Universal Health Coverage in the ASEAN Region

Professor Nathorn Chaiyakunapruk - School of Pharmacy
Professor Nathorn Chaiyakunapruk - School of Pharmacy

World Health Organisation (WHO) describes that the goal of Universal Health Coverage, is to ensure everyone obtains the health services they need without suffering financial hardships when paying for them. It is thus a critical component of sustainable development and poverty reduction, and a key element to reduce social inequities.

“In comparison to her ASEAN neighbours, Malaysia is doing very well, especially with regards to incidence of catastrophic medical expenditures. However, the country should look at improving the quality and services at public hospitals, in order to reduce out of pocket expenditures,” shared Nathorn Chaiyakunapruk, Professor of Health Economics at the School of Pharmacy, Monash University Malaysia.

He further elaborated that the score of 35.6% in out-of-pocket, vs total health expenditure in 2012, is still considered high. This would place Malaysians at risk financially, individually as well as in terms of household.

In a recent paper ‘Progress towards Universal Health Coverage in ASEAN’ written together with a team of researchers representing Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam, it is reported that ASEAN countries face several common barriers in achieving Universal Health Coverage. This includes financial constraints due to low levels of government funding; insufficient health workforces and unequal distribution of health professionals; and increasing burdens of No Claim Discount (NCD), persisting infectious diseases, and reemerging pandemic infectious diseases.

With the ASEAN Economic Community (AEC) setting a goal of regional economic integration by 2015, ASEAN leaders have identified healthcare as a priority sector. The opening of healthcare markets promises substantial economic gains but intensifies existing challenges to promote equitable access to healthcare within countries. The services sector integration goals of the AEC present the biggest challenges as well as biggest opportunities for the region.

Some countries such as Singapore and Thailand have already become significant exporters of modern services in sectors such as professional services and information and communication technology (ICT), including business processing outsourcing (BPO), higher education, and health tourism. Some countries face challenges related to the opening of healthcare markets. For example, despite the golden opportunity to tap into the large market of the Indonesian population, multinational healthcare companies had shown lukewarm responses to invest in Indonesia due to the restrictions and regulations on foreign investments in the country.

Progressive liberalisation of services of health professionals also poses risks to health equity within and between countries. According to the Mutual Recognition Arrangement (MRA) of the AEC, physicians, nurses, and dentists are among seven selected professional groups that are free to work across member countries. Although the financial returns from this strategy seem substantial, issues of equity within UHC have become a concern due to the possibility of health worker flight from poorer regions already struggling to ensure UHC.

On a brighter note, UHC can be achieved even among low and middle-income countries by strengthening the health system, securing sustainable and equitable financing, selecting the right benefit package, and reorganising domestic health expenditures to be used more efficiently. For ASEAN countries, UHC can be explicitly considered to mitigate damaging effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalisation’s risks to health equity as well as migration and population aging which will increase demand on health systems.

It is definite that ASEAN countries face immense challenges when it comes to ensuring UHC. However with aligned regional policies and increased investment in public health systems, the outlook is positive as the region shows potential to become a force to be reckoned with on championing better health. Hopefully this will result in higher health and safety standards, comprehensive social protection, and improved health status of the ASEAN population.

For more information on programs offered at the School of Pharmacy, Monash University Malaysia, please visit www.pharm.monash.edu.my/.