Technical assistance for sustainable health financing policies toward universal health coverage (UHC) for MOH Palau

The World Health Organization (WHO) is seeking offers for technical assistance for sustainable health financing policies toward universal health coverage (UHC) for MOH Palau

BACKGROUND 

In the past decade, Palau has made great strides in providing more available and accessible essential health services to their population. The Republic of Palau Healthcare Fund (HCF) was established in 2010 with the mandate of “promot[ing] the health and social welfare of citizens of Palau through a healthcare financing system that provides free or subsidized healthcare for its citizens.” The HCF is intended to function as a self-sufficient system that allows all citizens to have access to healthcare in Palau as well as necessary medical referral facilities outside of the country. It consists of two separate schemes: the National Health Insurance (NHI), covering inpatient services for patients admitted in national hospitals as well as medical referral facilities outside Palau, and the Medical Savings Account (MSA), covering outpatient services in national hospitals as well as private clinics in the country. The total membership covered under the NHI is 15,538 (88% of the population) while the MSA covers 18,496 (100% of the population) as of November 2022.

Despite this, the HCF faces increasing challenges in equitable health service provision and long-term sustainability. As medical referral costs continue to grow, the need for a broader range of in-country health services has become apparent, especially for high-cost, chronic care services such as renal replacement therapies and post-operation cancer treatments that are excluded from the NHI. Patients are paying out-of-pocket to receive these treatments, potentially resulting in catastrophic expenditure, and the geographic constraints of an island country such as Palau could result in foregone care for some members of the population. Further, the HCF continues to grapple with limited resources allocated to healthcare (including the premium collections from the population), the impact of the COVID-19 pandemic on the economy and health system, as well as the evolving healthcare demands in the country.

With these considerations, understanding the financial stability and sustainability of the HCF is critical to effectively managing current healthcare financing and service provision needs while broadening the scope of services offered. This will pave the way for health financing and system policies that secure a sustainable, affordable, and equitable future for all citizens.

WORK TO BE PERFORMED 

Under the supervision of the Technical Officer of Health Financing, Health Policy and Service Design, Division of Health Systems and Services, the contractor will carry out the following tasks:

1. Conduct a desk review of the key functions and performance of Palau’s HCF schemes, including its coverage, entitlement policies, benefits package design, and service provision, and the historical performance of the HCF to provide an overview of the current health financing situation.
2. Work with the WHO and the MOH Palau to collect and compile data and information for analysis, including the following information from the HCF claim database and other relevant sources:
   1. General burden of illness data and other country-level epidemiological information as needed, service utilization, and cost data
   2. Disease/treatment-specific data
   3. HCF scheme financial operation data
   4. Other information, such treatment pathways, service availability, etc.
3. Perform a rapid review of the cost-effectiveness of existing options for renal replacement therapy and post-surgery care for cancer patients to inform decision-making on the adjustment of the benefits package
4. Develop a budget impact analysis model based on the HCF schemes, and conduct budget impact and feasibility analysis of the inclusion of treatment for chronic kidney disease and renal failure as well as post-surgery cancer care in the HCF.
5. Provide policy options for the potential absorption of these high-cost interventions into the HCF and their impact on the short and medium-term sustainability of the scheme.
6. Work with WHO and MOH Palau to validate the study results and findings.
7. Draft the technical report of this study and facilitate with dissemination upon request.

Deliverable 1: Technical brief on Palau’s healthcare system, including the main characteristics of the HCF schemes and service delivery pattern, together with a draft data collection form and data analysis strategy;

Deliverable 2: An excel-based budget impact analysis model tailored to Palau’s contexts and needs;

Deliverable 3: Final technical report on the financial analysis of the HCF’s operation, the budget impact of high-cost services (i.e., renal replacement therapies and post-surgery cancer care), and policy options for their inclusion while ensuring the sustainability of the overall HCF.

CHARACTERISTICS OF PROVIDER 

The successful bidder is expected to demonstrate experience and list relevant projects as follows:

Mandatory experience:

Health financing, health expenditure tracking, health technology assessment, actuarial analysis, etc. Demonstrated quantitative skills to produce evidence and information to strengthen health systems.

Desirable experience:

Knowledge of health financing systems in countries in the Western Pacific Region

SUBMISSIONS

Qualified and interested specialists should submit the following documents to the Supply Officer through WP RO UNGM at < wproungm@who.int > by 8 March 2023

• • Company Profile {for institutional applications} 
• • Technical proposal indicating solution, methodology and timelines, in addition to the below annexes: 
  • o   Annex 2: Confidentiality Undertaking
  • o   Annex 3: Vendor Information Form
• • Financial proposal

Please use Tender Notice No. WPRO/2023-02/DHS_HPS/192708 as subject to all submission. Only successful candidates will be contacted.

Last day of receiving queries for this tender is on 1 March 2023