Bernarda Zamora participated as a guest speaker for a session of the November 2018 round of the Professional Certificate in Strategic Health Planning, a certificated course delivered by the International Centre for Parliamentary Studies (ICPS), which offers the opportunity to achieve a Chartered Management Institute professional qualification.
Bernarda’s lecture covered the topic of health financing options for achieving Universal Health Coverage (UHC), focusing on case studies for different countries to demonstrate various effects of similar financing and cost-containment policies.
The lecture started with the analysis of relevant international studies showing the importance of different determinants of escalating public health spending. While demographics and income are the demand-side factors associated with most of the variability in health spending growth across countries, the focus of most health financing policies is on supply-side factors. Examples of supply-side policies are macro-level controls (budget caps, supply constraints, and price controls) and micro-level reforms (public management and coordination including decentralisation, contracting, and market mechanisms). Even though some general lessons have been learnt from the implementation of these policies in different countries, as shown by a recent OECD study, an analysis of case studies, included in an IMF book, demonstrates that similar policies do not always have the intended effect.
The achievement of UHC has been included as one of the targets of the Sustainable Development Goal 3: Good health and well-being. Bernarda presented a timeline for pursuing UHC, focusing on the creation of fiscal space, and the design of new funding instruments. Based on the World Bank framework for innovative funding for health, examples were drawn from Indonesia’s reduction of energy subsidies and the earmarking of a proportion of VAT in Ghana and Chile.
Eleven professionals attended the course from ten different countries, most from middle-income countries including small island states and Arabian Gulf countries, which were less well represented in the studies analysed, given the special characteristics of these countries in terms of vulnerabilities, population size, and less diversified sources of government revenue.
Participants contributed to the discussions, detailing their experiences with health reforms, including case studies in the lecture. Participants asked for in-depth analysis of the role of social health insurance as an instrument for achieving UHC, the implementation of which was discussed in relation to the relative size of formal and informal labour markets. The design of the gatekeeping role in primary care also emerged as a topic for further discussion.
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