WorldWideScience

Sample records for health decentralization financing

  1. Health financing changes in the context of health care decentralization: the case of three Latin American countries

    Directory of Open Access Journals (Sweden)

    Arredondo Armando

    2000-01-01

    Full Text Available OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing.

  2. Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries.

    Science.gov (United States)

    Arredondo, Armando; Orozco, Emanuel; De Icaza, Esteban

    2005-01-01

    The main objective was to identify trends and evidence on health financing after health care decentralization. Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing. Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.

  3. HEALTH & FINANCE

    African Journals Online (AJOL)

    HEALTH & FINANCE. Patrick Thokwa Masobe. Patrick Thokwa Masobe completed his undergraduate studies at Grinnel/. University in the USA, and a Master. Degreefrom the University of London in. 1995. He is wrrently employed by the national Department of Health, where he led the task team charged with making.

  4. HEALTH & FINANCE

    African Journals Online (AJOL)

    payments and coinsurance, the establishment of a minimum set ... costs are higher for aged and sick members. ... human nature to ensure you get good value for money. This ... rating. Australia has a National Health Insurance (NHI) system.

  5. HEALTH & FINANCE

    African Journals Online (AJOL)

    and less information and expertise available to them. This exact same item has also been mentioned as an advantage, because it hinges on the level of education of the specific consumer. The Department of Health is also concerned about the potential income tax advantages created by a savings account. If contributions ...

  6. Subnational Adaptation Finance Allocation: Comparing Decentralized and Devolved Political Institutions in Kenya

    OpenAIRE

    Sam Barrett

    2015-01-01

    Adaptation finance is designed to help vulnerable populations withstand effects of climate variability and change. However, levels of vulnerability seldom determine finance distribution. Political and economic preferences of national and local government decision-makers tend to direct funding streams. This article takes an institutional approach to adaptation finance allocation by comparing decentralized and devolved local governance structures managing adaptation finance in Kenya before and ...

  7. The contribution of fiscal/financial decentralization to the debt expansion of the local financing platform

    Science.gov (United States)

    Huayang, Yin; Di, Zhou; Bing, Cui

    2018-02-01

    Using soft budget theory to explore the formation mechanism and the deep institutional incentive of the local financing platform debt expansion from the perspective of fiscal / financial decentralization, construct theoretical framework which explain the expansion of local debt financing platform and conduct an empirical test, the results showed that the higher the degree of fiscal decentralization, fiscal autonomy as a soft constraint body of local government the stronger, local financing platform debt scale is greater; the higher the degree of financial decentralization, local government and financial institutions have the higher autonomy with respect to the central, local financing platform debt scale is bigger; financial synergy degree is stronger, local government financial mutual supervision prompted the local government debt more transparency, local debt financing platform size is smaller.

  8. Centralized vs. decentralized child mental health services.

    Science.gov (United States)

    Adams, M S

    1977-09-01

    One of the basic tenets of the Community Mental Health Center movement is that services should be provided in the consumers' community. Various centers across the country have attempted to do this in either a centralized or decentralized fashion. Historically, most health services have been provided centrally, a good example being the traditional general hospital with its centralized medical services. Over the years, some of these services have become decentralized to take the form of local health centers, health maintenance organizations, community clinics, etc, and now various large mental health centers are also being broken down into smaller community units. An example of each type of mental health facility is delineated here.

  9. Health financing changes in the context of health care decentralization: the case of three Latin American countries Mudanças no financiamento da saúde no contexto de descentralização da saúde: o caso de três países latino-americanos

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2000-10-01

    Full Text Available OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing.OBJETIVO: São apresentados os resultados de um estudo longitudinal com o objetivo de identificar os efeitos da descentralização nas políticas de financiamento em três países da América Latina: México, Nicarágua e Peru. MÉTODOS: A metodologia teve duas fases principais. Na primeira, foram analisadas as fontes de dados secundários, referentes às seguintes variáveis: tipo de descentralização implementada, fontes de financiamento, provedores de serviços, mecanismos de alocação de recursos e destino final de recursos. Na segunda fase, foram analisadas as fontes de dados primários obtidos por meio de entrevistas diretas com pessoal-chave do setor de saúde, tomando como guia as mesmas variáveis da primeira etapa. RESULTADOS: Os resultados identificaram as fortalezas e as debilidades de cada país em matéria de políticas de financiamento e de descentralização. CONCLUSÕES: As principais mudanças no

  10. Financial decentralization and its impact on local finance system of Ukraine

    Directory of Open Access Journals (Sweden)

    I. V. Mizina

    2016-07-01

    Full Text Available The article researches the influence of the process of financial decentralization system on local finance system in Ukraine. Author determined the basic transformations of local finances system as a result of reform measures and ways to adapt to new conditions. The basic characteristics of the changing role of public authorities and local governments, their relationships and relationships in the system, strengthening public participation in decision­making of local importance are revealed. The main requirements of local finances taking into account the impact of fiscal decentralization processes are formulated. They include the formation of an effective and sustainable framework for the mobilization of financial resources within each territorial community; providing sufficient resources for sustainable and dynamic development at the local level; improve management of local finances with the application process and project approaches. An action plan to change the system of local finance Ukraine in the context of fiscal decentralization on a 5­year period is proposed. The action plan envisages normalization of regulatory provisions in the area of local finance, training local government officials, development resources, monitoring and evaluating the effectiveness of the current system of local finance.

  11. [Dilemmas of health financing].

