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Health financing country diagnostic: a foundation for national strategy development

KUTZIN, Joseph

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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.

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.

Cost-effectiveness analysis in health. A practical approach (2nd edition)


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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.

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



Disease control priorities in developing countries. 2nd edition. Chapter 15. Cost-effectiveness analysis for priority setting.


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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


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