Part Four - Taking action: essential steps for success
Chapter One: Providing a unifying framework - the role of government
Health financing. Spotlight: Thailand
Health financing is an important mechanism by which policies and plans are translated into reality. Financing decisions based on principles of equity and effectiveness ensure adequate health-care access and coverage for all. Various financing components (funding, resource allocation, contracting and reimbursement) should be used to encourage the implementation of chronic disease prevention and control policies and plans. As a first step, it is important that a line item for chronic disease prevention and control is included in the annual health budget. This will ensure that these activities are not lost among competing priorities.
As reviewed in Part Three, an effective policy instrument for reducing the use of tobacco products is to tax them. Taxation also influences the consumption of food and drinks. Revenue from dedicated taxes can be earmarked for specific purposes. These taxes do not necessarily become part of consolidated revenue but can be allocated directly to a specific purpose such as population-wide prevention interventions
A number of country and state governments have dedicated part of their tax revenues for particular health promotion initiatives. One innovative model to administer these tax revenues is the health promotion foundation (see spotlight, left). The benefit package for chronic diseases should allow for preventive interventions as well as covering appropriate management of acute symptoms and long-term care (including rehabilitation and palliative and hospice care). Financing long-term care is a major and growing challenge, as it is a major cost to health systems. Some countries use special premiums and general taxation funding, alone or in combination. Home-based care should also be included in financing schemes.
Implementation step and suggested milestones: STEP 1 CORE: A line item for chronic disease prevention and control is included in the annual health budget.
STEP 2 EXPANDED: Tobacco taxes are implemented and revenue is earmarked for population-wide interventions to reduce risk and promote health.
STEP 3 DESIRABLE: The health financing system is reviewed and harmonized across diseases and levels of care, and designed to maximize equity and effectiveness. The health benefit package includes preventive treatments and long-term care for chronic diseases.
The Thai Health Promotion Foundation (ThaiHealth) was established in 2001 as a statutory, independent public organization, following the success of Thailand’s nationwide anti-smoking movement. Funding of approximately US$ 50 million per year comes from a 2% excise tax on alcohol and cigarettes. Through policy advocacy and efforts by civil society groups, and with support from a series of studies managed by the Health System Research Institute, the Government and the Ministry of Finance became convinced that a Health Promotion Fund would be beneficial to the country. Its goal is to support activities that reduce risk factors and promote healthy behaviour.
ThaiHealth plays a catalytic and facilitating role, and focuses its support on activities that yield sustainable results. The organization has fostered health promotion alliances and networks and expanded its activities to reach as many people as possible. The “open grants” programme allows community-based and other organizations to secure funding for their heath promotion activities, and proactive grants support projects according to specific objectives such as model health-promoting schools. ThaiHealth has played a leading role in the movement against tobacco use, the campaigns to prevent drink-driving and reduce alcohol consumption, and activities to promote physical activity.