Comment on “Sustainable Health Financing for COVID ‐19 Preparedness and Response in Asia and the Pacific”

Abstract

Kwon and Kim (2022) summarize the impact of COVID-19 on health and the economy in Asia and the Pacific and how countries have responded to the challenge. In addition, they propose ways to strengthen the health care system so that governments can better prepare for a pandemic. This is a timely study because many countries worldwide are still struggling with dealing with the COVID-19 pandemic successfully. The health care systems in the region are significantly different, and the pandemic response varies from country to country. As a result, there are ample opportunities to learn from the experiences of other countries, and Kwon and Kim (2022) do an excellent job of emphasizing them under a unified framework. I like Kwon and Kim's (2022) paper for four reasons. First, this paper is comprehensive and examines various aspects of the health care system that can increase resilience to a pandemic. In particular, Kwon and Kim (2022) highlight the importance of investing in financing, service delivery, and governance and provide some examples of how governments can do so. Second, it covers many countries in Asia and the Pacific with different income levels, which allows all countries to learn from other countries that share similar health care systems and challenges. Third, Kwon and Kim (2022) emphasize that pandemic “preparedness” is vital for a resilient health care system and urge governments to reassess existing arrangements and prepare for future crises. I agree with this. Finally, I find the discussion of “mobilizing private sector providers” stimulating and valuable. Private sector providers often play a crucial role in Asia and the Pacific, so it is essential to mobilize them during a pandemic. This is also a big problem in Japan, where I live. The rest of this comment will focus on this issue. Mobilizing private sector providers may not be easy. As Kwon and Kim (2022) state, many countries in Asia and the Pacific – such as the Republic of Korea, Japan, the Philippines, Cambodia, India, Indonesia, and Bangladesh – rely on private sector providers. In contrast, Thailand, Bhutan, Timor-Leste, Sri Lanka, and the Pacific Island nations rely primarily on public providers. If the health care system relies mainly on public sector providers, mobilizing providers in an emergency would be relatively easy. However, mobilizing private sector providers may not be straightforward, as the treatment of COVID patients can be costly and not financially attractive. For example, providers must bear the initial setup costs to prevent infection and purchase specialized equipment such as ventilators and extracorporeal membrane oxygenation machines. Treating COVID patients also require a significant number of nursing staff. The need to separate COVID and non-COVID patients may reduce bed turnover, and COVID patients may require longer hospital stays. Health care providers are also at risk of losing future patients if they refer non-COVID patients to other hospitals that do not accept COVID patients. Governments may mobilize private sector providers in two ways. The first is to increase provider payments to cover the higher cost of treating COVID patients. Kwon and Kim (2022) do a great job of discussing several such attempts in the region. For example, Japan doubled provider payments for treating critically ill COVID patients in intensive care since April 2020 (tripled since May 2020). More recently, in December 2020, the government began paying up to US$142,000 per bed to cover the initial setup costs and fixed costs to treat COVID patients. Unfortunately, however, these financial incentives did not appear to be sufficient to secure beds for COVID patients. In Japan, less than 1% of all hospital beds are available for COVID patients, significantly lower than in other countries such as the USA (11%) and the United Kingdom (23%). Kwon and Kim (2022) also discuss government responses in Bangladesh, India, and Korea. Like Japan, some of these countries have raised provider payments for treating COVID patients. Others have subsidized hospitals to cover the fixed costs of accepting COVID patients. A further discussion of better-combining provider payments and subsidies would help us prepare for future pandemics. A clear alternative to higher provider payments is the command-and-control approach. As Kwon and Kim (2022) state, countries can introduce legislation that mandates providers to accept COVID patients. This does help mobilize private sector providers and mitigate bed shortages in emergencies, but it may create another set of problems. For example, determining the amount and duration of compensation for private providers may not be easy, as the impact and length of the pandemic are unpredictable. Kwon and Kim (2022) discuss Thailand's approach, where private hospitals must take COVID patients when COVID patients at public hospitals exceed a threshold. This approach makes sense, and it would be further enlightening if Kwon and Kim (2022) could discuss similar or different regulatory strategies that other countries in the region have implemented.