Spending Wisely Buying Health Services for the Poor

by Preker, Alexander S.; Langenbrunner, John C.

• ISBN13: 9780821359181
• ISBN10: 0821359185
• Edition: 1st
• Format: Paperback
• Copyright: 2005-06-15
• Publisher: World Bank Publications

Summary

With a special focus on strategic purchasing and contracting of services from nongovernmental providers, 'Spending Wisely' reviews ways to make public spending on health care more efficient and equitable in developing countries.The underlying premise is that it is necessary to separate the function of financing from service delivery to improve public sector performance and accountability. In moving from passive budgeting to active purchasing of health care, the authors recommend policymakers ask five fundamental questions: for whom to buy, what to buy, from whom to buy, how to pay and at what price? In coming to grips with these questions, different authors throughout the book emphasize the important role of organizational, institutional and management issues to the performance of public spending on health care in low- and middle-income countries.

Table of Contents

Acknowledgments	xiii
Acronyms and Abbreviations	xv
Introduction	1	(1)
Part I: The Conceptual Framework	2	(5)
Part II: Making Strategic Purchasing Pro-Poor	7	(2)
Part III: Purchasing Health Services	9	(3)
Part IV: Purchasing Inputs	12	(3)
Part V: Supply, Demand, And Markets	15	(3)
Part VI: Legal And Regulatory Issues	18	(3)
PART I. THE CONCEPTUAL FRAMEWORK	21	(98)
Managing Scarcity through Strategic Purchasing of Health Care	23	(24)
Alexander S. Preker
The Evolution of Health Systems and Collective Financing of Health Care	23	(6)
Reform Trends in Public Spending on Health Care	29	(1)
Continued Need for Strong Public Policy in Managing Scarce Resources	30	(3)
The Purchaser-Provider Split	33	(5)
Getting Value for Public Money Spent on Health Care	38	(1)
Forthcoming Books on Resource Allocation and Purchasing in the Health Sector	39	(1)
References	39	(8)
For Whom to Buy? Are Free Government Health Services the Best Way to Reach the Poor?	47	(14)
Davidson R. Gwatkin
The Beneficiaries of Government Health Service Expenditures	48	(4)
Focusing Government Services on the Poor	52	(3)
Encouraging the Better-Off to Pay for Their Own Services	55	(3)
Conclusions	58	(1)
Notes	58	(1)
References	59	(2)
What to Buy? Revisiting Priority Setting in Health Care	61	(18)
Katharina Hauck
Peter C. Smith
Maria Goddard
Some Approaches to Priority Setting	61	(1)
Economic Evaluation	62	(2)
Equity Issues	64	(3)
Practical Constraints	67	(6)
Conclusions	73	(1)
References	73	(6)
From Whom to Buy? Selecting Providers	79	(10)
Fernando Montenegro-Torres
Cristian Baeza
Defining and Identifying Eligible Providers and Matching the Intervention	79	(4)
Can the Purchaser Buy the Desired Intervention from the Eligible Providers?	83	(4)
References	87	(2)
How to Pay? Understanding and Using Payment Incentives	89	(18)
John C. Langenbrunner
Xingzhu Liu
Payment System Types and a Conceptual Framework for Incentives	89	(2)
Which Payment System Should Be Chosen?	91	(11)
Discussion	102	(2)
Notes	104	(1)
References	104	(3)
At What Price? Affordable and Realistic Fees	107	(12)
Hugh Waters
Peter Sotir Hussey
Overview of Provider Payment Methods	107	(3)
Calculating Costs---Methods and Information Available	110	(4)
Characteristics of Purchasers and Providers	114	(1)
Conclusions	115	(1)
Notes	116	(1)
References	116	(3)
PART II. MAKING STRATEGIC PURCHASING PRO-POOR	119	(50)
The Equity Dimensions of Purchasing	121	(22)
Paolo Carlo Belli
The Evidence	121	(2)
What Does An ``Equitable Distribution of Health and Health Benefits'' Mean?	123	(3)
Defining Variables: Resource Allocation and Purchasing Reforms	126	(8)
Conclusions and Recommendations	134	(1)
Notes	135	(4)
References	139	(4)
Reversing the Law of Inverse Care	143	(10)
Finn Diderichsen
The Inverse Care Law At Work in Rich and Poor Countries	143	(1)
The Infrastructure of Inequity	144	(1)
Methodological Issues: How to Construct Resource Allocation for Equity in Access	145	(6)
References	151	(2)
