Table 1 Characteristics of the included study and findings
Author, Year, Country, study design | How has SDGs influenced the process of health financing reforms (HFR) for UHC? | What dimensions of health financing have been influenced by SDGs declaration? | How stakeholders used the declaration to influence HFR for UHC |
|---|---|---|---|
Agustina et al [33], 2019, Indonesia, Study design: Qualitative, documentary review | – SDGs led to discussions on health financing sustainability for UHC – Establishment of a scheme that was adaptable, accommodate diverse needs, assures financial risk protection – In 3 years (by 2019), the NHIS became the largest single-payer health insurance scheme in the world | Revenue Collection – Intense solicitation of payments from self-enrolled members – Categorization of contributors/sources of revenue for pooled fund Pooling of funds – Reduced fragmentation in risks pools – Establishment of Social Security Agency for Health (SSAH) – Law of mandatory % allocation of government budget to health Purchasing – A Single payer for UHC established – Payment-capitation and diagnostic-related group based on Indonesia tariff. Policy on benefit entitlements – Scope of services covered by capitation payment is determined by Indonesian Medical Council – Decrease in fee-for-service payment | |
Fahim et al [38], 2018, Bangladesh, Study design: Mixed method, documentary review | – The national health policy 2011–2032 updated to address contemporary issues of SDG and UHC – Health financing policy emphasizing solidarity in financing, equity of access and provision of quality care | Pooling of funds – Policy emphasis on allocating a significant percent of government spending to health – Exploring ways of reducing OOP | |
Chilufya and Kamanga [39], 2018, Zambia, Study design: Commentary Study aim: | – Zambia’s transformational health agenda is in tandem with SDGs target 3.8 – Health sector strategic plan 2017–2021 was informed by the SDG agenda – Country building on the progress past health reforms during SDG era. | Revenue Collection – Exploring ways of implementing sustainable health care financing – Mandatory pre-payment contribution being established Pooling of funds – Commitment to allocating sufficient government funding for health – Establishment of NHIF fund as a pooling agency Purchasing – Exploring reforming payment mechanism from inactive to active purchasing | |
Ahmadnezhad et al. [40], 2019, Iran, Study Design: Quantitative, document review | – Health transformation plan recalibrated to form part of government commitment on SDG agenda | Purchasing – Ministry of Health and Medical Education (MOHME) reduced co-payment Policy on benefit entitlements – Basic health insurance coverage extended from 83.2% of population to 93.2% – Aim to decrease prevalence of catastrophic expenditure to less than 1% by end of 2021 | |
Lee et al. [41], 2019, Republic of Korea, Study design: Qualitative, documentary review | – In 2017, government announced NHI reform ‘Moon Jae-in care’ to increase coverage rate to 70% by 2022 and its considered a government’s commitment to health-related SDG – Reinforcing the benefits and financial coverage of national health insurance (NHI) is a core aspect of the reform – The advent of SDGs and inclusion of the President’s name in the health financing reform indicates how seriously the government has taken health financing reforms for UHC | Policy on benefit entitlements – The population already covered, reform focuses on increasing the scope/depth of coverage and reducing cost-sharing – Reducing out-of-pocket (OOP) from the cost sharing component to minimize the catastrophic and impoverishing expenditure | |
Nagpal et al. [42], 2019, LPDR, Study design: Quantitative, review of surveys data | – Approved national health insurance (NHI) Law in 2017 – To achieve the health targets in the SDG and meet new and emerging challenges, the Government of LPDR accelerated its efforts towards universal health coverage, e.g. the nationwide scale-up of free at point of care MCH services – The NHI was quickly rolled out in 15 provinces by the end of 2017, and covered the entire country except Vientiane capital by the end of 2018 | Pooling of funds – In 2016/17, free MCH program was consolidated with 3 other social protection schemes into a single national health insurance scheme (reducing number of risk pools), Purchasing – User fee payment by pregnant women and children under 5 replaced by case-based payment under the MCH initiative | |
