الحمد لله حمدا كثيرا و سبحان الله بكرة و اصيلا و صلي الله علي سيدنا محمد وسلم لقد نمن فعاليات ورشة العمل الخاصة بطرق تمويل قطاع الصحة و امكانية الاستفادة من الامكانيات المتاحة. ساوافيكم بالتوصيات بها غدا انشاالله د. العربي القماطي Conference Summary 1. A 2-day workshop was held at the Rixos Hotel, in Tripoli, Libya to debate options for health financing and experiences from wide range of high and middle income countries, oil rich countries and transitional contexts. The workshop was attended by 150 delegates including members from the Health Committee of the General National Congress (GNC), The Minister of Health, the Head of the National Centre for Disease Control (NCDC), directors from the Ministry of Health and from the Ministry of Finance, the European Union (EU) Delegation to Libya, the LHSS Technical Assistance Team, representatives of international organisations such as the World Health Organisation (WHO) and the African Development Bank (AfDB). During the first day, delegates were introduced to health financing models and experiences. During the second day, delegates debated the applicability of these models to the Libyan context and agreed to a number of priorities, which will shape the reform agenda. 2. Discussions rested on the premise of Universal Health Care Coverage as an overarching goal and were underpinned by a position paper, which is the culmination of a series of meetings of the Working Group on Strategic Planning and Health Financing. Delegates agreed that financing health care systems is one of major challenges facing policy makers all over the world. 3. Conference delegates concurred that in the long run there is a need to move away from a narrow revenue base heavily dependent on oil. The advantages and disadvantages of several health financing options were debated including: general revenue-based financing, social health insurance and medical savings accounts (MSAs) —whereby an anticipated amount of money needed is saved up ex ante by each individual in a special account set aside to cover health care expenses. The potential role of indirect taxes (sin taxes) and local taxes was highlighted. Several country experiences were reviewed including those of Egypt, Lebanon, Somalia, Afghanistan. Palestine, Angola, Hong Kong, Singapore, Finland and the UK. 4. There was a considerable consensus over the following: i) there is no de facto choice between one system and the other as most health systems are financed through a mix of tax revenues, payroll taxes, private health insurance and out of pocket payments; ii) where health service delivery is plagued by governance problems, transitions from one health financing model to another are bound to fail because governance problems persist; iii) decisions for a complete overhaul of the system should be evidence-based, well planned and well sequenced and hence require further information. For this reason, delegates agreed to postpone decisions for a complete overhaul of the system and work on short-term quick impact priorities. 5. Delegates agreed that the Libyan health budget is modest as compared to other high income and oil rich countries. However, participants concurred that the real question to be debated is not how to raise additional resources, either through taxes or social health insurance, but how to increase the absorption capacity of the system. Without this as a precondition, increasing the budget will not translate into much change on the ground. Strengthening the absorptive capacity of the Libyan health care system —that is spending at a faster rate— was seen as a key priority before more resources are added to the government budget. For this reason, delegates agreed that an exploratory study would be conducted to understand the main bottlenecks to efficient spending. 6. There was broad consensus on the fact that out-of-pocket payments are high and should be reduced. Out-of-pocket direct payments at the point of service can cause individuals to incur catastrophic expenditures, which in turn can push them into poverty. The need to pay out-of-pocket can also mean that individuals do not seek care when they need it. 7. A particular concern was raised in as far as the financial implications of those seeking health care abroad and the rising health care costs due to sustained increases in obesity, diabetes and other non-communicable diseases. Delegates agreed that curbing excessive consumption of health care in Libya is a priority. Some advocated for “demand side” strategies such as MSAs to influence the quantity of health services consumed. Others noted that fundamental values of solidarity in financing and equity of access should be preserved. The main forces that drive medical travel and its implications on health systems, in particular the impacts on access to health care, financing and the health workforce are not well understood. In order to better understand the nature of health expenditure and the epidemiological profile of the country, delegates agreed to launch a Burden of Disease Study and a National Health Accounts exercise. The information generated would help devising a package of well-thought out, well-sequenced reforms. 8. Delegates agreed that public expenditure efficiency is low and that quality of care is a persistent problem. Some advocated for a separation of functions (regulation, service provision and oversight). Others noted that Libya could reap significant savings by improving the management of its human resources and by strengthening procurement and logistics management for medicines and medical supplies. All agreed that a proactive strategy to raise the quality of care would ensure quicker and more tangible change for the Libyan citizens at the point of delivery. Delegates further agreed to give due consideration to key payment reforms. Strategies would include offering providers financial incentives to deliver higher quality, patient-centred care. Pay for performance strategies would be implemented on a pilot basis and regularly reviewed. 9. The LHSS stakeholders, the EU, the WHO and the AfDB agreed to work together on the realization of these priority actions under the leadership of the Ministry of Health and in close cooperation with the GNC Health Committee, the NCDC, the Ministry of Finance. For this purpose, a clear division of labour will be devised to ensure maximum synergies amongst all short-term quick impact priorities identified. 10. To study and analyse the Law 20 for the year 2010 regarding social health insurance to cover Libyan citizen, advantages and disadvantages.
Posted on: Sun, 29 Sep 2013 18:03:44 +0000
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