The Use of Evidence-Informed Deliberative Processes for Designing the Essential Package of Health Services in Pakistan.

BACKGROUND: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages. METHODS: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process. RESULTS: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socio-economic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process. CONCLUSION: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.

The Use of Evidence to Design an Essential Package of Health Services in Pakistan: A Review and Analysis of Prioritisation Decisions at Different Stages of the Appraisal Process.

BACKGROUND: Pakistan embarked on a process of designing an essential package of health services (EPHS) as a pathway towards universal health coverage (UHC). The EPHS design followed an evidence-informed deliberative process; evidence on 170 interventions was introduced along multiple stages of appraisal engaging different stakeholders tasked with prioritising interventions for inclusion. We report on the composition of the package at different stages, analyse trends of prioritised and deprioritised interventions and reflect on the trade-offs made. METHODS: Quantitative evidence on cost-effectiveness, budget impact, and avoidable burden of disease was presented to stakeholders in stages. We recorded which interventions were prioritised and deprioritised at each stage and carried out three analyses: (1) a review of total number of interventions prioritised at each stage, along with associated costs per capita and disability-adjusted life years (DALYs) averted, to understand changes in affordability and efficiency in the package, (2) an analysis of interventions broken down by decision criteria and intervention characteristics to analyse prioritisation trends across different stages, and (3) a description of the trajectory of interventions broken down by current coverage and cost-effectiveness. RESULTS: Value for money generally increased throughout the process, although not uniformly. Stakeholders largely prioritised interventions with low budget impact and those preventing a high burden of disease. Highly cost-effective interventions were also prioritised, but less consistently throughout the stages of the process. Interventions with high current coverage were overwhelmingly prioritised for inclusion. CONCLUSION: Evidence-informed deliberative processes can produce actionable and affordable health benefit packages. While cost-effective interventions are generally preferred, other factors play a role and limit efficiency.

Pakistan's Progress on Universal Health Coverage: Lessons Learned in Priority Setting and Challenges Ahead in Reinforcing Primary Healthcare.

Pakistan developed an essential package of health services at the primary healthcare (PHC) level as a key component of health reforms aiming to achieve universal health coverage (UHC). This supplement describes the methods and processes adopted for evidence-informed prioritization of services, policy decisions adopted, and the lessons learned in package design as well as in the transition to effective rollout. The papers conclude that evidence-informed deliberative processes can be effectively applied to design affordable packages of services that represent good value for money and address a major part of the disease burden. Transition to implementation requires a comprehensive assessment of health system gaps, strong engagement of the planning and financing sectors, serious involvement of key national stakeholders and the private health sector, capacity building, and institutionalization of technical and managerial skills. Pakistan's experience highlights the need for updating the evidence and model packages of the Disease Control Priorities 3 (DCP3) initiative and reinforcing international collaboration to support technical guidance to countries in priority setting and UHC reforms.

Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.

BACKGROUND: In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP. METHODS: We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams. RESULTS: We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections. CONCLUSION: Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

Assessing Global Evidence on Cost-Effectiveness to Inform Development of Pakistan's Essential Package of Health Services.

BACKGROUND: Countries designing a health benefit package (HBP) to support progress towards universal health coverage (UHC) require robust cost-effectiveness evidence. This paper reports on Pakistan's approach to assessing the applicability of global cost-effectiveness evidence to country context as part of a HBP design process. METHODS: A seven-step process was developed and implemented with Disease Control Priority 3 (DCP3) project partners to assess the applicability of global incremental cost-effectiveness ratios (ICERs) to Pakistan. First, the scope of the interventions to be assessed was defined and an independent, interdisciplinary team was formed. Second, the team familiarized itself with intervention descriptions. Third, the team identified studies from the Tufts Medical School Global Health Cost-Effectiveness Analysis (GH-CEA) registry. Fourth, the team applied specific knock-out criteria to match identified studies to local intervention descriptions. Matches were then cross-checked across reviewers and further selection was made where there were multiple ICER matches. Sixth, a quality scoring system was applied to ICER values. Finally, a database was created containing all the ICER results with a justification for each decision, which was made available to decision-makers during HBP deliberation. RESULTS: We found that less than 50% of the interventions in DCP3 could be supported with evidence of cost-effectiveness applicable to the country context. Out of 78 ICERs identified as applicable to Pakistan from the Tufts GH-CEA registry, only 20 ICERs were exact matches of the DCP3 Pakistan intervention descriptions and 58 were partial matches. CONCLUSION: This paper presents the first attempt globally to use the main public GH-CEA database to estimate cost-effectiveness in the context of HBPs at a country level. This approach is a useful learning for all countries trying to develop essential packages informed by the global database on ICERs, and it will support the design of future evidence and further development of methods.

Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience.

BACKGROUND: Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. METHODS: EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. RESULTS: The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. CONCLUSION: Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.

Factors affecting private sector engagement in achieving universal health coverage: a scoping review.

BACKGROUND: Universal Health Coverage (UHC) is one of the most important strategies adopted by countries in achieving goals of sustainable development. To achieve UHC, the governments need the engagement of the private sector. OBJECTIVE: The aim of this study was to identify factors affecting private sector engagement in achieving universal health coverage. METHODS: The study is a scoping review that utilizes Arkesy & O'Malley frameworks. Data collection was conducted in MEDLINE, Web of Sciences, Embase, ProQuest, SID, and MagIran databases and the Google Scholar search engine. Also, manual searches of journals and websites, reference checks, and grey literature searches were done using specific keywords. To manage and screen the studies, EndNote X8 software was used. Data extraction and analysis was done by two members of the research team, independently and using content analysis. RESULTS: According to the results, 43 studies out of 588 studies were included. Most of the studies were international (18 studies). Extracted data were divided into four main categories: challenges, barriers, facilitators, goals, and reasons for engagement. After exclusion and integration of identified data, these categories were classified in the following manner: barriers and challenges with 59 items and in 13 categories, facilitators in 50 items and 9 categories, reasons with 30 items, and in 5 categories and goals with 24 items and 6 categories. CONCLUSION: Utilizing the experience of different countries, challenges and barriers, facilitators, reasons, and goals were analyzed and classified. This investigation can be used to develop the engagement of the private sector and organizational synergy in achieving UHC by policymakers and planners.

Main findings: Governments are key in healthcare provision, but the private sector's involvement is increasingly vital for universal health coverage.Added knowledge: This paper explores the evolving role of the private sector in universal health coverage, analysing barriers, challenges, facilitators, reasons, and goals for engagement while suggesting areas for further exploration.Global health impact for policy and action: The private sector's contributions to achieving Universal Health Coverage necessitate comprehensive policy frameworks and targeted actions to ensure equitable and sustainable health outcomes worldwide.

Universalization of Healthcare for Non-Communicable Diseases in India - Promise of Health and Wellbeing, Insurance for Universal Health Coverage.

SUMMARY: Noncommunicable diseases (NCDs) pose a significant global health and economic burden, necessitating universal health coverage (UHC). Out-of-pocket (OOPs) payments for healthcare, particularly in low- and middle-income countries lacking social protection and health insurance, contribute to impoverishment and catastrophic expenditure. This scoping review aimed to assess the state of UHC for NCDs in India, including the progress made, coverage of government health insurance schemes, challenges faced, and their potential solutions. A literature search was performed in major databases such as PubMed, Ovid, Web of Science, Embase, Cochrane Library, and Google Scholar using appropriate keywords. Findings indicated that UHC remains a distant dream in India with a disproportionately high NCD burden and a substantial portion of health-care expenses (80% outpatient, 40% inpatient) relying on OOP expenditures, causing financial hardship. Limited universal social security exacerbates health-care access challenges. The coronavirus disease-2019 pandemic has further hindered NCD services and UHC progress. The Ayushman Bharat program, featuring health and wellness centers and the Pradhan Mantri Jan Arogya Yojana, aims to address primary health-care needs and provide NCD coverage in India. Despite this, challenges persist, including inadequate availability of essential medicines and technologies in health-care facilities, as well as gaps in rural health-care access. Telemedicine services like "eSanjeevani" have been implemented to improve access in remote areas. To achieve UHC for NCDs in India, it is crucial to strengthen primary health-care, ensure medicine availability, enhance human resources, establish a referral system, address social determinants, and implement social protection.

The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review.