Capuno et al. [43], 2018, Philippines, Study design: Mixed method, depth interviews and documentary review | – Duterte government’s aims to attain the health-related SDG targets through extending health insurance coverage to all, thus ensuring each Filipino “financial freedom when accessing services”, – The Philippines Health Agenda 2016–2022 was informed by and has taken into consideration Philippines commitment to SDG agenda – Main health goals and strategic policies including on health financing are reflected in the Mid-term Philippine Development Plan developed based on ambition to achieve SDG targets | Revenue Collection – Continued preservation of Sin Tax for health – Earmarking has helped to sustain progress towards achieving of SDG target on UHC Purchasing – PhilHealth as single purchasing agency Policy on benefit entitlements – Poor, marginalized and vulnerable protected from cost of health care through Sin Tax | – There is stronger link between DOH’s national objective for health and the national development plan following the SDG declaration – DOH was successful in generating political and financial support to pursue universal health access and in legislating various proposal e.g. Sin Tax Law |
Dayrit et al. [44], 2018, Philippines, Study design: Health system review, mix method | – SDGs has informed Philippine Health Agenda [Administrative Order No. 2016–0038] which is about reforming PhilHealth into main national purchaser of health services – SDGs is seen as facilitator of natural progression towards universal health access | Pooling of funds – Changes in pooling arrangement with mandatory PhilHealth cover Purchasing – Reformed capitation and no-balance billing arrangement for members – Fee-for-service phased out and case-rate payment applied by PhilHealth Policy on benefit entitlements – Increased benefit ratio -expanding enrollment of the poor in the NHIP & promoting quality of services | |
Ranabhat et al. [45], 2019, Nepal, Study design: Systematic review | – National health system has prioritized achievement of UHC in line with UN SDG declaration | Policy on benefit entitlements – Free maternal and child health (MCH) services at point of care – Development of MCH service package – Nationwide scale-up of the scheme following limited geographic scope | – Lobby by visionary health care professionals, international organization and interest groups that consistently made reference to government commitment to SDGs led to establishment of national health insurance program. – In 2016 the government through Ministry of Health and Population started social health insurance scheme in some district and extended to 22 other districts by 2018. |
Gera et al. [46], 2018, India, Study design: Commentary | – Government has taken important policy level initiatives in the recent years, especially after the launch of SDGs that include establishment of National Institution for Transforming India (NITI Aayog) and roll out of national health policy 2017. – The Integration of SDG agenda in NHP-2017 and NITI Aayog’s Vision for Health (2032) has provided an unprecedented opportunity for health financing reforms for UHC | Pooling of funds – Establishment of new flagship National Health Protection Scheme recently launched by the union government Policy on benefit entitlements – Exploration on how to incrementally expand coverage to cover larger population proportion and the range of services covered | – Leadership of federal Ministry of Health (MOH) has fostered a collaborative effort with other Government ministries and agencies, and state governments in the SDG era leading to the formation of national health protection scheme. – Effective stewardship from the federal MOH, reorganization of health care service delivery and strengtehing community participation and accountability. |
Wang et al. [34], 2020, China, Study design: Qualitative, documentary review | – As part of Healthy China 2030, health is considered crucial entry-point to achieving SDGs because of its ability to lift people out of poverty – “Healthy China 2030” will improve access to essential health services covered by health insurance and financial assistance scheme | Policy on benefit entitlements – 95% of the population covered by health insurance schemes – Improved medical care insurance for targeted poverty-stricken population | |
Tan et al [47], 2018, China, Study design: Commentary | – Healthy China 2030 was a response to the 2030 United Nations SDGs – A momentous endeavor to enhance public health | Revenue Collection – Encourage development of commercial health insurance schemes to supplement National Health Insurance Schemes Policy on benefit entitlements – Improved health insurance system targeting economically backward region – Healthy China 2030 has led to financial protection for the poor |