[Subgroup-health] Rép. : Systems Design

[Iddo Dror]

Dear Bill, Valérie and all,

Thanks for the mail and interesting publications.  I look forward to 
resuming our discussion on the mission statement and the research 
agenda.  At some point, it may also be a good idea to take stock of the 
existing body of peer-reviewed publications on areas around our topic(s) 
so that we have a better point of departure for our research.

I have a few quick questions/comments on the topics you raise.

1. Who defines what is the essential package?  They say /he who pays the 
piper calls the tune, /and by the same token, those who want to call the 
tune, should be ready to pay the piper...  Still, at least in the 
context of developing countries, the vast majority of spending on 
healthcare is borne by households, not by governments.  So, there is a 
potential risk that in defining these packages, presumably through 
central govt committees, one could dampen WTP from the real payers by 
not involving them in the process.

2. In the publication you (Valérie) refer to it is stated that  
/“According to ILO calculations, less than 2 per cent of the global_ 
_Gross Domestic Product (GDP) would be necessary to provide a basic set 
of social security benefits to all of the world’s poor (ILO, 2006).”/   
How likely is it that rich countries increase their donations to poor 
countries’ health system by such amounts (if we are talking about 
_global_ GDP here, not 2% of GDP of developing countries)?  The trends 
are actually opposite – according to OECD figures, donations have 
actually gone down by about 20% from 2001 to 2007.   So, if the donor 
route is not a realistic option and national government fall short of 
the desired 4% of GDP benchmark for health spending, it would seem that 
we go back to the primary payer – households / communities.
 
3. It does seems likely that in the context of developing countries, we 
are looking at multiple sources of funding.  What (evidence-based) 
research has been done to determine what model / delivery system of 
micro health insurance is most efficient and compatible with other 
sources of financing?  Perhaps we can add this to the potential areas of 
research for the subgroup.
 
Best regards,
 
Iddo

-- 
Iddo Dror, PhD 

Director of Operations
Micro Insurance Academy
http://www.microinsuranceacademy.org

//

Valérie Schmitt-Diabate wrote:
> Dear Bill, dear all,
>  
> Yes Bill you are right it is a bit quiet after the rush!!
>  
> In the coming weeks however we will exchange again  :
> 1) on the mission statement (we need to produce and share the final 
> version based on all the contributions and we will decide if we wish 
> to disseminate it during the MI Conference)
> 2) on the organization of our subgroup meeting to be held during the 
> MI Conference (what are the objectives of this meeting ? do we want to 
> start working on some of the issues mentionned as priority in our 
> previous discussions before this meeting ? and then be able to 
> exchange / share the first results of this preliminary work during the 
> meeting ? etc. )
>  
> In the meanwhile, *thanks for sharing this interesting paper with us*. 
> Some of the ideas may be applicable to developping countries.
>  
> It is the case of Pr Reinhard Busse's "health basket synthesis" 
> conceptual framework which includes several dimensions : range of 
> benefits that should be included (depth), extent to which they should 
> be financed from public funds (height), and population coverage (breadth)
>  
> The idea of the /*essential healthcare package*/ mentioned in the 
> paper is in line with the ILO Social security department's basic 
> social security concept; basic social security is a set of 
> guarantees (access to health care, minimum pensions ...) that should 
> be provided to all citizens in a country ; the "depth" and "height" of 
> this SS Floor depends of course on the share and amount of public 
> spending allocated to social protection and the country's GDP. Above 
> the SS Floor the other stairs of the "social security house" can be 
> built with social security statutory schemes, linked schemes and 
> complementary voluntary schemes.
> Please find attached an interview of our Director on this concept 
> http://www.ilo.org/gimi/RessShowRessource.do?ressourceId=2691
> and the publication  can be downloaded under following link:
> http://www.ilo.org/public/english/protection/secsoc/downloads/policy/policy3e.pdf
>  
> The idea of organizing access to this basic benefit package through 
> mutual helth organizations is also an idea that seems feasible as 
> shown by the Colombian subsidized regime where 60% of the market is 
> held by mutual health organizations.
>  
> However many other options exist to deliver the basic social security 
> package (mutual health organizations; community based schemes; 
> partner-agent model; MFIs providing health microinsurance products; 
> etc.)  and our subgroup decided in its mission statement to explore 
> each option without preconceived idea. This may be one of our research 
> topics in the coming months.
>  
> It is also important to stress that low income countries may need to 
> rely (at least during a transatory phase) on various sources of 
> funding in order to finance the basic social security package 
> (contributions from the citizens who can pay at least a share of the 
> premium, State's budget, contribution from the corporate sector, cross 
> contributions from statutory schemes, international solidarity). It 
> may also interesting to explore existing approaches to capture 
> international solidarity and document them. Please find a presentation 
> I made in Morrocco on these various financing options (in French)
> http://www.ilo.org/gimi/RessShowRessource.do?ressourceId=5932 
> <http://www.ilo.org/gimi/RessShowRessource.do?ressourceId=5932&longTitle=Garantir+un+socle+de+s?curit?+sociale&author=Val?rie+Schmitt+Diabat?&ressYear=2008>
>  
> I hope some other members of our subgroup will be willing to react on 
> your paper !!
>  
> Thanks again
> Valérie
>  
>  
>  
>  
> >>> "bill mcpate" <billmcpate at btinternet.com> 06/17/08 11:41 am >>>
> Hello All,
> It has gone very quiet after the rush to plan the conference?
>  
> I have just finished writing a case for a wider role for mutuals in 
> healthcare as offering the best chance of coping with rising demand. 
> Whilst it is addressed mainly at the situation in Europe I have 
> attached it because it argues that the "best" national system design 
> template involves a partnership between the state and mutuals and that 
> this applies equally to the developing world.
>  
> I hope you find these thoughts of interest.
>  
> Bill McPate
> The Benenden Healthcare Society
>  
>  
>
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