Good Practices in Health Financing

Description

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.

Sujets

• Health

Informations

• Publié par: world-bank-publications
• Publié le: 20 juin 2008
• Nombre de lectures: 50
• EAN13: 9780821376836
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

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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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 wi