Health Financing Revisited: A Practitioner's Guide

by Gottret, Pablo E.

• ISBN13: 9780821365854
• ISBN10: 0821365851
• Edition: 1st
• Format: Paperback
• Copyright: 2006-04-01
• Publisher: World Bank

Summary

This publication examines key trends, developments and policy challenges involved in designing or reforming financing mechanisms for the healthcare sector in developing countries, in the context of global evidence, international aid systems, cross-sectoral interactions, national macroeconomic frameworks and overall development plans. Topics discussed include: disease burdens and health expenditure patterns, revenue collection and purchasing, risk pooling mechanisms, official development assistance, achieving the Millennium Development Goals for health, improving efficiency of government spending, and lessons to be drawn from health financing in low-income, middle-income and high-income countries.

Table of Contents

Foreword	p. xiii
Acknowledgments	p. xvii
Acronyms and Abbreviations	p. xviii
Overview	p. 1
The numbers	p. 2
Patterns and effectiveness of current health spending	p. 3
Health financing functions and sources of revenues	p. 4
Risk pooling mechanisms	p. 7
Development assistance for health	p. 12
Realities of government spending and policy levers	p. 14
Health financing challenges in low-income countries	p. 15
Health financing challenges in middle-income countries	p. 18
Learning from high-income countries	p. 20
Health transitions, disease burdens, and health expenditure patterns	p. 23
Demographic dynamics	p. 24
The epidemiological transition and health spending	p. 28
Implications of demographic and epidemiological transitions for health financing	p. 32
Global distribution of health expenditures	p. 34
Sources of health spending	p. 36
Population pyramids and global health expenditures by region and income group	p. 39
Collecting revenue, pooling risk, and purchasing services	p. 45
Health financing functions: definitions and implications	p. 46
Revenue collection and government financing of health services	p. 49
Risk pooling, financial protection, and equality	p. 54
Risk pooling and prepayment	p. 58
Purchasing	p. 61
Health financing policies and fiscal space to increase health spending	p. 63
Classifications of health financing systems	p. 66
Risk pooling mechanisms	p. 73
State-funded health care systems	p. 75
Social health insurance	p. 82
Community-based health insurance	p. 96
Voluntary health insurance	p. 103
The four types of financial risk in voluntary/private health insurance	p. 115
External assistance for health	p. 123
Trends in official development assistance	p. 125
Trends in private financial flows	p. 131
Trends in health aid	p. 133
The effectiveness of aid	p. 138
Recent efforts to revamp aid	p. 150
Improving health outcomes	p. 161
Government health expenditures	p. 163
Reaching the Millennium Development Goals for health	p. 164
Government health expenditures, donor funding, and health outcomes: data and methods	p. 170
Increasing the efficiency of government spending	p. 185
Institutions and policies at the country level	p. 187
Policy instruments to improve public sector management	p. 189
Targeting health expenditures	p. 198
Decentralizing health care	p. 201
Financing health in low-income countries	p. 209
Health spending by region	p. 211
The cost of the Millennium Development Goals	p. 214
Public sources of revenue for health	p. 218
Private sources of revenue for health	p. 227
Equity and efficiency of health spending in low-income countries	p. 236
Four models to estimate the cost of the Millennium Development Goals for health at the country level	p. 244
Financing health in middle-income countries	p. 249
Commonality and variations in health systems	p. 250
Common health financing challenges	p. 252
Revenue mobilization	p. 254
Risk pooling	p. 259
Purchasing services	p. 265
Other considerations	p. 272
Summary of recent health reforms in middle-income countries	p. 273
Financing health in high-income countries	p. 279
Main reform trends in high-income countries	p. 280
Coverage decisions and benefit entitlements	p. 282
Collection of funds	p. 290
Pooling of funds	p. 298
Purchasing and remuneration of providers	p. 302
Index	p. 311
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