Southeast Asia’s middle-income countries–specifically Indonesia, Malaysia, the Philippines, Thailand, and Vietnam–have seen rapid and immense changes in their economic, political, and social conditions in the last half century. They have benefitted from significant economic growth and income increases. They differ greatly in political conditions and evolution. These changes have also transformed their health and health systems. Although geographically close and with some overlapping heritages, these five nations remain quite diverse in terms of history, language, culture, and social and economic development. The developments of their health systems towards the Universal Health Coverage (UHC) are also following diverse paths.
Regarding demographic and health change, these nations reflect wider changes in the Southeast Asia region: significant declines in fertility and increases in life expectancy driven by rapid reductions in child mortality and improvements in related determinants; rapidly aging population; rising incidence and prevalence of non-communicable diseases. The health systems responses in these five nations, however, differ greatly. They include Malaysia’s dominant statist national health service; Thailand’s universal coverage with multiple government-linked schemes; Indonesia and Vietnam’s recent forays into unitary social health insurance; and the Philippines more mixed public-private financing and delivery system. Each of these health systems is grappling in various and diverse ways with key issues relevant to all health systems, such as rapid health, economic, social, and cultural change, how to assure adequate and sustainable financing; how to provide benefits to the informal and rural sectors and improve equity; introduction of purchasing and improving efficiency and quality; managing the growth of the private sector in health driven by rising expectations and demand; developing and managing governance; and assuring political support.
In this PMAC 2020 side meeting, we will be sharing the lessons learned from our previous discussions at the meeting on “Health and Health Systems in Southeast Asia”, which was organized by Harvard T. H. Chan School of Public Health and Harvard University’s Asia Center in Cambridge, Massachusetts on June 25-26, 2019. Strategies to advance the Universal Health Coverage in Southeast Asia and relevant implications for health systems reforms in other LMICs will be synthesized and shared. Further questions will be examined, including:
– Does the UHC mean differently in different countries? What does the UHC mean for these five Southeast Asian countries?
– How will the countries match dream of UHC to reality? If the goals were not met, how can they achieve the UHC given current financial constraints?
– What are the reasons for various challenges regarding strategic purchasing to arise? How can they be mitigated? What are some best practices and why?
– What are the roles that the private sector can play in ensuring effective UHC expansion? What regulations are needed for effective service delivery by the private sector?
– What are the strategies to improve and maximize financial risk protection? How can the UHC resources be efficiently mobilized to address catastrophic spending and impoverishment?