Written by Patricia Moser, Lead Health Specialist
A recent Reuters news article highlighted the challenges and opportunities of health reform in Asia. The article highlights the situation of a family whose premature infant daughter dies as a result of being unable to obtain infant ICU services in Jakarta, Indonesia. The article indicates that the problem resulted from increased demand for health services as a result of a recent health insurance scheme introduced for the poor in Jakarta. The new scheme has empowered more people to seek services, overwhelming the limited health services available.
The situation in Indonesia is mirrored in other economies that have expanded social health insurance legislation or introduced new programs to cover the poor in efforts to meet political commitments to universal health coverage. Demand for health services, particularly for the poor, is often constrained by ability to pay. New programs that entitle populations or individuals to no-cost or lower-cost health services often increase service use – an intended outcome of these programs.
However, program sponsors must consider how these new demands are to be met. Will this result in additional clients for already strained services? How can policymakers and politicians make sure that service suppliers are ready to take on the challenge of increased demand? Where will financing be found to expand services at the same time new public financing is being used to finance the demand based programs? How to ensure a supply side response? How to mitigate the lag time between increased demand and improved supply? What roles does the private sector play in service delivery or facilities finance? And especially - how do health systems maintain and improve the quality of services as they rapidly expand?
These and many other considerations underlie the discussions on universal health coverage. Expanding coverage through well-targeted demand-based programs (CCTs, social health insurance, vouchers) can provide greater social protection – but also opens new challenges and opportunities for health services supply. To focus on the opportunities side: there is great potential for creating new incentives for both public and private health providers to respond to national health goals, but such incentives and the impacts of financing reforms must be constantly measured, evaluated and amended to improve health services functioning. This will take sustained effort on the part of our public sector counterparts and on ADB and health development partners throughout the region.
As noted by the World Bank President Jim Kim in his address to the world’s Health Ministers at the 2013 World Health Assembly, it is time to expand “the science of [health services] delivery” to help countries determine how best to build health systems that respond to the real health needs of the poor. Determining how best to promote both quality supply and effective demand for essential health services should be at the top of that new science agenda.
The problem for Indonesia is not too much demand, but too little supply.