The Geneva Health Forum Abstracts

D.B. Evans1 1Health Systems Financing, World Health Organization, Geneva, Switzerland

Key issues: In high income countries, concern has been primarily with the rate at which health costs are rising, but there is growing concern about the extent to which poor and vulnerable groups are able to access needed services. In lower income settings, the costs of seeking and obtaining care can be considerable because of the prevalence of fees or charges for services and the long distances people have to travel to obtain care. The consequent expenditures for those who do seek care can result in financial catastrophe and even impoverishment. At the same time, the need to pay these costs, which can be substantial even when services are officially free, discourages other people from accessing needed services. Subsequent untreated illness pushes some of them into poverty, and deepens the poverty of others, through its impact on their ability to work. Other typical concerns from the perspective of the population in all settings, rich and poor, are the quality of care, the quality of amenities and whether health personnel treat patients with dignity and respect. All are influenced by the way the health system is fi nanced.
Meeting challenges: Recognizing these issues, the 192 member states of the World Health Organization recently adopted a resolution urging countries to develop health financing systems that ensured that their populations had access to needed health services without the risk of financial catastrophe and impoverishment. In some countries it will take many years to achieve this vision, called universal coverage. The challenge is to devise ways of moving as quickly as possible towards greater reliance on pooled funds for health and less reliance on out-of-pocket payments in low and middle income countries.
Conclusion and recommendations: The talk describes the steps required to achieve this goal, and strategies that could be adopted during the transition period, all involving the establishment or further development of prepayment systems. Most countries use a combination of tax-based funding and insurance contributions. Important principles are to ensure adequate crosssubsidization from richer to poorer groups, and from the healthy to the sick. This will generally require compulsory contributions, which can take many formats including private, community and social health insurance as well as tax-based funding.

ALTERNATIVES IN HEALTHCARE FINANCING: EXAMPLES FROM LOW- AND MIDDLE-INCOME COUNTRIES S. Nishtar1 1President, Heartfi le, Pakistan
Summary: Pakistan currently principally uses three modes of financing health ? taxation, out of pocket payments and donor contributions of which the latter is the least signifi cant in terms of size. The government spends 0.6 of its GDP and 11.6% of its development budget on health. Less than 3.6% of the employees are covered under the social security scheme and there is a limited social protection mechanism, which collectively serves the health needs of 3.4% of the population. The main issues in health financing include low spending, lack of attention to alternate sources of financing and issues with fund mobilization and utilization. With respect to the first, recently proposed health reforms make a strong case for promoting the reallocation of taxbased revenues and developing sustainable alternatives to low levels of public spending on health. With respect to alternative sources of health financing, the proposed reforms as articulated in the Gateway Paper lay stress on exploring policy options for private health insurance, broadening the base of Employees Social Security, creating a Federal Employees Social Security Programme, developing social health insurance within the framework of a broad-based social protection strategy, which scopes beyond the formally employed sector, establishing a widely inclusive safety net for the poor; mainstreaming philanthropic grants as a major source of health financing; developing a conducive tax confi guration; generating greater corporate support for social sector causes within the framework of the concept of Corporate Social Responsibility and developing cost-sharing programmes, albeit with safeguards. The Gateway Paper regards efficient fund utilization a priority and lays stress on striking a balance between minimizing costs, controlling costs and using resources more efficiently and equitably ? in other words, getting the best value for the money, on the one hand, and increasing the pool of available resources, on the other. specific interventions such as the promotion of transparent financial administration, budgeting and cost controls and enhancing the capacity to overcome onerous financial management procedures and decentralizing decision-making are underscored as a priority as is the need for ensuring greater financial procedural clarity at the federal-provincial-district interface.

G. Ellena1 1Director, Health and Education Department, International Finance Corporation, World Bank Group, USA