A self-learning e-learning course on health financing for universal health coverage is available. It is a foundation course which targets participants of various levels of experience and expertise. The modules are: overview; revenue raising; pooling revenues; purchasing; benefit package design; and summary.
Health systems’ analysis is not an exact science in the sense that it is not a case of calculating an indicator and comparing that to a target that is set in stone. Instead, the analysis rests on describing elements of the existing system and critically assessing this on the basis of a clear understanding of health financing policy, the objectives associated with UHC, and relevant comparisons with and lessons from other countries. The paper attempts to provide guidance on how this can be done by highlighting the key issues that should be considered and some of the specific questions that should be addressed. It is not intended to provide a strict chapter-bychapter outline for a system assessment, but instead to foster and guide a systematic approach to the analysis of the health financing system. The health financing country diagnostic is written for Ministries of Health, advisors and others actors responsible for developing and implementing health financing policies, and provides step-by-step guidance on how to undertake a situation analysis of a country’s health financing system. Topics considered include: key contextual factors that influence health financing policy and attainment of policy goals; overview of health expenditure patterns; review of health financing arrangements; analysis UHC goals and intermediate objectives; and overall assessment - priorities for health financing reform.
"This report takes stock of the main public financing for health trends over the past fifteen years in the African region, and highlights opportunities for accelerated progress toward universal health coverage (UHC) based on better-informed budget planning and utilization decisions. The report presents new evidence on the critical role played by domestic public financial management systems on the level, effectiveness and quality of public spending on health in Africa. It argues that these systems should be reconsidered if countries are to move towards UHC. Country experience in reforming public finance systems to support progress towards UHC indicates that success depends on more than simply increasing the level of public budgets. Rather, it requires appropriately targeted health budget allocations, complete execution of health’s public budgets, and improved efficiency in the use of public resources for health.
The report is composed of three sections. The first section is articulated around three policy highlights: aligning budget resources and health priorities; closing the gap between health budget allocation and expenditure; and maximizing UHC performance with the money available. Section 2 is dedicated to providing detailed health financing information on countries, and includes 48 country profiles focused on key health financing trends. The last section includes information on progress towards the development of health financing strategies in the region, as well as regional and country benchmarks on key health financing indicators"
Presentations from the seminar are reported on the themes of: a diagnostic tool, universal health coverage, financial access experiences, Madagascar’s experience and advocacy. Presentations included: The economic diagnostic tool for physical and functional rehabilitation and its deployment in Burkhina Faso, Colombia and Laos; Equity funds and cash transfers, link with UHC; Universal Health Coverage, contributory and case management schemes usable in order to finance physical and functional rehabilitation; Vietnam: Orthopaedic devices and fair cost recovery system; Burundi: Financial access to healthcare and performance-based financing; Burkhina Faso: Equity fund for rehabilitation projects; Mali, Rwanda, Togo: Evaluation of three rehabilitation equity funds; Nepal: Cost calculation of assistive devices; Madagascar Experience (Operating and financial access of orthopaedic devices and physical rehabilitation services of Pzaga Mahajanga University Hospital, Social Welfare Policy and Universal health coverage in Madagascar, Mutual Health Insurances)
Universal health coverage (UHC) for inclusive and sustainable development synthesises the experiences from 11 countries—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The UHC policies for each country are examined around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The path to UHC is specific to each country, but countries can benefit from experiences of others and avoid potential risks
This paper analyses how embezzlement of donor funds might occur in a donor-funded project and what could be done to minimize the risk
Cost-effectiveness analysis is used to evaluate medical interventions worldwide, in both developed and developing countries. This book provides process-specific instruction in a concise, structured format to provide a robust working knowledge of common methods and techniques. Each chapter includes real-world examples and tips that highlight key information. Calculations concerning disability life adjusted years are covered. The third edition contains new discussion on meta-analysis and advanced modelling techniques and a long worked example.
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.
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
What cost-effectiveness analysis (CEA) does and does not provide, how it is related to the concept of burden of disease, and how it can be used, along with other criteria, in setting priorities is discussed. The several meanings of the term CEA and the way that interventions are classified and evaluated are described. Estimating the effectiveness of an intervention requires specifying the units which in turn requires choices of several parameter values, including, in the analyses reported here, the discount rate applied to future years; the disability weights that describe the severity of diseases and conditions, corresponding to the health losses that they cause; and the life expectancy at different ages. Costs of interventions to include in the analysis, and conversion of costs to equivalents in U.S. dollars for international comparisons are described. Variations of results and uncertainty of estimates are discussed. Two ways are suggested to consider costs and outcomes at the population level, allowing for large differences among countries in the size of population; the incidence or prevalence of a disease, condition, or risk factor; and the amount spent or available to spend on an intervention
The purpose of this document is to facilitate the identification of factors contributing to financial sustainability, of key-players of financial sustainability and of internal tools related to financial and economic issues related to rehabilitation centres. Financial sustainability relies on precise knowledge of functioning costs. The differences in the context and constraints of rehabilitation centres is highlighted. Topics discussed include systems of health financing, possible sponsors of rehabilitation centres (including international donors, international and local associations, the state, hospitals), social security and recovery of costs by user fees
Before presenting accounting tools developed within the frame of HI or partners’ projects, basic accounting concepts (production costs, direct/indirect cost, etc.) are presented, so that a non-specialist can understand the scope of the different tools. The second part presents tools that enable calculation of the costs associated with a rehabilitation centre. The last part presents two kinds of tools that complement the first parts: provisional budget management methods and a database enabling stock monitoring
An overview is presented of the use of cost-effectiveness analysis in healthcare resource allocation decision-making. Threshold figures (i.e. cost per unit of health gain) currently proposed for, or applied to, resource-allocation decisions are reviewed. Disability Adjusted Life-Years (DALY) are mentioned. A table of data provides a summary of cost-effectiveness thresholds and CE ratios in terms of either QALYs (quality-adjusted life-year) or LYGs (life-year gained). Threshold figures and evolution of thresholds are discussed.
This report identifies strategies to strengthen the workforce of health systems. The Joint Learning Initiative was launched because many people believed that the most critical factor driving health system performance, the health worker, was neglected and overlooked
"The question of how to generate sufficient revenue to pay for health care has become a serious concern for nearly all European policy-makers. This book examines the advantages and disadvantages of funding arrangements currently in use across Europe. Adopting a cross-national, cross-disciplinary perspective, it assesses the relative merits of the main methods of raising resources including taxation; social, voluntary and supplemental forms of insurance; and self-pay including co-payments. Chapters written by leading health policy analysts review recent evidence and experience in both eastern and western Europe. The volume is introduced by a summary chapter which integrates conceptual issues in funding with an overview of the main advantages and disadvantages of each method of funding drawn from the expert chapters"
Health sector reforms that many countries around the world are undertaking have goals of improving equity, access, quality, efficiency, and/or financial sustainability of their health systems. This primer proposes a framework for policy-makers in developing countries to use when they consider equity issues in the context of health sector reform initiatives and goals. It summarises key service delivery and financing decisions in the design and implementation of programmes to address equity, while paying attention to cost-effective approaches and the need to adapt equity policies to specific country circumstances. The primer also identifies indicators that might be used to monitor progress in equity and highlights lessons learned from real world experiences
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