Good Practices in Health Financing
530 pages
English

Good Practices in Health Financing

YouScribe est heureux de vous offrir cette publication
530 pages
English
YouScribe est heureux de vous offrir cette publication

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For humanitarian reasons and the concern for households' economic and health security, the health sector is at the center of global development policy. Developing countries and the international community are scaling up health systems to meet the Millennium Development Goals (MDGs) and are improving financial protection by securing long-term support for these gains. Yet money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills; well structured, results-based financing reforms are needed. Unfortunately, global evidence of "successful" health financing policies that can guide the reform effort is very limited and therefore the policy debate is often driven by ideological, one-size-fits-all solutions.
'Good Practices in Health Financing: Lessons from Reforms in Low- and Middle-Income Countries' attempts to begin to fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The participating countries are: Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. The study seeks to identify common enabling factors of their good performance. While the findings for each country are important, collectively they send a clear message to the global community that more attention is needed to define "good practice" and then to evaluate and disseminate the global evidence base.

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Publié le 20 juin 2008
Nombre de lectures 50
EAN13 9780821376836
Langue English
Poids de l'ouvrage 2 Mo

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LESSONS FROM REFORMS IN
LOW– AND MIDDLE–INCOME COUNTRIES
GOOD PRACTICES
IN HEALTH
FINANCING
LLOOWW-INCINCOMEOME MIDDLE-INCMIDDLE INCOMEOME HIGHHIGH-INC INCOMEOME
COUNTRIES COUNTRIES COUNTRIES
PRIVATE OUT
OF POCKET
PRIVATE OUT
OF POCKET
PRIVATE POOLED
PRIVATE OUT
OF POCKET
PRIVATE POOLED
PRIVATE POOLED GOVERNMENT
GOVERNMENT
GOVERNMENTGood Practices in
Health Financing Good Practices in
Health Financing
Lessons from Reforms in Low- and
Middle-Income Countries
Pablo Gottret, George J. Schieber, and Hugh R. Waters
Editors
The World Bank© 2008 The International Bank for Reconstruction and Development / The World Bank
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This volume is a product of the staff of the International Bank for Reconstruction and Development /
The World Bank. The findings, interpretations, and conclusions expressed in this volume do not neces-
sarily reflect the views of the Executive Directors of The World Bank or the governments they represent.
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ISBN-13: 978-0-8213-7511-2
eISBN-13: 978-0-8213-7512-1
DOI: /10.1596/978-0-8213-7511-2
Library of Congress Cataloging-in-Publication Data
Good practice in health financing : lessons from reforms in low and middle-income countries / Pablo
Gottret, George J. Schieber, and Hugh R. Waters, coeditors.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8213-7511-2 (alk. paper)
ISBN-10: 0-8213-7511-3 (alk. paper)
1. Medical care—Developing countries—Finance. 2. Health care reform—Economic aspects—
Developing countries 3. Medical policy—Economic aspects—Developing countries. 4. Medical care,
Cost of—Developing countries. 5. Health status indicators—Devountries. I. Gottret, Pablo
E. (Pablo Enrique), 1959- II. Schieber, George. III. Waters, Hugh. IV. World Bank.
[DNLM: 1. Health Care Reform—economics—Statistics. 2. Health Care Reform—standards—
Statistics. 3. Delivery of Health Care—eco 4. Developing Countries—Statistics. 5.
