Reducing out-of-pocket payments for health in order to achieve universal health coverage in Mongolia

Policy Blog
Healthcare costs are among the largest barriers to accessing health services and achieving universal health coverage (UHC) in Mongolia. In 2014, 0.7% or 5,681 households in Mongolia experienced catastrophic health expenditures due to out-of-pocket (OOP) expenses, spending more than 40% of their household subsistence income on health care.1 In this blog, I discuss the origins and impacts of these OOP payments, potential policy solutions and their likely impacts, and the challenges that Mongolia is likely to face in tackling OOP expenses in the future. How Mongolia’s health system has evolved since 1990 Since the early 1990s, when Mongolia transitioned to a market economy, the Mongolian health system has undergone a number of healthcare financing reforms, gradually moving away from the centralized, state-controlled “Semashko-style” model. In 1993, Social Health Insurance (SHI)…
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Indonesia’s pursuit of universal health coverage: challenges in selecting high-value healthcare and preventing waste

Policy Blog
This was an invited guest blog written by colleagues in Thailand’s Health Intervention and Technology Assessment Program. Health care technologies, including medicines, vaccines, and devices, contribute towards improved health outcomes but are also drivers of the rising costs of healthcare. Therefore, in the interest of sustainability it is essential to assess the value of these technologies on a regular basis. Indonesia, the fourth most populous country in the world, has a prime example of an evolving health system that is facing rising health care costs. This challenge, along with Indonesia’s transition from official development assistance for health and a budget deficit facing the country’s social insurance administration organization (called BPJS), which administers the national health insurance program, have made health technology assessment (HTA) a critically important tool. HTA can help…
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Always the Bridesmaid…

Latest News from the Center, Policy Blog
The following article was originally featured in the December 2018 issue of  The Medicine Maker magazine. The complete December 2018 issue of the magazine can be found here. You can download the PDF version of this article here ( Article_Always the Bridesmaid) Author: Gavin Yamey ( @GYamey) is the Director of the Center for Policy Impact in Global Health and a Professor of the Practice of Global Health and Public Policy at the Duke Global Health Institute.
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Development Assistance for Health: 4 Key Developments to Watch for in 2019

Policy Blog
2018 has been a year of many firsts that could help to mobilize global health financing and improve collaboration among global health actors.  Among these firsts, the Global Financing Facility’s (GFF) first replenishment, China’s establishment of its new aid agency, and a global action plan uniting the leading health multilateral agencies together for accelerating progress towards the Sustainable Development Goals (SDGs) stand out. 2019 is also shaping up to be a crucial year for global health development assistance. Here are the top things I’ll be watching in the coming year: Replenishment Mania GFF kicked off the health replenishment cycle in Norway last month with somewhat disappointing results: donors agreed to provide $1 billion to the GFF, achieving half of its target of $2 billion. More pledges may roll in after the…
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Donor Transitions From HIV Programs: What Is The Impact On Vulnerable Populations?

Policy Blog
This blog was originally published in Health Affairs Blog on December 14, 2018. The original version can be found here.  Many middle-income countries are transitioning away from donor-funded health programs in a range of areas including immunization, maternal and child health, tuberculosis, malaria, and HIV. Unless these donor exits are managed well, they could imperil the sustainability of the remarkable gains that have been achieved over the past two decades in fighting killer infectious diseases and maternal and child health conditions. Donor exits could particularly jeopardize gains in global HIV control. Countries and donors have spent more than $500 billion on HIV programs in low- and middle-income countries over the past two decades, but the gains from these investments are fragile. When donor funding for HIV programs ends, there is an especially acute…
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Intensified multilateral cooperation on global public goods for health: three opportunities for collective action

Latest News from the Center, Policy Blog
Through a number of collaborative projects with partners such as SEEK Development, UCSF’s Evidence to Policy Initiative, Open Consultants, and Spark Street Consulting, The Center for Policy Impact in Global Health has been studying the “global functions” of donor financing for health. By global functions, we mean collective action activities that address transnational health challenges. These activities can be categorized as (i) global public goods (GPGs), e.g., knowledge generation and sharing, or product development for neglected diseases; (ii) control of negative regional and global externalities, e.g., pandemic preparedness, and (iii) global health leadership and stewardship, e.g., global convening to build consensus. In one study led by our colleague Marco Schäferhoff, we found that there is substantial underinvestment in this critical area: only one-fifth of all donor financing for health targets…
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What is Essential Universal Health Coverage?

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In a new report written by the Lancet Commission on Investing in Health (the CIH), launched at last week’s Alma Ata at 40 meeting, the CIH draws on evidence from the third edition of the Disease Control Priorities (DCP3) to define essential universal health coverage (EUHC). DCP3 was a 7-year international collaboration that synthesized evidence on the most effective way to tackle priority health conditions in low-income countries (LICs) and middle-income countries (MICs). A key output of DCP3 was a set of 21 essential packages of interventions, each one aimed at a different health priority (e.g. reproductive health, pandemic preparedness).  As the CIH notes in the Alma Ata at 40 report: “Interventions were included in these 21 packages if they provided good value for money, were feasible to implement in…
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Let’s End the Fuzziness in Universal Health Coverage

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This Op-Ed first appeared in Global Health Now. [caption id="" align="alignnone" width="850"] The line begins at dawn in Myameyamu, Zambia for a monthly clinic that provides the only essential medical services for miles. Image: © 2012 Malcolm Spence/On Call Africa, Courtesy of Photoshare.[/caption] The global health community is gathering this week in Astana, Kazakhstan, to mark the 40th anniversary of the 1978 Alma Ata conference on primary health care. This time around, primary health care is being framed through the lens of universal health coverage (UHC). While everyone agrees that UHC is the right aspiration, the term has come to mean all things to all people, a catch-all with multiple proposed interpretations. The problem with this fuzzy language is that, without specificity, UHC risks being an empty promise. What does UHC mean, exactly?…
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Tracking financial commitments to women’s, children’s, and adolescents’ health

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One of our key research interests at The Center for Policy Impact in Global Health is studying how money flows through the global health “system.”  We are interested in questions such as where does global health financing come from, through which channels does it flow, where does it end up, and how is it used?  There is an enormous financing gap to achieve the ambitious health-related Sustainable Development Goals (SDGs)—one study suggests that an additional $371 billion is needed annually across low- and middle-income countries—and the tracking of finance flows is critical in knowing whether the gap is being closed.  Just meeting the child and maternal health targets in SDG3 alone is estimated to require an additional $33 billion annually. In recent months, along with our colleagues at Open Consultants…
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We need breakthrough technologies to reach the Sustainable Development Goal targets for health

Latest News from the Center, Policy Blog
This blog was originally published as part of the Future Development blog series of the Brookings Institution on October 5, 2018. The original version can be found here. Sustainable Development Goal (SDG) 3—ensuring healthy lives and promoting wellbeing for all—is accompanied by a very ambitious set of targets. These include ending avertable child deaths and ending the epidemics of AIDS, tuberculosis (TB), malaria, and neglected tropical diseases by 2030. Are these achievable or can they be dismissed as just a “fairytale”? ARE THE TARGETS ACHIEVABLE? Researchers have tried to answer this question using two complementary approaches. The first is to look at recent trends in death rates and then extrapolate these trends forward to 2030. The second is to model what would happen if today’s health interventions—such as medicines, vaccines, insecticidal…
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