JLN Decentralization Event in Washington, DC April 2017: A half-day learning exchange was hosted by the JLN Health Financing Revisited Initiative (facilitated by the World Bank) and the Provider Payment Mechanisms Initiative (facilitated by R4D) on April 19, 2017 in Washington, D.C. as a side event of the Annual UHC Financing Forum.  As Indonesia continues to simultaneously implement a national health insurance system with a single purchaser and a high level of fiscal decentralization and local government responsibility for health service delivery, the learning exchange provided an opportunity to learn from the experience of other peer countries.  Along with a delegation from Indonesia, contributors from three countries participated: Argentina, Chile, and Nigeria.  These countries shared experiences on specific implementation challenges of strategic health purchasing in decentralized settings, practical solutions, and other learnings from experience building effective models of strategic health purchasing and financial risk-sharing in decentralized contexts.

The overarching message that came out of the of the learning exchange is that strategic health purchasing needs to be approached with a view of the whole system—the organization service delivery and investment in the supply side, the consolidation and effective use of financing and incentives, and the roles and responsibilities of all actors at all levels. The participants agreed that strategic health purchasing is an important lever but cannot solve all problems, especially those related to achieving service delivery objectives.  The vision for service delivery should be defined nationally, and then strategic purchasing organized around that vision. Strategic purchasing levers need to send the right signals, but they are not a substitute for system-wide policy and planning.

The full report can be found here.

Learning Exchange with USG Health Officials from Maryland State Health Services Cost Review Commission and the Center for Medicare and Medicaid Services.  During this week, USAID and the HFG project hosted a learning exchange for a delegation from the Government of Indonesia, including a Director at the National Health Insurance Agency, members of the Indonesian Social Security Council, an advisor to the Minister of Health, Ministry of Finance representatives, two USAID representatives, and one person from the World Bank/Indonesia.  The objective was for Indonesian policymakers to learn about health financing innovations and challenges in the U.S. health care system. HFG organized a half-day meeting with the Maryland State Health Services Cost Review Commission, which presented an update on innovations Maryland is piloting, including the all-payer rate setting system, global budgeting process, and quality-based purchasing. Later, the delegation visited the Center for Medicare and Medicaid Services (CMS), and left with a better understanding of payment arrangements for Medicare, how quality is measured and monitored, and a sense of the role and purpose of the Center for Medicare and Medicaid Innovations. Many of the issues the U.S. has faced are relevant to the challenges Indonesia is currently facing with its new single payer system, and the delegation appreciated the learning exchange greatly.