ADB and Universal

Health Coverage
Eduardo P. Banzon
Senior Health Specialist
SDAS/SDCC

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.

Operational Plan For Health (OPH) 2015-2020

2.5% of total ADB portfolio invested in health in 2015
but pipeline plateauing

Increase health lending from

<2 to 3-5% ($ 700m-1b) by 2020

Million $
800
700

Focus on 9-12 DMCs

Support DMCs to achieve
Universal Health Coverage
(UHC)

600
500
400
300

Expand health sector team

Leverage partnerships with
Centers of Excellence

200

100
0
2014 2015 2017 2018 2019 2000
ADF and OCR

OPH and UHC

Strengthen health systems for Universal
Health Coverage
1. Health infrastructure/service delivery
2.Health governance
3.Health financing

Focus on 912 ADB DMCs

Build best practices/ current projects , share

knowledge/convene, evaluate impact

Universal Health Coverage

Universal Health Coverage is
defined as ensuring that all
people can use the
promotive, preventive,
curative, rehabilitative and
palliative health services they
need, of sufficient quality to be
effective, while ensuring that the
use of these service does not
expose
other user to of
Three Dimensions
financial
hardship. (WHO)
UHC

One of the SDGs

calls on countries to pursue
Universal Health Coverage

Population coverage
Health Service Coverage
(Breadth)
Cost coverage (Depth)

Covering all People to

Access
What we have to achieve in terms of
population coverage:

UNIVERSALITY
Everyone should be included
Not based on employment status

Needed Health Services

In-patient
service use
among the
selected low- to
middle-income
Asian economies
are pro-rich.
(Poor use less
services)

Inadequate Primary
Care and Referral
Services

Propoor

Prorich

Source: ODonnel et al.

(2008)

No Risk of Financial Catastrophe

when Accessing Needed Health
Services
Reduction of Out
of Pocket Spending
(OOPs) in Health

Prevent incidents
of Catastrophic
Health Spending

Univer
sal
Health
Covera
ge
Financial Catastrophe in Health: Occurs when households
payment for health services reach 40% or more of households capacity
to pay in a year. (Xu, et. al., 2007)

3.5

4.0

Impoverishment and out-of-pocket payments by country income

.25

.5

1.5

2.5

High OOP
>> Poor
Financial
Protection

10

20
30
40
50
60
70
80
Out-of-pocket payments as a percentage of total health expenditure
Low

Source: Xu et al. 2010

Low-middle

Upper-middle

High

90

National Poverty Rate (Kyrgyztan)

32.0%

3.7%

203,500
individuals
are pushed
into poverty
due to health
care
payments
0.0%

20.0%

40.0%

without health payments

60.0%

80.0%

100.0%

with health payments

OOP
increases
Poverty
Source: Kyrgyz Integrated Household Survey, 2010
WHO estimations

South Africa
Ghana
Croatia
Malawi
Cape Verde
Djibouti
Thailand
Jordan
Philippines
Morocco
Mexico
Rwanda
Zambia
Yemen
Senegal
Argentina
Tunisia
Sri Lanka
Kenya
Burkina Faso
Ukraine
Lebanon
Bangladesh
Uganda
Nepal
Cambodia
Indonesia
Egypt
India
Kyrgyzstan
Republic of Moldova
China
Colombia
Georgia
Cte d'Ivoire
Brazil
Viet Nam

Globally each year

150M people face catastrophic expenditure
100M people face impoverishing expenditure

12.00%

10.00%

8.00%

6.00%

4.00%

2.00%

0.00%

% of hshds w/ catastrophic expenditure

Source: compiled based on data from Xu et al. 2010

% of hshds w/ impoverishing expenditure

Catastrophic
spending hits the
poor the hardest

% households in Sudan with

catastrophic health expenditure

14.0%

12.2%
12.0%

9.6%

10.0%
8.0%

6.8%

6.2%
5.4%

6.0%
4.0%
2.0%
0.0%
Poorest 20%

Source: SHHUES, 2008

Q2

Q3

Q4

Richest 20%

Decreasing OOPs means

Increasing Prepayments for
Health
GENERAL
GOVERNMENT
REVENUE
Financed through
budgetary
allocation
Main source of
funding in:
UK, Australia,
Finland, Italy,
Greece, Sweden and
others.

SOCIAL
(MANDATORY)
HEALTH
INSURANCE
Financed through
obligatory/mandator
y payroll taxes
Main source of
funding in:
Germany, Japan,
France, South Korea,
Turkey and others.

OTHER
ARRANGEMENT
S
Voluntary Health
Insurance
Private Health
Insurance
Community-Based
Health Insurance

Medical Saving
Accounts mandatory
with no pooling

National Health Insurance (NHI) for UHC

Historically, SHI covered formal sector (primarily
public but also private) through obligatory payroll taxes
Today, SHI evolved into NHIs which are
prepayment arrangements that cover
ALL formal and informal sectors (universality) and is
financed by a mix of mandatory contributions and
government budgetary allocations

Partly driven by:

In low- and middle-income countries: large

informal sector (poor and non-poor) and vulnerable

populations, unemployment
In high-income countries: aging populations,
unemployment

National Health Insurance for UHC

CHARACTERIZED BY

DRIVING

Quasi-) Independent and Protected

(Pooled) Fund/s with Autonomy
Split between Financing and
Provision
Funded by payroll taxes and
government revenues
Governed by (harmonized)
policies

Strategic Health Purchasing for

Enhanced Efficiency
Equity and Fairness
Quality of Care
Comprehensive Health Services
(primary care, medicines,
referral, hospital INCLUDING
sexual and reproductive health
services ++)

Entitlements because of your

citizenship and not because of your
job (Universality of population
coverage)
Increased Social Solidarity

Harnessing the private sector

Empowerment of the insured
you do not owe the provider a
favor