Provider Payment System in Asia

[assalamualaikum & salam sejahtera]

Provider Payment System is one of the system that play a very important role in the health system. This sub-system in a complex system closely related to the main sources of input such as money, human resources. As this is one of the important criteria in health system, I would to share information on the provider payment system in Asia.

 

Basically, Health system in Asia are mostly derived from the British model of health system which is predominantly publicly financed and provided care. Thus, in the last two decades, most countries already move towards to large and growing private sector, both in terms of financing and provision care. Today’s, there are 3 broad group that classify the Asia countries.

The first group is made up of countries which have kept the original payment methods from the colonial times. This model named as The Beveridge Model, named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax  payments, just like the police force or the public library. Hospital are paid by the national budget allocation (tax), and physicians employed in the government hospital paid by salary while those who are employed in the private hospital are paid by fee-for-service method. Both public and private sector are independently managed in the country. This system applied in India, Malaysia, Sri Lanka, and probably Pakistan and Bangladesh.

The second group consist of countries that have implemented some degree of social health insurance. This reformation have adopted health financing systems which are closer to the Bismarck model. Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of  the unification of Germany in the 19th century. This system using insurance system which usually financed jointly by employers and employees through payroll education, thus its providing health care would look familiar to Americans. Small-scale employer-based insurance schemes have gradually grown into universal coverage without the development of a substantial tax-financed delivery system. The countries that apply this system include Japan, Korea, and Philippines.

The remaining group of Asian countries appear to be moving from the British model with public sector delivery and financing of care toward one based on the social insurance. This reformation as result of broader economic transitions. Incomes of citizens grew greatly from few decades ago, thus result in transition of public health services to private health services due to less satisfied of existing public services. Indonesia, Thailand and Vietnam is some of the countries in the Asia that apply this system. Limitation of the central government financial support reduces the improvement of the public health services that would have satisfied the public, and therefore social insurance was seen as a way to mobilize resources and offer universal coverage to citizens.

References:

1. Wang, Hong, Mark McEuen, Lucy Mize, Cindi Cisek, and Andrew Barraclough. February 2009. Private Sector Health in Indonesia: A Desk Review. Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc.

2. PHNP Resources. Health Care Systems - Four Basic Models