UHC Forward: Towards Universal Health Coverage

First: an idea. Second: deliberation and scoping for interest. Third: full scale planning and preparation. Fourth: An international workshop with great minds and one objective—the development of a costing manual for provider payment. In-between: Decisions on every little thing with plenty to go wrong (that probably will).

Thus is the journey in sum to the JLN Provider Payment track’s recent workshop—The Costing Collaborative Core Working Group (CWG) in Kuala Lumpur, Malaysia. Sure, that’s a grossly oversimplified version of how participants from Malaysia, the USA, Vietnam, Indonesia, India, Kazakhstan, and the Philippines arrived here. There were broken, high-static Skype conversations, endless e-mails to people around the world, cancelled flights, budgeting calculations, and multiple surprises. Nevertheless, we are here and the collaboration really begins.

You wouldn’t initially think costing could be such a hot, interesting topic. It could lull a three-year-old asleep wired on red bull who just lost his favorite stuffed bunny. Not the case here. There’s so much to consider and only three days to consider it in the first of three CWG workshops.

Costing work alone is complicated – involving all kinds of questions. How do you choose the activities included in a costing template and determine the allocation coefficient? How often do you adjust for lack of data? Different facilities have different services and there are different severities of diseases. How do you create a template to cover these differences and should you cost based on the mean or median of treating the different severities of the disease?

Time is essential to how comprehensive your costing study is. It very much determines how many facilities are included as well as whether you do top-down costing or bottom-up costing. There are advantages and disadvantages to top-down or bottom-up approaches, and most times a mixed approach is best. All of these issues and more are essential to determining the economic cost vs. the financial cost of running a health system. Costing for provider payment adds a new layer – what are the policy objectives that you are trying to achieve? Costing becomes less about finding an actual number, and more about finding the basis for relative costs so it’s clear how to divide up the pie among providers. A good cost basis is essential to effectively and efficiently running a health system.

These are difficult, important issues, especially for lower to middle income countries working towards universal health coverage. Each and every one of these participants is working to make that process easier. Individuals with lessons from Kazakhstan, the Philippines, Indonesia, and beyond with over 100 collective years of costing experience will help others to provide health care for millions.

There is still a long way to go in the development of this manual. The last month, this workshop, and the next few months will only address costing methodology. There will be more e-mails, high-static early morning or late night Skype calls, and lots of technical details to work out. Beyond that, there is data collection and application to cover along with two more international workshops. The commitment of these people to collaboration and costing will drive this work. The liveliness and insight of this workshop makes the whole process seem very hopeful. The debate and work energizes all—with no red bull or lost stuffed bunnies—because it is so essential to establishing a successful universal health coverage system.