Health-financing reforms in southeast Asia: challenges in achieving universal coverage

Abstract

Please refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alternatively contact researchonline@lshtm.ac.uk. A Ab bs st tr ra ac ct tThis paper reviews and draws lessons on health financing reforms in seven countries in South East Asia which have sought to reduce dependence on out-of-pocket payments and increase pooled health finance. The resource-poor countries, Cambodia and Lao, have relied largely on donor-supported Health Equity Funds to target the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide scaling-up. Payroll-tax-financed social health insurance is commonly applied to formal sector employees (Malaysia excepted), with varying outcomes in term of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged, contributory arrangements and taxfinanced schemes, with differing abilities to achieve universal coverage rapidly. Fiscal space and mobilization of payroll contributions are both important in accelerating universal coverage. As reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened.3

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