ASIA
ABSTRACT
A rapidly aging population along with the increasing burden of patients with chronic conditions in Asia requires efficient health systems with integrated care. Although some efforts to integrate primary care and hospital care in Asia are underway, overall care delivery remains fragmented and diverse, eg, in terms of medical electronic record sharing and availability, patient registries, and empowerment of primary health care providers to handle chronic illnesses. The primary care sector requires more robust and effective initiatives targeted at specific diseases, particularly chronic conditions such as diabetes, hypertension, depression, and dementia. This can be achieved through integrated care – a health care model of collaborative care provision. For successful implementation of integrated care policy, key stakeholders need a thorough understanding of the high-risk patient population and relevant resources to tackle the imminent population demographic shift due to the extremely rapid rate of increase in the aging population in Asia.
HOW DOES THE ASIA HEALTH SYSTEM WORK?
The reimbursement system in Asia mainly consists of government assistance, out-of-pocket and prepaid private spending. For more developed countries with established health care systems and better government reimbursements, the reimbursement system aims to transition toward providing universal health coverage. Japan has now nearly achieved universal health coverage under two insurance schemes, with long-term care insurance to cater to older patients living with morbidities. South Korea also aims to implement universal health coverage; however, cost sharing is generally quite high, resulting in people still relying largely on private insurance. Thailand achieved universal health coverage in 2002 with three public health insurance schemes covering the entire population. China also appears to be working toward a universal health care approach. In Indonesia, the universal health scheme was started in 2014 and is expected to cover the whole population in 2019. In the Philippines, PHILHEALTH (the national insurance agency) provides limited support because patients are still liable for substantial copayments. There has been a national reform of this system in place under the principles of universal health coverage.
Less developed nations rely on development assistance for health as well as private health insurance due to limited government-assisted reimbursement. Their reimbursement systems are still undergoing transformation to achieve universal health coverage, and out-of-pocket expenses with private health insurance still account for the majority of health care cost. Therefore, low-income patients face greater barriers to adequate health care due to the pressure of out-of-pocket payments in the absence of government reimbursement.
Across Asia, efforts for integration between primary care and hospital care are underway to help relieve the health care burden, especially in the setting of increasing NCD burden. Each country has its own integrated care initiatives based on the local context, such as medical electronic record sharing and availability, patient registries, and empowerment of primary care health providers to handle chronic illness. These initiatives are targeted at specific conditions, which differ between countries, but are mostly aimed at chronic diseases such as diabetes, hypertension, depression, and dementia.
More efforts toward integration are needed because there is a general lack of integration between public and private services to share the burden of NCDs, and prevention strategies require collaboration of primary and secondary care.