BACKGROUND: Efforts to move towards universal health coverage (UHC) aim to rebalance health financing in ways that increase efficiency, equity, and quality. Resource constraints require a shift from passive to strategic purchasing (SP). In this paper, we report on the experiences of SP in public sector health insurance schemes in nine middle-income countries to understand what extent SP has been established, the challenges and facilitators, and how it is helping countries achieve their UHC goals. METHODS: We conducted a systematic search to identify papers on SP. Nine countries were selected for case study analysis. We extracted data from 129 articles. We used a common framework to compare the purchasing arrangements and key features in the different schemes. The evidence was synthesised qualitatively. RESULTS: Five countries had health technology assessment (HTA) units to research what services to buy. Most schemes had reimbursement mechanisms that enabled some degree of cost control. However, we found evidenced-based changes to the reimbursement mechanisms only in Thailand and China. All countries have some form of mechanism for accreditation of health facilities, although there was considerable variation in what is done. All countries had some strategy for monitoring claims, but they vary in complexity and the extent of implementation; three countries have implemented e-claim processing enabling a greater level of monitoring. Only four countries had independent governance structures to provide oversight. We found delayed reimbursement (six countries), failure to provide services in the benefits package (four countries), and high out-of-pocket (OOP) payments in all countries except Thailand and Indonesia, suggesting the schemes were failing their members. CONCLUSION: We recommend investment in purchaser and research capacity and a focus on strong governance, including regular engagement between the purchaser, provider and citizens, to build trusting relationships to leverage the potential of SP more fully, and expand financial protection and progress towards UHC.

Determinantes sociales que influyen en el acceso en Chile al Plan GES, según CASEN 2017 / Social determinants of access to the explicit guarantees health program implemented in Chile

BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.

Conferencia de Prensa OPS COVID-19 - 2 de diciembre 2020

Conferencia de Prensa OPS COVID-19 2 de diciembre 2020 - áudio Español

PAHO information session for the press on COVID19 - December 2, 2020

PAHO information session for the press on COVID-19 - December 2, 2020 - audio English

Sesión informativa de la OPS sobre COVID-19

Sesión informativa de la OPS sobre COVID-19 / PAHO’s press briefing on COVID-19 - audio original

Geraldo Medeiros (SES/PB): I Encontro Regional de Saúde Nordeste

Aproximadamente 220 pessoas – gestores, especialistas, profissionais e estudantes de saúde – estiveram reunidos ontem e hoje (7 e 8), na Escola de Saúde Pública da Bahia, no 1º Encontro Regional de Saúde do Nordeste, promovido pela Secretaria de Estado da Saúde da Bahia e pelo Conass, com apoio do Consórcio Nordeste. Participaram da abertura do encontro o anfitrião, secretário Fábio Vilas-Boas (SES/BA); o presidente do Conass, Alberto Beltrame (SES/PA); o representante da Opas, Renato Tasca; a presidente do Cebes, Lucia Souto; a presidente da Abrasco, Gulnar Azevedo; e o vice-presidente do Cosems/BA, Raul Molina.

Análise do Seguro Popular de Saúde mexicano: uma revisão integrativa da literatura / Analysis of Mexican Popular Health Insurance: an integrative review of literature

RESUMO Esse artigo objetiva analisar a reforma do sistema de saúde mexicano, a partir da implantação do Seguro Popular de Saúde, destacando seu funcionamento, aspectos positivos e negativos. Foi realizada uma revisão integrativa da literatura nas bases Lilacs e SciELO Regional no período de janeiro de 2011 a dezembro de 2018. Foram incluídas publicações que atendiam a três questionamentos: história do sistema de saúde mexicano, seu funcionamento e pontos positivos e negativos do Seguro Popular de Saúde. A literatura aponta que o Seguro Popular surgiu após um processo de reformas neoliberais no sistema de saúde mexicano, consonante com a proposta de Cobertura Universal de Saúde, que visa reduzir o empobrecimento por gastos em saúde na população sem seguridade social. O Seguro Popular oferece menor variedade de diagnósticos e tratamentos do que a seguridade social, menor número de consultas, atendimentos de urgência e medicamentos. Seu maior impacto foi nas populações indígena e rural, mas 20% da população continua descoberta e o atendimento permanece desigual. A análise do Seguro Popular permite inferir possíveis impactos que teriam os planos de saúde acessíveis no cenário brasileiro, acarretando acesso a um elenco menor de procedimentos para a população atualmente coberta pelo Sistema Único de Saúde.

