Overview of Pathways project, key concepts of UHC and translation into an Irish context

Steve ThomasPrincipal Investigator Pathways ProjectDirector, Centre for Health Policy and Management

Context

• Commitment to Universalisation – 2011• 1st time ever• Compulsory Private Health Insurance (UHI) and Free GP Care…

• Questions about appropriate road

• 2011- 2014 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 - https://medicine.tcd.ie/health-systems-research/

• Twitter : @healthsystemie

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 GapYear 1 workshop

National policy vs UHC

Analysis of Financial

Protection

Components 2 and 3: Moving forwardWhich Pathway?• Identify possible distinct options• Assessing their feasibility of translation and

implementation • Resource requirements of different modelsOrganisational 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

9.00 Overview 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

9.20 Indicators of UHC dimensions Dr Sara Burke, Centre for Health Policy and Management, TCD

9.45 Discussion Open to the floor 10.00 Key findings from WHO Europe Financial Protection

Research Jon Cylus, LSE and WHO Barcelona Office for Health Systems Strengthening

10.15 Irish findings on Financial Protection Bridget Johnston, Centre for Health Policy and Management, TCD

10.30 Early findings from UHC – Organisational Outcomes Systematic Review

Dr Sarah Barry, Centre for Health Policy and Management, TCD

10.55 Discussion Open to the floor 11.25 Coffee 11.55 The gap between the intent of universalism in Irish

health policy and what has happened 2011-15Dr Sara Burke, Centre for Health Policy and Management, TCD

12.15 Reflections on the seminar & international lessons on introducing and sustaining UHC

Dr Sarah Thomson, WHO Barcelona Office for Health Systems Strengthening

12.45 Discussion Open to the floor 1.00 Close and lunch

Deconstructing Universal Healthcare (UHC)

Steve Thomas, Sara Burke and Sarah BarryCentre 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

Deconstructing 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

Deconstructing UHC

2. Access to what?

Full Package

Needs based

Sufficiently Resourced

Threshold

Efficiency

Quality

Best practice

Timely

Integrated

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

financialprotection

packageof 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