HEALTH FINANCING IN THE UHC ERA

A tool for engaging private providers

Christy Hanson

2

PATIENT PATHWAY ANALYSIS GAVE US INSIGHTS INTO KEY GAPS IN DELIVERY

L00%

29%

19%

4%

88%

69%

68%

L08%

4. Coverage of

Treatment Among

Health Facilities

L00%

90%

42%

23%

2%

89%

71%

43%

L02%

2. Coverage of

Microscopy Among

Health Facilities

1. Initial General Care Seeking

Patterns

41%

Public

Sector

39%

Privat

e

Sector

21%

Inform

al

Privat

e

Sector

Sector

10%

Privat

e

19%

Public

Sector

3. Access to

Microscopy at

Initial Care

Seeking

7%

Privat

e

23%

Public

Sector

5. Access to

Treatment at

Initial Care

Seeking

43%

Missin

g

5%

Privat

e

52%

Public

Secto

r

6. Location

of

Notification

(Among

Estimated

Burden)

43%

Missin

g

7% Tx

Not

Succes

s

48%

Tx

Succes

s

7. Tx

Outcomes

(Among

Estimated

Burden)

Patie

nts

may ite

rate

thro

ugh t

he d

iagnosis

path

way m

ultip

le

tim

e b

efo

re b

ein

g in

itia

ted o

n t

reatm

ent.

8%

L0

17%

L1

15%

L2

20%

L1

12%

L2

21%

L0

L3

L3

7%

L0

Level

8. Tx Cure

Rate

(Among

Estimated

Burden)

43%

Missin

g

7% Tx

Not

Succes

s

~43%

Relaps

e Free

Cure

~5%

Relaps

e

1. DIAGNOSTIC

GAP

2. PRIVATE

PROVIDER GAP3. POOR / UNKNOWN

QUALITY OF CARE

© Bill & Melinda Gates Foundation | 3

NTP

Private

Pharmacy

Private lab

Private for-profit

NGO / mission

National reference

lab

Public facilities

© Bill & Melinda Gates Foundation | 4

UNDERLYING CHALLENGE OF SUSTAINING PPE: FINANCING AND ACCOUNTABILITY

Hospitals

Clinics

Pharmacies

Labs

Community health

Hospitals

GPs

Pharmacies

Labs

NGO

Private

o Who pays private providers?

o How is quality care

monitored and ensured?

Public

© Bill & Melinda Gates Foundation | 5

THE PUBLIC SECTOR CAN “BUY” TB SERVICES FROM THE PRIVATE SECTOR

Hospitals

Clinics

Pharmacies

Labs

Community health

Hospitals

GPs

Pharmacies

Labs

NGO

PrivatePublic

© Bill & Melinda Gates Foundation | 6

ENGAGING THE PRIVATE SECTOR GIVEN SHIFTS IN FINANCING FLOWS?

6

Private

Pharmacy

Private lab

Private for-profit

NGO / mission

National reference

lab

Public facilities

Treasury

MOH

NTP

Donors

Supply Side Financing

Social health Insurance

Demand Side Financing

Out-of -Pocket

7

Social health insurance creates a

guaranteed payer

Administrative costs to participate in SHI is

high for individual providers

“Aggregators” / large providers can benefit

by networking with providers who

otherwise wouldn’t participate

USING MARKET FORCES OF CONSOLIDATION

Hospitals

GPs

Pharmacies

Labs

NGO

Private

© Bill & Melinda Gates Foundation | 8

ORGANIZING (DE-FRAGMENTING) THE PUBLIC/PRIVATE SECTOR MARKETS MAY BE POSSIBLE USING FINANCING OPTIONS

QUALITY

QUALITY

MOTIVATION

FRAGMENTATION

CAPACITY

CONSOLIDATION CAN ADDRESS SOME KEY CHALLENGES

Fragmentation of private providers

Inadequate provider

incentives

Limited alignment with NTP

guidelinesInconsistent

quality of drugs and

diagnostics

Limited capacity and

lack of training

Social health Insurance must be well designed and

functional

✓

✓

✓✓

✓

Necessary Sufficient / Optimal

TB as a notifiable disease ➢ Enforcement of policy

➢ Incentivize notification and quality monitoring

➢ Unique patient ID for monitoring

➢ IT and HMIS system linked to private providers

Social health insurance or

domestic funding for PHC,

including private sector

engagement

➢ TB package within health insurance sufficient to incentive

private providers

➢ Reimbursement according to NTP quality standards

➢ PHC coverage includes all TB diagnostic tests

➢ TB included in essential health package

Policy enabling contracting of

private providers

Intermediary or Aggregator to extend reach of NTP

Budget through NTP (supply side)

designated for PPE

NTPs to plan for a hybrid of demand and supply side

financing

WHAT CAN TB PROGRAMMES AND PARTNERS DO