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Access to social protection among people with disabilities: Evidence from Viet Nam

et al
January 2019

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This study uses mixed methods to explore participation in disability‐targeted and non‐targeted social protection programmes in Viet Nam, particularly in the district of Cam Le. Following an overview of social protection in Viet Nam, and in addition to presenting quantitative measures of access, this article identifies challenges and facilitators to participation in social protection.

A mixed‐methods approach was used to evaluate the extent to which people with disabilities are accessing existing social protection programmes, including an evaluation of the effects of barriers and facilitators to access. First, a national policy analysis was conducted to provide an overview of available social protection entitlements, and how their design and implementation may affect access for people with disabilities. Second, qualitative and quantitative research was conducted in one district of Viet Nam to measure coverage and uptake of specific entitlements and to explore factors influencing access in greater depth.


International Social Security Review,Vol. 72, 1/2019

Understanding financial access to physical and functional rehabilitation services in developing countries.

July 2014

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"This document is an overview aimed at providing an understanding of the economics of the physical and functional rehabilitation system. It is the first part of a study aimed at giving Handicap International’s teams in the field a tool for diagnosing the economic system for physical and functional rehabilitation, starting with West Africa. The proposed diagnostic tool will be the subject of another publication. The study was done in two stages. First, an analysis of the economic system for physical and functional rehabilitation was done and this led to an initial draft of a tool. Starting from that draft, a study done in Burkina Faso then helped to clarify many points and give a concrete picture of the concepts which would be useful in carrying out the analysis. This report is devoted to providing an economic analysis of the physical and functional rehabilitation system"

Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

Lagomarsion G.
Garabrant A.
Adyas A.
Otoo N.
Muga R.
et al
September 2012

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The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.

Access to medicines via competition not protectionism and price regulation

OPLAS, Bienvenido Nonoy
February 2010

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This paper is based on a presentation given in the Philippines on the right to health. Several topics were tackled there, from drug prices and price control, to drug availability, patent for new medicines, health insurance, among others. The focus was on the philosophy of 'health as a right' juxtaposed with 'health as personal responsibility'. The paper concludes that rather than favouring one group of pharma companies and demonising another, public policy should focus on expanding the people’s options in choosing the right mixture of medicines and healthcare that are appropriate for them given their existing resources and health needs

Universal coverage of health services: tailoring its implementation

XU, Ke
EVANS, David

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In 2005, the Member States of WHO adopted a resolution encouraging countries to develop health financing systems capable of achieving and/or maintaining universal coverage of health services – where all people have access to needed health services without the risk of severe financial consequences. In doing this, a major challenge for many countries will be to move away from out-of-pocket payments, which are often used as an important source of fund collection. Prepayment methods will need to be developed or expanded but, in addition to questions of revenue collection, specific attention will also have to be paid to pooling funds to spread risks and to enable their efficient and equitable use. Developing prepayment mechanisms may take time, depending on countries’ economic, social and political contexts. Specific rules for health financing policy will need to be developed and implementing organizations will need to be tailored to the level that countries can support and sustain. In this paper we propose a comprehensive framework focusing on health financing rules and organizations that can be used to support countries in developing their health financing systems in the search for universal coverage.

Protecting households from catastrophic health spending

Xu Ke
David B. Evans
Guido Carrin
Ana Mylena Aguilar-Rivera
Philip Musgrove
Timothy Evans
et al
July 2007

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Many countries rely heavily on patients’ out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care.  Data from a large data set (116 surveys covering 89 countries) provided global estimates of the extent of catastrophic spending and impoverishment associated with out-of-pocket payments. Prepayment mechanisms protect people from financial catastrophe, but no strong evidence is reported that social health insurance systems offer better or worse protection than tax-based systems. Health system and population characteristics associated with high levels of catastrophic spending are examined to provide a basis for assessing the policy options available to reduce the incidence of financial catastrophe



The new public/private mix in health : exploring the changing landscape


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This book, aimed at researchers and policy-makers in developing countries, explores strategies which may be used to develop and implement the regulation of private health care provision.
The book is divided into four sections, with examples drawn from Africa, Latin America and Asia and dealing with: regulation of private health providers; contribution of private providers to public health goals; public/private mix in health insurance; and quality and affordability of care in public and private settings

Too poor to be sick : coping with the costs of illness in East Hararghe, Ethiopia


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Examines the effects of a decade of health sector reforms in Ethiopia. Identifies the high cost of drugs as the major barrier to healthcare for the vast majority. Findings include the fact that most people do not use the public healthcare system, largely due to drug shortages, which mean people buy drugs from private pharmacies. The potential of 'Special Phramacies' however, has been overstated, since they exclude the majority, contributing to a two-tier health system. Exemption mechanisms are weak or not working in most places, so do not protect the poor. Roughly one-third of households sacrifice other essential spending to seek treatment, contributing to further indebtedness. Recommendations include: the need to increase levels of public funding of the health sector (Ethiopia would have to spend 100-133 per cent of its total budget to meet World Bank and WHO minimum health funding targets). Invest more heavily in alternative sources of funding through a range of risk pooling and health insurance initiatives - particularly look at the feasibility of community health insurance schemes, possibly linked to local savings societies. Strengthen equity priorities within a national user fee policy, with a priority to strengthen exemption systems or differential charging, perhaps using livelihood based assessments of ability to pay

Sustainable health care financing in southern Africa : papers from an EDI health policy seminar held in Johannesburg, South Africa, June 1996

BEATTIE, Allison
et al

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This book summarizes a senior policy seminar in Johannesburg, South Africa, that examined two facets of sustainable health care financing: using available resources more effectively to extract more value for the money; and raising additional revenues for health care. Topics included orienting public health resources toward primary health care, improving control of and accountability for district financing, improving hospital efficiency, and making more effective use of donor funding


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