Health Care Costs—Statistics. 6. Health Expenditures—Statistics. WA 530.1 G646 2008]
RA395.D44G66 2008
362.1’04252091724—dc22
2008008389
Cover design by Rock Creek Creative. Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix
Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii
Part 1 Assessing Good Practice in Health
Financing Reform
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2 Health Financing Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
3 Criteria for Defining “Good Practice” and Choosing
Country Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
4 Summaries of Country Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
5 Enabling Factors for Expanding Coverage . . . . . . . . . . . . . . . . . . . . . . . . . .57
References for Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Part 2 Nine Case Studies of Good Practice in
Health Financing Reform
6 Chile: Good Practice in Expanding Health Care Coverage
Lessons from Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Ricardo D. Bitrán and Gonzalo C. Urcullo
7 Colombia: Good Practices in Expanding Health Care Coverage . . . . . . .137
Diana Masis Pinto
8 Costa Rica: “Good Practice” in Expanding Health Care Coverage
Lessons from Reforms in Low- and Middle-Income Countries . . . . . . . .183
James Cercone and José Pacheco Jiménez
9 Estonia: “Good Practice” in Expanding Health Care Coverage . . . . . . . .227
Triin Habicht and Jarno Habicht
10 The Kyrgyz Republic: Good Practices in Expanding Health Care
Coverage, 1991–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
Melitta Jakab and Elina Manjieva
vvi Contents
11 Sri Lanka: “Good Practice” in Expanding Health Care Coverage . . . . . .311
Ravi P. Rannan-Eliya and Lankani Sikurajapathy
12 Thailand: Good Practice in Expanding Health Coverage
Lessons from the Thai Health Care Reforms . . . . . . . . . . . . . . . . . . . . . . .355
Suwit Wibulpolprasert and Suriwan Thaiprayoon
13 Tunisia: “Good Practice” in Expanding Health Care Coverage
Lessons from Reforms in a Country in Transition . . . . . . . . . . . . . . . . . .385
Chokri Arfa and Hédi Achouri
14 Vietnam: “Good Practice” in Expanding Health Care Coverage
Lessons from Reform in Low- and Middle-Income Countries . . . . . . . .439
Björn Ekman and Sarah Bales
Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .487
Boxes
2A Measures of Financial Protection in Tunisia . . . . . . . . . . . . . . . . . . . . . . 12
6.1 Chile: Key Political Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
8.1 Costa Rica: Cooperatives as Health Care Providers . . . . . . . . . . . . . . . .217
10.1 The Kyrgyz Republic: The Manas National Health
Care Reform Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .298
12.1 Thailand: Minimum CUP Requirements . . . . . . . . . . . . . . . . . . . . . . . . .370
Figures
1.1 Determinants of Health, Nutrition, and Population Outcomes . . . . . . . .5
2A.1 Payments as Share of Total and Nonfood Expenditure
in Tunisia, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
3.1 Population Health Indicators Relative to Income and
Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
3.2 Health Service Delivery Indicators Relative to Income and
Spending21
3.3 Total Health Spending Relative to Income . . . . . . . . . . . . . . . . . . . . . . . . .21
3.4 Health Spending as Share of GDP and per Capita vs. Income . . . . . . . . .22
3.5 Revenue to GDP Ratio vs. Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
3.6 Government Share of Health vs. Income . . . . . . . . . . . . . . . . . . . . . . . . . .23
3.7 Out-of-Pocket Spending Relative to Income . . . . . . . . . . . . . . . . . . . . . . .24
3.8 Hospital Bed and Physician Capacity vs. Income . . . . . . . . . . . . . . . . . . .25
3.9 Literacy vs. Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
5.1 Real GDP Trends per Capita, 1960–200560
5.2 Political Freedom Trends in Case Countries, 1900–2004 . . . . . . . . . . . . .64Contents vii
6.1 Chile: Economic Growth, 1810–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
6.2 Growth of Real GDP, 1997–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . .91
6.3 Chile: GDP per Capita, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
6.4 External Debt, 1996–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