Risk Pooling and Purchasing	153	(16)
Peter C. Smith
Sophie N. Witter
Approaches to Risk Pooling	154	(5)
Practical Issues	159	(6)
Conclusions	165	(1)
Note	166	(1)
References	167	(2)
PART III. PURCHASING HEALTH SERVICES	169	(66)
Paying for Public Health Services: Financing and Utilization	171	(24)
Xingzhu Liu
Sheila O'Dougherty
Who Should Pay for Public Health Services?	171	(7)
How Should Providers Be Paid?	178	(5)
Toward Better Financing and Payment Policies	183	(4)
References	187	(8)
Buying Results: Contracting for Primary Health Care Delivery	195	(18)
Benjamin Loevinsohn
April L. Harding
Why Contract---Ideology or Pragmatism?	195	(2)
Approaches to Contracting	197	(1)
Study Methodology	197	(2)
Results: Contracting Can Quickly Improve Service Delivery	199	(6)
Methodological Limitations of This Review	205	(1)
Is Contracting a Sustainable Approach?	206	(2)
Recommendations	208	(2)
Note	210	(1)
References	210	(3)
Purchasing Hospital Services: Key Questions for Policymakers	213	(22)
Eric de Roodenbeke
Key Criteria for Effective Purchasing Decisions	213	(1)
For Whom to Buy?	214	(4)
What to Buy?	218	(4)
From Whom to Buy	222	(3)
How to Pay?	225	(2)
At What Price?	227	(3)
Moving Forward	230	(2)
Notes	232	(1)
References	232	(3)
PART IV. PURCHASING INPUTS	235	(64)
Paying for Health Care Labor	237	(14)
Pascal Zurn
Orvill Adams
Purchasing Health Care Labor	237	(1)
Framework for Purchasing Health Labor	237	(9)
Conclusions	246	(1)
Note	247	(1)
References	247	(4)
Purchasing Pharmaceuticals	251	(16)
Ulrika Enemark
Anita Alban
Enrique C. Seoane-Vazquez
Andreas Seiter
Pharmaceutical RAP in Developing Countries	251	(2)
Core Policy RAP Strategies to Increase Access to Drugs	253	(7)
Organizational and Institutional Arrangements	260	(3)
From Passive to Active Purchasing of Pharmaceuticals	263	(1)
Notes	264	(1)
References	264	(3)
Paying for Capital	267	(12)
Jon Sussex
Sandra Sosa-Rubi
The Commercial Model	267	(1)
Capital Financing	268	(1)
Capital Charging	269	(2)
New Assets or All?	271	(1)
Notional Versus Real Capital Charges	272	(1)
Time Profiles of Capital Charges	273	(1)
Asset Valuation	274	(2)
Conclusions	276	(1)
Notes	276	(1)
References	277	(2)
Paying for Knowledge and Research	279	(8)
Dean T. Jamison
Priority Areas for R&D	280	(1)
RAP for R&D	281	(5)
Notes	286	(1)
References	286	(1)
Using Resource Profiles	287	(12)
Anders Anell
Classification of Resources and Typical Imbalances Data	288	(2)
Construction of Health Care Resource Profiles	290	(5)
Discussion	295	(1)
References	296	(3)
PART V. SUPPLY, DEMAND, AND MARKETS	299	(58)
Single-Payer Health Insurance	301	(18)
Gerard F. Anderson
Peter Sotir Hussey
Differences Between Single- and Multiple-Payer Systems	301	(11)
Two Options for Reforming Single-Payer Insurance Systems	312	(2)
Considerations Specific to Low- and Middle-Income Countries	314	(2)
Conclusions	316	(1)
Notes	316	(1)
References	316	(3)
Multiple Payers in Health Care: A Framework for Assessment	319	(20)
Peter Zweifel
Theoretical Background	320	(5)
Complementary Agents: Their Objectives and Constraints	325	(10)
Conclusions	335	(1)
Notes	336	(1)
References	336	(3)
Influencing the Demand Side of Purchasing	339	(18)
Tim Ensor
Stephanie Cooper
Demand-Side Barriers	340	(8)
Policy Discussion and Research Implications	348	(3)
Notes	351	(1)
References	351	(6)
PART VI. LEGAL AND REGULATORY ISSUES	357	(32)
Law and Regulation	359	(16)
Frank G. Feeley
A Typology of RAP Arrangements	360	(1)
Regulating What Is Purchased	361	(5)
Regulating the Choice of Providers	366	(3)
Regulating the Purchasing Transaction	369	(4)
References	373	(2)
Quality-Based Purchasing in the United States: Applications in Developing Countries?	375	(14)
Peggy McNamara
Call to Action for U.S. Employers	375	(1)
Quality-Based Purchasing By Employers	375	(2)
Barriers to Quality-Based Purchasing	377	(1)
Employer Activists	378	(2)
Generic Employer Strategies to Promote Health Accountability for Quality	380	(3)
Impact of Employer Strategies on Quality	383	(1)
Conclusions	384	(2)
Notes	386	(1)
References	386	(3)
About the Coeditors and Contributors	389	(12)
Index	401