem Universal free health care is no more the World scenario. User fees are a major barrier. Other barriers may be even more important. As a result, very high Out-of-Pocket Payment. It has a major negative impact on Health and Welfare.

4. Assumptions Free National Health Service will not be re- established for a while. Social Health Insurance will take time, Community Based Health Insurance coverage remains limited. New roles for the State. –Less involvement in provision of care. –Stewardship, regulation and funding.

5. The new institutional environment Health facilities will have more autonomy, states will lose the authority of the owner. Issue: how to organise and guarantee the public missions of the health system? –Regulation. –Another key channel to influence performance of the health system: the funding function.

6. The new institutional environment From budget funding (input) to purchasing (output funding): –User Fees, –Social or Community-based Health Insurance, –Contracting, –“Health Equity Fund”. The new key role: Purchasing Bodies.

7. Social Assistance Fund A Fund purchasing services on behalf of the poor. Stop the fiction of the exemption policy. Link funding to output for the poor. For the poor: Health and Welfare benefit. For the system: a major incentive for performance. More than just funding: an opportunity for a holistic approach (other barriers, social care…).

8. Why now or never? Ethics & Fairness. Global political reasons: –Millennium Development Goals. Ideological momentum: –Higher consideration for welfare intervention. Technical reasons: targeting is possible. First evidence seems to show that it works.

9. Benefit Incidence of public spending Source: “Public spending on health care in Africa: do the poor benefit? F. Casrtro-Leal et al, Bulletin of WHO, 2000, 78 (1), pp 66-78. &&