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    Extending Social Health Protection in the Asia-Pacific Region: Progress and challenges

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    Ravi P. Rannan-Eliya
    20 May 2008

    Abstract: Access to healthcare matters because it is instrumental in enabling people to achieve better health and to realize their full potential, and also because lack of access leads to economic insecurity, impoverishment and poverty. Social health protection in access terms is defined as comprising two elements. First, arrangements that ensure that all covered persons are able to access needed services when sick, and second, arrangements that prevent households being forced to incur impoverishing levels of expenditure in order to use needed healthcare. Given this, there are large disparities in access globally, with South Asia doing worse than the global average, and access better in wealthier countries. The global evidence indicates that public financing for healthcare and mechanisms that achieve a high-degree of risk-pooling are critical for improving access. Amongst the various mechanisms of financing available, only general revenue taxation and social health insurance have proved effective. Each of these have proved to have their own advantages and disadvantages. Other mechanisms such as private health insurance, out-of-pocket financing and community health insurance have not proved effective in extending coverage substantially.

    Within the Asia-Pacific region, some countries have achieved universal coverage with social health protection using taxation, such as Sri Lanka, Thailand and Malaysia, whilst a second group has done so using social health insurance, such as Japan and Korea. In the first group, poorer economies have not been able to achieve high levels of tax financing, so rely on substantial levels of private financing, but this is done in such a way that public financing reaches the poor and vulnerable in a reasonable manner. Those countries that have succeeded using social health insurance on the other hand have only done so by using general revenue taxation to subsidize or pay for the extension of insurance coverage to the poor and vulnerable. Countries and ILO can build on this experience by recognizing the primary need for government financing in ensuring universal coverage, and the need to design country-specific strategies in a careful manner.




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