Regional Conference on Enhancing Social Protection in

the Asia and Pacific Region, 21-22 April 2010, Manila

Social Health Insurance in Asia

and the Pacific
Dr Dorjsuren Bayarsaikhan
WHO Regional Adviser

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not
necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of
Governors, or the governments they represent. ADB does not guarantee the accuracy of the data
included in this paper and accepts no responsibility for any consequence of their use. Terminology
used may not necessarily be consistent with ADB official terms.
 Outline

• SHI development in Asia and the Pacific

• Needs for strengthening social health protection
• Policy focus on universal coverage
• Attainment of universal coverage under SHI
 SHI development in Asia and the Pacific

Different development factors:

• Economic (Japan and Korea)
• Social ( Indonesia, Philippines and Thailand)
• Political (Mongolia and Viet Nam)
Different policy focuses:
• Financing mechanism
• People’s participation
• Social health protection
 Health Care Financing: spending vs income

10
9
8
7 Total health
expenditure
GDP, %

6
5 Government
4 health
3
2
1
0
Tonga
PNG

Viet Nam
Malaysia

China

Samoa

Mongolia

Australia
Philippines
Brunei

Countries
 Percentage of GDP
M
ya
n

0
1
2
3
4
5
6
7
8
La ma
o r
P
D
R
B
an In
gl dia
ad
S es
in h
ga
po
In re
B d
ru P one
ne h s
i D ilip ia
ar pin
us e
sa s
la
C m
am
bo
di
a
N
e
M pal
al
a
S ysia
ri
La
nk
a
P C
ap
ua T hin
N ha a
ew ila
D
em G nd
.P ui

Government health spending

ne
eo a
pl
e'
s
R V F
ep ie iji
. ot N
f Kam
or
ea

B
hu
t
V an
an
R ua
ep
ub tu
lic To
of ng
C K a
oo or
k ea
Is
Private health spending

la
nd
s
S
am
S
ol M oa
om o
on ngo
Is lia
la
nd
s
Government and private health spending,%
 Health financing situation
Composition of total health expenditure across Regions
and Countries EMR
impoverishment
100% AFR
Other Private
expenditure
catastrophic
Out-of-pocket
80% EUR
Private health
60% insurance
SEA
Social health
insurance
40%
Tax Funded AMR

20%
WPR
0%
- 30 60 90
* includes OECD count r ies
Source: National Health Accounts,
Number of people (mil ion)
EIP/HSF/CEP, World Health Organization
 Social Health Protection
ILO estimates that 80% of the population do have social guarantees to deal with life’s risks.

In 2009, the UN launched Social Protection Floor Initiative. In terms of health it means social
health protection to increase population coverage, access and financial protection against
health related impoverishment through contributory and non-contributory funding arrangements.
SHI is one of the principle mechanisms that support social health protection.
Universal coverage

1. OOP should not exceed 30%-

40% of THE;

2. THE should be at least 4%-5% of

GDP;

3. Over 90% of population covered

by prepayment and risk pooling
schemes; and

4. Close to 100% coverage of

vulnerable population with social
assistance and safety net
programmes.
 Challenges for Developing Countries

• Small formal sector workers limits how many people could be

enrolled.
• High number of poor people require large new government
budget to subsidize.
• Barriers to enroll the non-poor informal sector workers.
• Establish an effective insurance fund agency to represent the
interest of the insured and acts as an effective purchaser.
• Transform public hospitals and clinics and reduce the
government subsidies to them.
• Regulate the private and public providers.
 Figure 8. Health insurance coverage, %

90

80
70

60

50 2005
40 2007

30
20

10
0
Chn Lao Mon Phl V tn
 SHI benefit spending in China, Philippines and Viet Nam
Breakdown of the percentage of total expenditure on health in China by main Breakdown of the percentage of total expenditure on health in Philippines, by main Breakdown of the percentage of total expenditure on health in Viet Nam, by main
contribution mechanisms, 1997 and 2007 contribution mechanisms, 1997 and 2007 contribution mechanisms, 1997 and 2007
100 100
100

80 80
80

65.5

60 60
60
54.5 54.8
52.9

46.5 1997 1997

1997
45.2 2007 2007 200

40 40 38.0 40

30.0
26.7 26.9 26.4 26.6

20 17.5 20 20
15.3
12.7
8.0
6.1 6.4 6.1
5.1 4.4 4.2 3.9 4.3
3.4 2.5 2.5 1.6 1.6
0.4
0 0 0
General Taxation Social Health Prepaid Private Out-of-pocket Other General Taxation Social Health Prepaid Private Out-of-pocket Other General Taxation Social Health Prepaid Private Out-of-pocket Other
Insurance Schemes payment Insurance Schemes payment Insurance Schemes payment
 Evolutions in social health insurance
Traditional views:
• Financing method
• Reduce financial burden
when sick
• Only formal sector
• Poor are excluded
• Cure diseases
• Passive third party payer
New features:
• Social health protection
• Large risk sharing and
keep insured healthy
• Universal coverage
• Subsidies the poor
• Health rather than
illness
• Active strategic
purchaser
 Attainment of universal coverage under SHI
• Mandatory enrolment is more efficient than voluntary
enrolment.
• All insurance and safety net schemes need good
coordination and regulation to attain universal coverage.
• Squeezing from the top: expand population groups for
mandatory coverage.
• Squeezing from the bottom: define and expand population
groups who needs subsidy.
•Strong government support, commitment and contribution
subsidy.
• Impacts on poverty prevention, economic productivity and aid
effectiveness.
 Conclusion

• No country relies on single financing method.

• SHI is one of the principle financing mechanisms.
• Extension is feasible through well coordinated mandatory,
voluntary and community based insurance schemes.
• Government role is critically important.
• Social protection and universal coverage are bringing new
features to SHI development and evolutions.
• Challenges exist and but they are solvable.
Thank you
bayarsaikhand@wpro.who.int