05-Oct-21

Purpose of a Sound Health care Financing Policy

Course: MSPH, Beyond “how much we spend”

Health care financing: A sound HCF should look at ;
Introductions The overall need and available funds
How money flows to ensure the system
reaches its objective
Creating incentives to enhance healthcare
delivery
Provide social protection against routine and
catastrophic healthcare expanses

The current government setup

Policy budget Current health care spending
FEDERAL surveillance
M&E
Oversight

Total : Rs 152 billion ( 2% of GDP)

Funds

Reporting

Or about USD 17 per capita

Government contribution is about a
Direct Oversight quarter
PROVINCIAL
M&E Reflects only about 50 % increase over
Oversight

the past 15 years (when adjusted for

Reporting
Funds

inflation and population growth)

Direct
DISTRICT Implementation
M&E

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Where it goes Some current restraints

Government : prevention, curative care
and infrastructure
Private sector and NGOs : mostly curative
care
Limited revenue collection (<15 % of GDP)
Limited revenue collection by district or
provincial governments
Distinction between recurrent and development
budgets, sometimes with management of each
with different depts.
Within subunits (eg hospitals) different things
are paid from different funding sources
Under utilization of allocated funds

Is increased funding needed…. General suggestion

Absolutely ! Need an overarching plan that looks at the overall
However , this is not the final answer health needs to establish the funding envelope ( and
Health outcomes are not well correlated with health also assign deliverables and responsibilities for
spending different stakeholders)

In fact setting a total as a target may not be very Making subunits (e.g for districts or even clinics)
helpful accountable for their budgets and their deliverables
Definition of “minimum essential” packages
Equally important to
1.Prioritize funding Assign accountability and responsibility for services

2.Design technically sound interventions and Financial and budgetary implications (rewards or
otherwise) ties to quality of service provided
3.Monitor results that are geared towards effective
and equitable targets M & E framework including results and finances

2

Raising Adequate funds
Taxation
Earmarking
Approach external donors
Allowing provincial or local revenues to
go directly to health locally
User fees
Equitable provision of services
Pro-rate user fees and other expanses
according to income of clients
Conditional cash transfer (CCT) to attract
clients to prevention services and as a social
support for the poorest
Support funds for indigent care ( zakat)
NGO and philanthropic support
05-Oct-21
Pooling Risk
Catastrophic health insurance is being provided in
Pakistan via the Rural Support Networks
Government Leverages expenses related to
natural disasters
Government increases coverage and payments for
expensive healthcare such as hospitalization,
especially when these payments are pro-rated
according to incomes
Efficient Provision of services
Adequate funding for what is planned
Timely and efficient disbursement of funds
A results monitoring system
Pilot trials of results based financing
Delegate control over budgets, implementation
as well as responsibility to local implementers
Local community involvement in planning and
then monitoring services
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Role of non-state actors

Providers of quality care ( Rural Support
Networks , Charitable hospitals/clinics)
Providers of essential services ( Edhi )
Providers of social safety nets ( Edhi ,other
NGOs) THANKS
Providers of employment / income generation (
include micro credit ,vocational training)
Piloting new health care models (AKHS)
Funding some care