6.5 Chile: Composition of External Debt, 2004 . . . . . . . . . . . . . . . . . . . . . . . .93
6.6 Population Structure, 1990, 2005, and 2020 . . . . . . . . . . . . . . . . . .95
6.7 Chile: Infant Mortality, 1960–2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
6.8 Life Expectancy, by Historical Period and Gender,
1950–2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
6.9 Chile: Poverty Compared with Other Latin American Countries,
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98
6.10 Chile: Infant Mortality and Life Expectancy Compared with
Other Latin American Countries, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . .99
6.11 Chile: The Mandatory Health Insurance System, 2006 . . . . . . . . . . . . . .101
6.12 Structure of Health Spending, by Source, 1998–2004 . . . . . . . . .103
6.13 Chile: Coverage of Social Security System, 1984–2005107
6.14 Cover Open ISAPREs, 2006 . . . . . . . . . . . . . . . . . . . . . . . . .107
6.15 Chile: Structure of Financing for Public Health Spending . . . . . . . . . . .110
6.16 Social Security System Beneficiaries, by Income Decile
and Insurance Type, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
6.17 Chile: FONASA and ISAPRE Beneficiaries, by Age,
1990 and 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
6.18 Chile: Available Beds in the SNSS System, 1990–2002 . . . . . . . . . . . . . .115
6.19 Chronology of Health Reforms, 1917–2006 . . . . . . . . . . . . . . . . .119
6.20 Chile: Cumulative Cost of the 56 GES-Covered
Health Conditions, estimates for 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . .126
7.1 Colombia: Age-Specific Fertility Rates140
7.2 C Population Pyramid, 2005140
7.3 Colombia: Flow of Funds in the Solidarity and
Guarantees Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144
7.4 Colombia: Funding for the Subsidized Regime, by Source, 2005 . . . . .145
7.5 C Main Reasons for Not Using Health Care Services,
by Income Quintile, 1992 and 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
7.6 Colombia: Reported Sources of Payment for Consultations
and Hospitalizations, by Insurance Status, 2000 . . . . . . . . . . . . . . . . . . .154
7.7 Colombia: Respondents with a Health Problem and Seen by a
Doctor, by Insurance Status and Location, 2000 and 2003 . . . . . . . . . . .156
7.8 Colombia: Population Reporting Use of Preventive Services,
by Insurance Status, 1997 and 2003156
7.9 Colombia: Population Reporting Hospitalization in Last Year,
by Insurance Status, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
7.10 Colombia: Total Enrollees, by Type of Health Plan
and Regime, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
7.11 Colombia: Expansion of CR and SR Insurance Coverage,
1992–2006 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164viii Contents
7.12 Colombia: Total CR enrollment, Contributors, and Beneficiaries,
1993–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
7.13 Colombia: Employment of SR Contributors, 1993–2006 . . . . . . . . . . . .165
7.14 C Insurance Coverage, by Income Quintile, 1992–2003 . . . . .166
7.15 Colombia: Growth of Insurance Coverage, by Regime and by
Residence, 1993–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
7.16 Colombia: National Health Spending Distribution and Trends,
1993–2003168
7.17 Colombia: Balance of FOSYGA Compensation Fund, 1996–2005 . . . .169
7.18 C Unemployment, GDP Real Growth, and Percentage
of Population in Poverty, 1991–2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
7.19 Colombia: SR Projected Resources versus Actual Expenditures,
1994–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
7.20 Colombia: SR Projected Resources versus Aces
of Solidarity Funding Sources, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172
7.21 Colombia: Projections for Universal Health Insurance,
2005–2010176
8.1 Costa Rica: Population Pyramids, 1990, 2005, and 2020 . . . . . . . . . . . .185
8.2 C Basic Demographic Indicators . . . . . . . . . . . . . . . . . . . . . . .187
8.3 Costa Rica: National Distribution of Public Spending on Health,
by Income Category, 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190
8.4 Costa Rica: Outpatient Consultations per Inhabitant,
by Income Decile, 1998 and 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
