ias presentation social_health_insurance_lamontagne
TRANSCRIPT
How does health insurance mechanisms and HIV interact: Overview of country experience
Erik Lamontagne, Ole Doetinchem, Robert GreenerSystems Integration, UNAIDS
Geneva
Bridging the Divide: Interdisciplinary Partnerships for HIV and Health SystemsVienna, Austria, 16-17 July 2010
From universal access to universal coverage
Coverage of AIDS services
Different types of mechanisms
private health insurance social health insurance public tax-funded provision
The review of country experiences
•Questionnaire on country situation: how is the overall health insurance and how HIV is eventually integrated •Excellent response rate (65/71) countries•Country analysed in terms of their vulnerability•Vulnerability level: incorporates proxy measures of
– Poverty rate– Extend of the informal economy(see World Social Security Report 2010)
Country characteristics
Classification using vulnerability index is coherent with usual characteristics
No clear trend of HIV prevalence Among vulnerability groups of countries
Government health expenditure
Health insurance coverage
Blue: % country including health insuranceGreen: proportion of providing ART coverageOrange: proportion of SHI providing PMTCT
The case of Ghana
The case of South Africa
Lessons to draw (1)
• Introducing health insurance is not an automatic recipe for increasing revenue collection for health or HIV
• Integrating HIV services in SHI: more challenging for low income countries ( f(prevalence) )
• Not a fatality: Ghana, South Africa and Rwanda
• Countries that choose to include HIV services in SHI are mainly those already having a functioning health insurance system in place.
Lessons to draw (2)
• The review shows that including HIV = essentially a political decision
• Possibility to progressively increase coverage (pop, cost, services)
• External aid, incl. HIV financing can support (and subsidise) progressive integration of HIV in SHI
Thank you
contact: Erik Lamontagne: [email protected], UNAIDS
AnnexeEconomic share of government
Angola
Comoros
Botswana
South Africa
Mauritius
Namibia
Tanzania
Swaziland
MalawiKenya
Mozambique
Lesotho
Zimbabwe
Zambia
UgandaRwanda
DR CongoEthiopia
DjiboutiGambia
Gabon
Nigeria
Niger
Senegal
Mali
Congo
Côte d'Ivoire
Burkina Faso
Ghana
Madagascar
TogoCameroon
Central African Republic
Sierra LeoneGuinea-Bissau
Chad
Guinea
Burundi BeninMauritania
R2 = 0.1757
0%
10%
20%
30%
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50%
$100 $1,000 $10,000
GNI per capita $US
Gov
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Health expenditures and GDP
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Log GDP/capita
Log
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4 5 6 7 8 9 10 11 12
Log GDP/capita
Log
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(most of ) Sub Saharan Africa
Van der Gaag et al, Economics Reference Group, Dec 2009
Projection of health funding
•GDP per capita is an almost perfect predictor of health expenditure per capita•The estimated income elasticity is higher than zero and close to or even higher than one.•This implies that health is regarded more as a “luxury good” than as a necessity (by the aggregate populations of most countries)
•Based on projections of health funding to 2030, Van der Gaag et al (2009) concludes that:
– over time (relatively fast growing) middle income countries may have sufficient funding…
– …but (relatively slow growing) low income countries will need significant financial support for years to come.