ABSTRACT This article aims to analyze the reform of Mexican health system, from the implementation of Popular Health Insurance, highlighting its operation, positive and negative aspects. An integrative review of the literature was conducted using Lilacs and SciELO Regional databases from January 2011 to December 2018. Publications included addressed three main themes: history of Mexican health system, its functioning and positive and negative points of the Popular Health Insurance. The literature points out that Popular Health Insurance emerged after a process of neoliberal reforms in the Mexican health system, consonant with the Universal Health Coverage proposal, which aims to reduce impoverishment by health spending in the population without social security. Popular Health Insurance offers a smaller variety of diagnoses and treatments than social security, less number of consultations, urgent care and medications. Its greatest impact was on indigenous and rural populations, but 20% of the general population remains uncovered and care is unequal still. Popular Health Insurance analysis allows us to infer possible impacts that the affordable health plans would have on the Brazilian scenario, resulting in access to a smaller set of procedures for the population currently covered by the public health system in place (SUS).

Evaluación del espacio fiscal para salud en Bolivia / Evaluation of fiscal space for health in Bolivia / Avaliação do espaço fiscal para a saúde na Bolívia

RESUMEN Objetivo Evaluar desde los puntos de vista técnico y político la capacidad de Bolivia para generar espacio fiscal para salud que le permita sostener los avances y cumplir el compromiso de un gasto público en salud de 6% del producto interno bruto (PIB). Métodos Se realizó una revisión de la evidencia internacional sobre espacio fiscal y sus mediciones. El análisis técnico se desarrolló a través del uso de estadísticas e informes oficiales de múltiples fuentes secundarias nacionales e internacionales. El análisis político y social se llevó a cabo mediante 20 entrevistas a representantes de organismos e instituciones. Resultados Existe capacidad para crear espacio fiscal en salud para Bolivia. Las fuentes con mayor factibilidad técnica y política son tres: el crecimiento económico vinculado al compromiso de repriorización del gasto público en salud, mejoras de las fuentes internas de recaudación a través de la reducción de la informalidad y reducción de los gastos tributarios. Con menos factibilidad se sitúa el financiamiento externo y el aumento de las contribuciones a la Seguridad Social. Conclusiones Bolivia está en condiciones de alcanzar un gasto público en salud de 6% del PIB. El tiempo en que logre esta meta depende de mantener la priorización del gasto en el sector, con el consenso de la mayoría social y política y en un marco de crecimiento y estabilidad económica.

ABSTRACT Objective To assess from a technical and political point of view the capacity of Bolivia to generate fiscal space for health that allows it to sustain progress and fulfill the commitment of a public health expenditure of 6% of gross domestic product. Methods A review of the international evidence on fiscal space and its measurements was conducted. The technical analysis was developed through statistics and official reports from multiple national and international secondary sources. The political and social analysis was carried out through 20 interviews with representatives of organizations and institutions. Results There is capacity to create fiscal space in health for Bolivia. There are three sources with the greatest technical and political feasibility: economic growth linked to the commitment to reprioritize public spending on health; improvements in the internal sources of revenue through the reduction of informal work; and reduction of tax expenditures. External financing and an increase of Social Security contributions are less feasible. Conclusions Bolivia is able to achieve a public health spending of 6% of gross domestic product. The timing to achieve this goal depends on maintaining the prioritization of spending in the sector, with social and political consensus and within a framework of economic growth and stability.

RESUMO Objetivo Avaliar do ponto de vista técnico e político a capacidade da Bolívia para gerar espaço fiscal para a saúde que lhe permita sustentar o progresso e cumprir o compromisso de uma despesa de saúde pública de 6% do Produto Interno Bruto (PIB). Métodos Foi feita uma revisão da evidência internacional sobre o espaço fiscal e suas medições. A análise técnica foi desenvolvida através do uso de estatísticas e relatórios oficiais de múltiplas fontes secundárias nacionais e internacionais. A análise política e social foi realizada através de 20 entrevistas com representantes de organizações e instituições. Resultados Existe capacidade para criar espaço fiscal em saúde para a Bolívia. As fontes com maior viabilidade técnica e política são três: crescimento econômico ligado ao compromisso de desajustar as despesas públicas em saúde, melhorias nas fontes internas de receita através da redução da informalidade e redução de despesas tributárias. Com menos viabilidade é o financiamento externo e o aumento das contribuições para a Segurança Social. Conclusões A Bolívia é capaz de alcançar gastos de saúde pública de 6% do PIB. O tempo que atinge esse objetivo depende da manutenção da priorização dos gastos no setor, com o consenso da maioria social e política, tudo em um quadro de crescimento econômico e estabilidade.

