The Who, What and How of Paying for Universal Health Coverage
In 2019, the JLN Provider Payment Mechanisms Technical Initiative developed a podcast miniseries as a joint learning modality to create an accessible learning tool that captures country insights and experiences in the voices of implementers. Season One described the core building blocks of strong provider payment – improving benefit packages, costing to improve the design of provider payment, and utilizing provider payment to achieve health system goals.
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The Philippines started its path toward universal health coverage (UHC) in 1969 with the creation of an early Medicare health insurance scheme, where direct payments were made to accredited providers or to patients for reimbursement. After decades of implementation, more than half the population remained without health coverage, prompting the creation of the Philippines Health Insurance Corporation (PhilHealth) in 1995—a parastatal entity tasked with managing delivery of a costed benefits package to all citizens through a mix of premiums, user fees, and government subsidies for the poor. PhilHealth has progressively expanded to cover a greater number of services for larger segments of the population, with Sin Taxes providing an avenue to drive expansion in fiscal space for health.
The use of JLN knowledge products is one clear example of the impact the JLN can have downstream in health systems; by enabling countries to use best-practices from JLN country experience as they work towards long-term health system goals, such as expanding and improving on UHC programs. These case studies profile the use of knowledge products in various settings.
There are many global resources, including datasets, visualizations, and various forms of analysis that can be used to help make the case for DRM for health. However, policymakers also need to know what policy options have or have not worked, under what conditions, and the key drivers for success. Additionally, a deeper understanding of whether efforts around DRM for health were enduring, consequential, and additional over time- as well as impacts on equity, efficiency, and access- is critical to determining whether they are worth pursuing.