Literature Global Health Economics
Session1
Mills: Health Care systems in Low- and Middle-income countries
Very important to focus on global health care economics because of:
• external funding
• underfunding for infrastructures
A functioning health care is fundamental to achieve universal healthcare coverage.
A number of countries tried to contribute in this sense, this article reviews the main weaknesses of
health care systems in low and middle-income countries and proposes three of the most important
responses for further review.
General taxation vs. contributory insurance:
Lack of financial support is the main problem in these countries. Almost 50% of hc financing comes
from OOP expenses in LOW income, 30% in middle and only 14% in high income countries.
The key financing issue: how to provide increased financial protection for households. It is also
commonly accepted that the poorest part of the population should be completely subsidized.
• Philippines and Vietnam: encouraging voluntary enrolmnent
• Thailand: used funds from general taxation
• Rwanda: obtained high insurance coverage
But the core problems are:
• keep the premiums sustainable and affordable
• maintaining voluntary enrolment
Financial incentives for households and providers:
Additional challenge — use financial incentives to encourage providers and services to guarantee
high quality. Such strategies form part of a wider approach known as results-based financing: P4P, or
“output based aid” – which are designed to address the problems of lack of demand for effective
interventions and poor responsiveness and motivation from providers.
Incentives can be differently targeted: to recipients of healthcare (i.e. with vouchers) or to invidual
health care workers or hc facilities.
• Latin America: usage of conditional cash transfers associated
with increased use of preventive services
• Rwanda: performance based payments of primary care has increased numbers of babies
delivered in hospitals & preventive care usage.
Use of private entities to extend coverage:
Private institutions are increasing in low- and middle-income countries.
There is still a lot of variation among the countries, though. The dynamic we witnessed in these
countries is that private sector can be contracted to manage services on behalf of the public sector,
due to its failure or capacity limitations.
Conclusion:
1) An approach working in one country could not work in another
2) Not all approaches are equally acceptable to all governments
3) There is no blueprint for an ideal health care system, nor are there any magic bullets that
will elicit improved performance
4) Need to create environment that supports innovation — need of orchestrated actions on
different fronts
,UCHday: what have we learned in the last 12 months about Universal Health Coverage
What is UCH?
Multiple choice question:
1) UHC is about giving everyone the legal right to health through a constitutional guarantee
2) UHC is about getting everyone into a health insurance or financial protection scheme
3) UHC is about ensuring everyone to get the health services they need without suffering
financial hardship
Countries are pursuing reforms in the name of UCH because not everyone is getting the care
needed, especially among the poor.
What do the data tell us about UHC attainment?
The poor have seen larger percentage improvements in key MDG interventions, but coverage
fallshort of 100% and are still systematically lower among the poor. The first WHO-World Bank UHC
global monitoring report highlights the low levels of effective coverage of some interventions
especially among the poor.
Have programs and policies helped move countries towards UHC?
2014 and 2015 saw a lot new work in this ares – expansion of hc insurance in Indonesia among the
poor. Thailand saw increased service utilization.
In China, more generous health insurance coverage among rural households led to higher utilization.
In Cambodia and Thailand, the universal coverage scheme reduces OOP spending.
Session3
DeAllegri et al.: Community Health insurance in sub-Saharan Africa: what operational
difficulties hamper its successful development?
A number of reviews generated evidence on the potential of community health insurance (CHI) to
increase access to care and offer financial protection against the cost of illness for poor people
excluded from formal insurance systems.
The aim of the paper was to provide policy makers with the necessary knowledge on the problems at
stake and with policy proposition to offset such problems, strengthening CHI and enhancing its role
within SSA health systems.
, Major difficulties:
i) Lack of clear legislative and regulatory framework
ii) Low enrolment rates
iii) Insufficient risk management measures
iv) Weak managerial capacity
v) High overhead costs
This review then calls for appropriate policy interventions
i) Greater commitment towards the development of adequate legislation in support of CHI
a. Need of explicit political commitment
b. International organizations cooperation
ii) Increasing uptake of measures to expand equitable enrolment
a. Focus on what discourages communities from joining CHI
b. Investment to expand and sustain relevant marketing campaigns
c. Increase knowledge
d. Explanation to people on how CHI works
e. Subsidize the poor to obtain equity in coverage
iii) The adoption of adequate risk management measures
iv) Substantial investments from host countries as well as from sponsoring agencies to
improve managerial capacity
a. Premium calculation
b. Risk management tools
c. Financial management and bookkeeping
d. Member registration
e. Contracting with providers
v) Collective efforts to contain overhead costs
a. Channelling towards lower administration fees
b. Accurate cost analysis
c. Development of schemes nested with pre-existing institutions (NGOs)
CHI represents a response to the problem of access to care and financial protection faced by those
excluded from formal insurance systems, mainly poor people working in the informal sector.
CHI attempts to bridge the gap in access and societal protection between people covered (formal
schemes) and those left to pay for care out of their own pocket.
CHI: expression to indicate community insurance arrangements described in literature. There are
different terms to define CHI, but they all indicate:
“voluntary, non-profit insurance scheme, formed on the basis of an ethic of mutual aid, solidarity
and the collective pooling of health risks, in which the members participate effectively in its
management and functioning”.