El universalismo en salud en Argentina entre 2003 y 2015: balances y desafíos desde una aproximación macroinstitucional / Health universalism in Argentina between 2003 and 2015: assessments and challenges based in a macro-institutional approach

RESUMEN Los debates en torno al universalismo en salud fueron ganando terreno en la región e ingresando a la agenda de las políticas con resultados desiguales. Aun en el contexto del federalismo, los cambios más profundos que se sucedieron en Argentina en la última década tuvieron lugar en la arena de la política nacional. A partir de los aportes teóricos del neoinstitucionalismo histórico y de los estudios de implementación, este trabajo se propone analizar el alcance de la política nacional en torno a la universalización en salud, en un nivel macroinstitucional. Se trata de un estudio descriptivo, basado en fuentes secundarias y en la revisión de resultados de investigaciones sobre la implementación del Programa Remediar, el Plan Nacer y el Programa Sumar en relación con cuatro variables: acceso, cobertura, conjunto de beneficios y derechos que recoge la política. Dadas las características de la matriz institucional argentina, puede esperarse que la implementación en los escenarios subnacionales recorra espacios complejos y heterogéneos en los que los programas pueden adquirir nuevos significados con relación al horizonte de la universalidad que cada uno de ellos plantea.

ABSTRACT Debates about universalism in health have been gaining ground in Latin America and have entered the policy agenda with differing results. Notwithstanding the country's federalism, the most profound changes that took place in Argentina in the last decade occurred in the arena of national politics. Based on the theoretical contributions of historical neo-institutionalism and implementation studies, this paper aims to analyze, from a macro institutional approach, the scope of the national policy regarding health universalization. This descriptive study is based on secondary sources and the review of research results on the implementation of the programs Remediar, Sumar and Plan Nacer in relation to four variables: coverage, access, sets of benefits and rights included in the policy. Given the characteristics of the Argentine institutional matrix, program implementation in subnational scenarios can be expected to confront complex and heterogeneous terrain in which the programs acquire new meanings with respect to the goal of universality that each poses.

Asignación financiera en el Sistema de Protección Social en Salud de México: retos para la compra estratégica / Financial allocations in the System for Social Protection in Health in Mexico: challenges for strategic purchasing

Resumen: Objetivo: Analizar la coordinación financiera del Sistema de Protección Social en Salud (SPSS) y su capacidad para apoyar la compra estratégica de servicios. Material y métodos: Se analizaron informes oficiales y encuestas. Resultados: El SPSS cubre una cápita por afiliado de 2 765 pesos mexicanos, equivalente a 0.9% del PIB para 2013. La Secretaría de Salud asignó 35% del total; los gobiernos estatales 16.7%, y los beneficiarios 0.06%. La Comisión Nacional de Protección Social en Salud recibió 48.3% de estos recursos, de los cuales asignó 38% a los estados y pagó directamente a prestadores 7.4% del total. El aporte estatal está en déficit mientras que las contribuciones familiares tienden a no cobrarse. Conclusión: El SPSS no ha integrado fondos especializados en la compra estratégica capaz de transformar los presupuestos históricos. La autonomía de los prestadores es clave para que puedan contribuir a reducir el gasto de bolsillo mediante la oferta de servicios de calidad.

Abstract: Objective: The financial coordination of the System of Social Protection in Health (SPSS) was analyzed to assess its support to strategic purchasing. Materials and methods: Official reports and surveys were analyzed. Results: SPSS covers a capita of 2 765 Mexican pesos, equivalent to 0.9% of GDP. The Ministry of Health contributed 35% of the total, state governments 16.7% and beneficiaries 0.06%. The National Commission for Social Protection in Health received 48.3% of resources, allocating 38% to State Social Protection Schemes in Health and paying 7.4% of the total directly to providers.The state contribution is in deficit while family contributions tend not to be charged. Conclusion: SPSS has not built funds specialized in strategic purchasing, capable of transforming historical budgets.The autonomy of providers is key to reduce out-of-pocket spending through the supply of quality services.