Full Report - Subregional Office for East and North-East Asia - escap

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ECONOMIC AND SOCIAL SURVEY OF ASIA AND THE PACIFIC 2013 Figure 4.5. Expenditure for disability payments to persons with disabilities, aged 15-65 years 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Percentage of GDP 2026 2027 2028 2029 2030 Source: ESCAP. Bangladesh China Fiji India Indonesia Malaysia Philippines Russian Federation Thailand Turkey would need to increase by 9% annually to reach the goal. In contrast, the effort required in other countries will be considerably less: in Turkey, the goal has already been reached and in Thailand, expenditure would need to increase by less than 2.5% per year to reach the target rate of 5% of GDP by 2030. As the required percentage increase differs by country, yet remains constant per country until the target date, the additional absolute increase in health expenditure will accelerate as the target date of 2030 approaches. Levels of expenditure on health are, of course, only one way of capturing progress towards implementing universal health coverage. Moreover, health costs alone do not take efficiency of expenditure into account. For instance, a number of countries in the region already spend significantly more than 5% of their GDP on health, but are far from achieving universal coverage. 4 At the same time, Thailand, which spends less than 5% of its GDP on health, is largely viewed as having achieved universal coverage of health services. Greater health expenditure should, therefore, go hand-in-hand with efforts to address the significant disparities that exist within countries in terms of health outcomes to capture inefficiencies and ensure that access to health care is universal and equitable. Figure 4.6. Expenditure for universal health coverage and annual percentage increase Percentage of GDP 5 4 3 2 1 0 2009 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Bangladesh Indonesia Philippines India Malaysia China Fiji Thailand Russian Federation Russian Federation Thailand Fiji China Malaysia India Philippines Indonesia Bangladesh 0 1 2 3 4 5 6 7 8 9 10 Percentage Source: ESCAP. 182
INVESTING IN INCLUSIVE AND SUSTAINABLE DEVELOPMENT CHAPTER 4 Box 4.2. The WHO Health Financing Strategy for the Asia-Pacific region Both a fundamental right and an investment in human capital, universal health coverage is a widely established objective in the Asia-Pacific region. In order to achieve appropriate preventive, curative, rehabilitative and palliative services at an affordable cost, countries need to advance along three dimensions: the breadth or extension of the population coverage by insurance schemes; the depth or the types of services that need to be provided, such as outpatient and inpatient services; and the height or the financial risk protection, such as co-payments (Tangcharoensathien and others, 2011). The global economic recession has put stress on health-care budgets and is generating greater vulnerability, especially among the poor and marginalized segments of the population. Current levels of out-of-pocket health expenditure in the Asia-Pacific region are much higher than in other parts of the world. In a high number of cases, households incur catastrophic health expenditures. Moreover, in many countries, government spending on health is too low to sustainably finance universal coverage. Behind this limited fiscal space is a low tax-base and insufficient progressivity of the tax structure. Given these constraints, governments in the region face the dilemma of negotiating two paths: providing a high level of services and financial protection for a small group of the population versus extending a high level of population coverage but with restricted services and financial protection. To achieve greater policy space for negotiating this trade-off, governments can expand health services, especially for primary health care, by increasing financial resources and achieving greater efficiency in use of resources. Prepayment and risk-pooling arrangements can also allow for the extension of services to more people and for the reduction of out-of-pocket payments, and, thus, catastrophic health expenditure. Against this backdrop, the WHO has proposed a health financing strategy to assist Member States in achieving universal coverage (WHO, 2009a). This framework is adapted to national contexts in collaboration with ministries of health and relevant national health-care stakeholders. The strategy identifies eight priority areas that countries in the region will need to focus on, as they move from “out-of-pocket” dominated health protection to universal coverage that would include tax-based financing, social health insurance and a mix of other prepayment schemes including private insurance. (1) Increasing investment and public spending on health: With the aim of ensuring adequate public financing, this strategy calls for increased government financial commitment to health care in medium- and long-term plans of action and for multi-sectoral synergy and coordination. (2) Improving aid effectiveness for health: Given that external aid will continue to serve as a key source of financing in many Asian and Pacific countries, it is essential to better align overseas development assistance (ODA) with national health programmes and objectives. (3) Improving efficiency by rationalizing health expenditures: Resources should be outcome-based and address inequities, inefficiencies and low service quality. All planning should be oriented towards the goal of achieving universal coverage through balanced allocations between primary, secondary and tertiary care. (4) Increasing the use of prepayment and risk-pooling: Prepayment and risk-pooling arrangements can improve equity, access and protection against the financial risks of ill-health. The advantage of these arrangements is that they of offer adequate options, such as social health insurance, with equitable contributions and benefits. 183
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UNDER EMBARGO UNTIL 03.30 GMT, THUR
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ECONOMIC AND SOCIAL SURVEY OF ASIA
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PREFACE The Economic and Social Sur
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EXECUTIVE SUMMARY FORWARD-LOOKING M
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on education and health. Indebted c
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ACKNOWLEDGEMENTS This report was pr
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CONTENTS Page Foreword ............
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CONTENTS (continued) Page Australia
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BOXES Page A. Forward-looking macro
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FIGURES (continued) Page 1.20. Ineq
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TABLES Page 1.1. Main destination e
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References to dollars ($) are to Un
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ABBREVIATIONS ADB AEC APEC ASEAN AS
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SOURCES OF QUOTATIONS (a) Page 1: a
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WHY FORWARD-LOOKING MACROECONOMIC P
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▲ WHY FORWARD-LOOKING MACROECONOM
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THE STATE OF INCLUSIVE AND SUSTAINA
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Page 161 and 162: MACROECONOMIC PERFORMANCE AND POLIC
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Page 237 and 238: 207 REFERENCES
Page 239 and 240: REFERENCES REFERENCES Abdyrasulova
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Page 243 and 244: REFERENCES (2012). World Energy Out
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Page 247 and 248: REFERENCES (2011b). Child Poverty i
Page 249 and 250: REFERENCES United Nations, Economic
Page 251 and 252: STATISTICAL ANNEX STATISTICAL ANNEX
Page 253 and 254: STATISTICAL ANNEX Table 2. Poverty
Page 255 and 256: STATISTICAL ANNEX Table 4. Resource
Page 257 and 258: STATISTICAL ANNEX Technical notes T
Page 259 and 260: STATISTICAL ANNEX Source: Barro, Ro
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This publication may be obtained fr
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READERSHIP SURVEY The Macroeconomic
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Half a decade since the onset of th
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Full Report - Subregional Office for East and North-East Asia - escap

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