Session1
Mills: Health Care systems in Low- and Middle-income countries
Very important to focus on global health care economics because of:
• external funding
• underfunding for infrastructures
A functioning health care is fundamental to achieve universal healthcare coverage.
A number of countries tried to contribute in this sense, this article reviews the main weaknesses of
health care systems in low and middle-income countries and proposes three of the most important
responses for further review.
General taxation vs. contributory insurance:
Lack of financial support is the main problem in these countries. Almost 50% of hc financing comes
from OOP expenses in LOW income, 30% in middle and only 14% in high income countries.
The key financing issue: how to provide increased financial protection for households. It is also
commonly accepted that the poorest part of the population should be completely subsidized.
• Philippines and Vietnam: encouraging voluntary enrolmnent
• Thailand: used funds from general taxation
• Rwanda: obtained high insurance coverage
But the core problems are:
• keep the premiums sustainable and affordable
• maintaining voluntary enrolment
Financial incentives for households and providers:
Additional challenge — use financial incentives to encourage providers and services to guarantee
high quality. Such strategies form part of a wider approach known as results-based financing: P4P, or
“output based aid” – which are designed to address the problems of lack of demand for effective
interventions and poor responsiveness and motivation from providers.
Incentives can be differently targeted: to recipients of healthcare (i.e. with vouchers) or to invidual
health care workers or hc facilities.
• Latin America: usage of conditional cash transfers associated
with increased use of preventive services
• Rwanda: performance based payments of primary care has increased numbers of babies
delivered in hospitals & preventive care usage.
Use of private entities to extend coverage:
Private institutions are increasing in low- and middle-income countries.
There is still a lot of variation among the countries, though. The dynamic we witnessed in these
countries is that private sector can be contracted to manage services on behalf of the public sector,
due to its failure or capacity limitations.
Conclusion:
1) An approach working in one country could not work in another
2) Not all approaches are equally acceptable to all governments
3) There is no blueprint for an ideal health care system, nor are there any magic bullets that
will elicit improved performance
4) Need to create environment that supports innovation — need of orchestrated actions on
different fronts
,UCHday: what have we learned in the last 12 months about Universal Health Coverage
What is UCH?
Multiple choice question:
1) UHC is about giving everyone the legal right to health through a constitutional guarantee
2) UHC is about getting everyone into a health insurance or financial protection scheme
3) UHC is about ensuring everyone to get the health services they need without suffering
financial hardship
Countries are pursuing reforms in the name of UCH because not everyone is getting the care
needed, especially among the poor.
What do the data tell us about UHC attainment?
The poor have seen larger percentage improvements in key MDG interventions, but coverage
fallshort of 100% and are still systematically lower among the poor. The first WHO-World Bank UHC
global monitoring report highlights the low levels of effective coverage of some interventions
especially among the poor.
Have programs and policies helped move countries towards UHC?
2014 and 2015 saw a lot new work in this ares – expansion of hc insurance in Indonesia among the
poor. Thailand saw increased service utilization.
In China, more generous health insurance coverage among rural households led to higher utilization.
In Cambodia and Thailand, the universal coverage scheme reduces OOP spending.
Session3
DeAllegri et al.: Community Health insurance in sub-Saharan Africa: what operational
difficulties hamper its successful development?
A number of reviews generated evidence on the potential of community health insurance (CHI) to
increase access to care and offer financial protection against the cost of illness for poor people
excluded from formal insurance systems.
The aim of the paper was to provide policy makers with the necessary knowledge on the problems at
stake and with policy proposition to offset such problems, strengthening CHI and enhancing its role
within SSA health systems.
, Major difficulties:
i) Lack of clear legislative and regulatory framework
ii) Low enrolment rates
iii) Insufficient risk management measures
iv) Weak managerial capacity
v) High overhead costs
This review then calls for appropriate policy interventions
i) Greater commitment towards the development of adequate legislation in support of CHI
a. Need of explicit political commitment
b. International organizations cooperation
ii) Increasing uptake of measures to expand equitable enrolment
a. Focus on what discourages communities from joining CHI
b. Investment to expand and sustain relevant marketing campaigns
c. Increase knowledge
d. Explanation to people on how CHI works
e. Subsidize the poor to obtain equity in coverage
iii) The adoption of adequate risk management measures
iv) Substantial investments from host countries as well as from sponsoring agencies to
improve managerial capacity
a. Premium calculation
b. Risk management tools
c. Financial management and bookkeeping
d. Member registration
e. Contracting with providers
v) Collective efforts to contain overhead costs
a. Channelling towards lower administration fees
b. Accurate cost analysis
c. Development of schemes nested with pre-existing institutions (NGOs)
CHI represents a response to the problem of access to care and financial protection faced by those
excluded from formal insurance systems, mainly poor people working in the informal sector.
CHI attempts to bridge the gap in access and societal protection between people covered (formal
schemes) and those left to pay for care out of their own pocket.
CHI: expression to indicate community insurance arrangements described in literature. There are
different terms to define CHI, but they all indicate:
“voluntary, non-profit insurance scheme, formed on the basis of an ethic of mutual aid, solidarity
and the collective pooling of health risks, in which the members participate effectively in its
management and functioning”.
