HIV/AIDS Service Coverage Financial Sustainability and UHC · • Surveillans • Menjangkau...
Transcript of HIV/AIDS Service Coverage Financial Sustainability and UHC · • Surveillans • Menjangkau...
Poor, and Informal, Formal Workers
Uncovered Covered
Civil Servants
Coverage Mechanism
Outpatient
OI Inpatient**
Others
ART
Diagnostic
Premium Contribution Taxes
Out of pocket
Coverage of AIDS services (Generic)
Population Coverage
Service Coverage*
Cost Coverage
*) Service Coverage depicted here is just an example **) OI = Opportunistic Infection
What about INDONESIA?
• How the diagram will look?
• Coverage: Who will be covered? Under Single Payer (BPJS)…?
• Benefits Package: What would be covered under the benefit package? What services would remain through supply side subsidy to health facilities?
• What is the level of financial coverage?
Indonesia: Insurance/Universal Health Coverage “Roadmap”
2013 2014 2015 2016 2017 2018 2019
1/1/2014 Jankesmas Jamstostek Askes Military Police
Merge 360 + Local Schemes (Jamkesda)
Unique Identifiers
Merge MIS systems Harmonize Benefit Packages
New Payment Systems
Strengthen Delivery Systems
100% Enrollment How? MOF: Contributions MOH: Subsidies
Pokjas 100 %
Dapatkah kita menggabungkan paket pelayanan?
Global Fund/LSM
Kemenkes
• Test kit
• Biaya operasional
• Tambahan biaya staf
• Obat “second line” /jarum suntik
• Pemantauan dan Evaluasi
• Surveillans
• Menjangkau masyarakat
• Kondom
• Obat first line
• Gaji -upah
• Dibawah BPJS? kapan?
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Fragmentasi HIV/AIDS (KIA juga)
Government/Donor HIV Partnership MOH, UI, UNAIDS, Global Fund, WB, ….BPJS? MOF?
Investment Case by UNAIDS
(AEM/Goals Model)
Allocative Efficiency
HIV-UHC Integration
Overall Strategy Optimisation of
allocations (Optima Model extension)
Financial Sustainability
Estimating Funding Gap
Fiscal Space for Health and HIV
System Integration and Strengthening
Coverage
Benefit Package (BPJS) + Premium Calculation (MOF)
Payment Methods (Capitation + Case Mix)
M&E
COVERAGE
Definition/scope Policy research questions
– Define target beneficiaries for
the HIV benefit under UHC
– Understand current coverage (of
at risk population groups
(MARPs)) under various
insurance schemes
– Identify and examine
current/potential barriers to
cover targeted beneficiaries into
JKN
- Who, where, and also what size of target beneficiaries
- What are the current coverage by different types of insurance, and
examine to what extent there is dual coverage of JKN and other
programs.
- What are the main barriers to get the coverage, what’s preventing
access to service
- Do existing law/regulations need to be altered?
- What are key perceived issues from stakeholders
- What are the options for expansion under JKN
Activities/Data requirement
- Desk review (published, grey lit, secondary data)
- Interviews (central & local gov’t, insurance carriers, advocacy groups)
- Data: epidemiologic data; enrolment data; ART coverage; utilization data from ANC and STI clinic
Deliverables A report/ a brief report as a part of the integration-to-UHC report)
BENEFIT PACKAGE and PREMIUM CALCULATION
Definition/scope Policy research questions
– Examine comprehensive list of HIV
services and current inclusion in
BBP for HIV services;
– Explore options for different
inclusion or exclusion of services;
– Premium calculation based on the
BBP scenarios;
– Primary care capitation calculation;
– Risk adjustment based on specific
disease conditions, geographical,
demographical
– Who would deliver services and
how services will be delivered and
financed.
- Which services to be included/excluded from the list, and why?
- What is the current HIV services included in the UHC BBP; for other
insurance schemes (included services in local schemes), and why?
- Does the existing list need an additional positive list of services and
consultations?
- Should cost sharing be included? How will it be folded into the current
technology assessment initiatives?
- What are potential features that should be included on the premium
calculation that may be incentives/disincentives for beneficiaries to use
HIV related services; and also to providers?
- How different level of risks to be calculated (taking into account in
premium rate calculation)?
- Is supply side prepared to provide service?
Activities/Data requirement
- Desk review (published, grey lit, secondary data)
- Workshop consultation with stakeholder (MOH, KPA/NAC)
- Field visit
Deliverables
A report that includes
- Global experience/lessons learned on benefit package
- Different scenarios of BBP with HIV services and premium rates of HIV services included
PAYMENT METHODS
Definition/scope Policy research questions
– Payment options for primary care
and for secondary level of care
including the
incentives/disincentives of each
option;
– Risk adjustment based on specific
disease conditions, geographical,
demographical;
– Funding allocations under the UHC
options (referring to Global
experiences).