8.5 Costa Rica: Income and Social Expense Distribution
by Function, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
8.6 Costa Rica: Distribution of Public Spending on
Health Nationally and Regionally, by Income Group, 2001 . . . . . . . . . .199
8.7 Costa Rica: Health Expenditures and Contributions to CCSS,
by Income Decile199
8.8 Costa Rica: Health Insurance Coverage, of Economically Active
Population 1990–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
8.9 Costa Rica: Primary Health Care Program Coverage, 1990–2003 . . . . .215
9.1 Estonia: Population Pyramids, 2004 and 2025 . . . . . . . . . . . . . . . . . . . .230
9.2 Estonia: Burden of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .231
9.3 Estonia: Average Life Expectancy at Birth Compared with
EU Countries, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232
9.4 Estonia: Distribution of Funding Sources, 1999 and 2004 . . . . . . . . . . .234
9.5 Estonia: Out-of-Pocket Payments Compared with
European Union, 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236
9.6 Estonia: Overview of the Health Financing System, 2004 . . . . . . . . . . .237
9.7 Estonia: The EHIF Contracting Process . . . . . . . . . . . . . . . . . . . . . . . . . .238
9.8 Estonia: Payment Methods for Inpatient and Outpatient
Specialist Care, 2005240
9.9 Estonia: Payment Methods for Family Physicians, 2005 . . . . . . . . . . . . .241Contents ix
9.10 Estonia: Number of Family Physicians, 1993–2004 . . . . . . . . . . . . . . . .245
9.11 Estonia: N Hospitals and Acute Care Admissions,
1985–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248
9.12 Estonia: Access to Medical Care, by Residence . . . . . . . . . . . . . . . . . . . .249
9.13 Estonia: Number of Doctors and Nurses per 100,000 Inhabitants,
1998–2004250
9.14 Estonia: Cumulative Increase in EHIF Pharmaceutical and
Health Care Services Expenditures, 1993–2006251
9.15 Estonia: Use of Cardiovascular Medicines, by Groups,
1994–2005252
9.16 Estonia: Milestones in Health Sector Reform, 1992–2003 . . . . . . . . . . .253
10.1 The Kyrgyz Republic: Key Economic Indicators, 1990–2004 . . . . . . . . .271
10.2yrgyz Re Population Pyramids, 1990 and 2005273
10.3 The Kyrgyz Republic: Leading Causes of Infant Mortality, 2004 . . . . . .274
10.4yrgyz Re Health Expenditures as
Share of the State Budget, 1995–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . .278
10.5 The Kyrgyz Republic: Access to Health Services,
by Income Level, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .287
10.6 The Kyrgyz Republic: Comparative Indicators of
Hospital Efficiency, 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
10.7 The Kyrgyz Republic: Reallocation of Public Expenditures
in the Single-Payer System from Fixed Costs to Variable Costs . . . . . . .293
10.8 The Kyrgyz Republic: Trends in Out-of-Pocket Payments,
2000–03 (KGS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299
10.9 The Kyrgyz Republic: Access to Outpatient Care and
Hospital Care, 2000 and 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301
10.10 The Kyrgyz Republic: Mean Payment by a Public
Hospital Patient, 2000 and 2003 (KGS) . . . . . . . . . . . . . . . . . . . . . . . . . .302
11.1 Sri Lanka: Population Pyramids 1991, 2006, 2026, and 2051 . . . . . . . . .316
11.2 Sr Government Recurrent Health Spending, 1927–2005 . . . . .324
11.3 Sri Lanka: Differentials in Infant Mortality Rate,
by Asset Quintile, 1987–2000327
11.4 Sri Lanka: Differentials in Medical Attendance at Childbirth,
by A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .327
11.5 Sri Lanka: Differentials in Use of Modern Methods of
Contraception by Currently Married Women, 1987–2000 . . . . . . . . . . .328
11.6 Sri Lanka: Trends in Infant Mortality Rates, Country and
Nuwara Eliya District, 1920–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .330
11.7 Sri Lanka: Government Hospital Provision, 1920–2000 . . . . . . . . . . . . .335
12.1 Thailand: Population Pyramids, 2005, 2010, and 2020 . . . . . . . . . . . . . .357
12.2 Shift in Budget Allocations, 1982–89 . . . . . . . . . . . . . . . . . . .360
12.3 Thailand: Health Service Delivery Indicators Relative to
Income and Spending, 1977–2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361

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