- What is the premium for HIV Services for different scenarios of BBP and
financial arrangement in the scheme; what would be financial implication
for each premium rate;
- What is the primary care capitation from the premium cost
- How different level of risks to be calculated (taking into account in
premium rate calculation)?
- What are the options for payment mechanisms; What are the
incentives/disincentives for each payment mechanism
- What are the options for financing and service delivery under the JKN
(BPJS) and what are the advantages / disadvantages of each option
Activities/Data requirement
- Desk review (published, grey lit, secondary data)
- Interviews (central & local gov’t, insurance carriers, advocacy groups) – if needed
- Policy analysis of various payment mechanism; financing and service delivery mechanism
- Policy workshops
Deliverables
A report that includes :
- Assessment on various payment mechanism, how the funding is allocated to Primary care and hospital
- Global experience/lessons learned on various payment methods; financing and service delivery mechanism
- Case studies (field observation)
PERFORMANCE INDICATORS (M&E)
Definition/scope Policy research questions
– Develop a list of Performance
Indicators
– Examine the current and M&E
framework and indicators of
BPJS/Other health insurance
schemes
- How to monitor performance: covering high risk population and
monitoring for quality of service?
- What are the indicators for HIV coverage?
- What information system needed to get the data?
Activities/Data requirement
- Desk review (published, grey lit, secondary data) especially on the JKN M&E framework
Deliverables
List of potential performance indicators
Government/Donor HIV Partnership MOH, UI, UNAIDS, Global Fund, WB, ….BPJS? MOF?
Investment Case by UNAIDS
(AEM/Goals Model)
Allocative Efficiency
HIV-UHC Integration
Overall Strategy Optimisation of
allocations (Optima Model extension)
Financial Sustainability
Estimating Funding Gap
Fiscal Space for Health and HIV
System Integration and Strengthening
Coverage
Benefit Package (BPJS) + Premium Calculation (MOF)
Payment Methods (Capitation + Case Mix)
M&E
Step 10: Implementation of the HIV/AIDS Financial Sustainability Framework (3 years)
Step 9: Other Systems Issues for Strengthening and Capturing Savings and Efficiencies (Indonesia – first line drugs)
Step 8: Integration in Delivery and Health System Strengthening Issues
Step 7: Efficiency and Value for Money – Strategic Purchasing (case-mix, other frontiers)
Step 6: Pooling of Funds and Governance (PEPFAR not on board; when is separate pool ok?)
Step 5: Integrating Long-Term Sustainability Analysis (M. Hacker and others)
Step 4: Raising Additional Revenue for the Health Sector and HIV/AIDS programs
Step 3: Government Priority Setting for Funding of HIV/AIDS Programs
Step 2: The Macroeconomic and Fiscal Context and Environment
Step 1: Understanding the HIV Epidemic and Estimating the Gap
Financial Sustainability Framework
Summary and Leadership
• MOF • All
stakeholders
• MOH/NAC /BPJS/
• MOH/NAC/MOF
• NAC/MOH
Gap Analysis Fiscal Space Assessment
Implementa-tion
Health Systems Integration
HIV Allocative Efficiency Analysis
Objective To analyze optimal allocations of HIV/AIDS resources (with
decreasing contribution from Global Fund) to yield the
maximal returns and determine the impact of policy/program
alternatives
Method Optimization analysis using the Optima tool
Analyses • Optimal mix of investment with varying funding level
• Return-on investment of HIV response
• Effect of reinvesting savings using new units costs
• Establish impact of continued investment into prevention
post-GF
Outputs A revised AE report with scenario analysis
Timeline January– March 2015
Area I: HIV Allocative Efficiency Analysis
Area II: UHC – HIV Integration
Integration of HIV/AIDS Programs into JKN
Objective To analyze options for integrating HIV/AIDS programs into
Universal Health Coverage (UHC) / JKN
Method Integration analysis including assessment and review of
coverage, benefit package and premium calculation, payment
methods, and M&E
Analyses • Coverage
• Benefit package + Premium Calculation
• Payment methods
• M&E
Outputs A final report on UHC – HIV integration with background
analysis and reports
Timeline September 2014 – March 2015
Area III: Financial Sustainability Analysis
Financial Sustainability Framework
Objective Develop a strategy for financial sustainability (post GF) with
specific action areas that can be committed and implemented
by key stakeholders involved, including MOF, MOH, and
partners
Method HIV Financial Sustainability Framework
Analyses • Gap Analysis
• Fiscal space analysis for Health and HIV
• System integration
Outputs FS strategy with transition plans
Implementation agreement (between MOH/NAC, BPJS , and
MOF)
Timeline September 2014 – March 2015