    Science.gov (United States)

    Herrera Zárate, M; González Torres, R

    1989-01-01

    The economic crisis had had a profound effect on the finances of health services in Mexico. The expenditure on health has decreased, both in absolute terms and in relation to the national gross product. Funding problems have been aggravated by inequities in budget distribution: social security institutions have been favored; geographical distribution of resources is concentrated in the central areas of the country and in the more developed states, and curative health care has prevailed over preventive medicine. Administrative inefficiency hinders even more the appropriate utilization of resources. Diversification of funding sources has been proposed, through external debt, local funding, and specific health taxing. But these proposals are questionable. The high cost of the debt service has reduced international credits as a source of financing. Resource concentration at the federal level, and the different compromises related to the economic solidarity pact have also diminished the potentiality of local state financing. On the other hand, a special health tax is not viable within the current fiscal framework. The alternatives are a better budget planning, a change in the institutional and regional distribution of resources, and improvement in the administrative mechanisms of funding.

  12. Decentralization of Health System in Islamic Republic of Iran

    Directory of Open Access Journals (Sweden)

    MJ Kabir

    2008-10-01

    Full Text Available Decentralization is the process of dispersing decision-making closer to the point of peripheral area, service or action. Basically decentralized governance, if properly planned and implemented, offers important opportunities for enhanced human development. The studies about this issue in different countries show that most of the decentralizations have been implemented in European countries and in comparison, the Middle East countries have been utilized lower degrees of the decentralization process. In fact, decentralization in the health system is a policy pursued for a variety of purposes including; increase in service delivery effectiveness and equity, improving efficiency and quality, fairness of financial contribution and planning for choosing the most appropriate interventions for the health priorities in peripheral regions. To implement decentralized governance, there is a spectrum of different choices that the government should regulate their degrees. Providing an appropriate atmosphere for decentralization is essential, otherwise lack of planning and achievement can result in complications for the system.

  13. Security for decentralized health information systems.

    Science.gov (United States)

    Bleumer, G

    1994-02-01

    Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).

  14. Health, autonomic financing and transferences

    Directory of Open Access Journals (Sweden)

    David Cantarero Prieto

    2002-01-01

    Full Text Available The present paper has as objective to study the whole relative problem to the autonomous communities and regional heath care expenditure financing in Spain. This article has a dual purpose. First, the financing of the current health care attendance is approached in the Spanish regions passing magazine to its possible variants and we observe that the balance of our system is clearly inclined towards the side of the integration in the general pattern of financing («Fiscal Room» with specific conditions («Mixed System». Secondly, we examine the new situation in the mark of health care and its corresponding financing in the new model approved in 2001, in terms of the effects of tax assignment on autonomous communities.

  15. Human resources for health and decentralization policy in the Brazilian health system

    Directory of Open Access Journals (Sweden)

    Pierantoni Celia

    2011-05-01

    Full Text Available Abstract Background The Brazilian health reform process, following the establishment of the Unified Health System (SUS, has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH, through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. Methods The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. Results The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them

  16. Human resources for health and decentralization policy in the Brazilian health system.

    Science.gov (United States)

    Pierantoni, Celia Regina; Garcia, Ana Claudia P

    2011-05-17

    The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short

  17. Health care entrepreneurship: financing innovation.

    Science.gov (United States)

    Grazier, Kyle L; Metzler, Bridget

    2006-01-01

    Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

  18. Financing the health care Internet.

    Science.gov (United States)

    Robinson, J C

    2000-01-01

    Internet-related health care firms have accelerated through the life cycle of capital finance and organizational destiny, including venture capital funding, public stock offerings, and consolidation, in the wake of heightened competition and earnings disappointments. Venture capital flooded into the e-health sector, rising from $3 million in the first quarter of 1998 to $335 million two years later. Twenty-six e-health firms went public in eighteen months, raising $1.53 billion at initial public offering (IPO) and with post-IPO share price appreciation greater than 100 percent for eighteen firms. The technology-sector crash hit the e-health sector especially hard, driving share prices down by more than 80 percent for twenty-one firms. The industry now faces an extended period of consolidation between e-health and conventional firms.

  19. Is health care financing in Uganda equitable?

    Science.gov (United States)

    Zikusooka, C M; Kyomuhang, R; Orem, J N; Tumwine, M

    2009-10-01

    Health care financing provides the resources and economic incentives for operating health systems and is a key determinant of health system performance. Equitable financing is based on: financial protection, progressive financing and cross-subsidies. This paper describes Uganda's health care financing landscape and documents the key equity issues associated with the current financing mechanisms. We extensively reviewed government documents and relevant literature and conducted key informant interviews, with the aim of assessing whether Uganda's health care financing mechanisms exhibited the key principles of fair financing. Uganda's health sector remains significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending. At 9.6 % of total government expenditure, public spending on health is far below the Abuja target of 15% that GoU committed to. Prepayments form a small proportion of funding for Uganda's health sector. There is limited cross-subsidisation and high fragmentation within and between health financing mechanisms, mainly due to high reliance on out-of-pocket payments and limited prepayment mechanisms. Without compulsory health insurance and low coverage of private health insurance, Uganda has limited pooling of resources, and hence minimal cross-subsidisation. Although tax revenue is equitable, the remaining financing mechanisms for Uganda are inequitable due to their regressive nature, their lack of financial protection and limited cross-subsidisation. Overall, Uganda's current health financing is inequitable and fragmented. The government should take explicit action to promote equitable health care financing by establishing pre-payment schemes, enhancing cross-subsidisation mechanisms and through appropriate integration of financing mechanisms.

  20. Decentralizing provision of mental health care in Sri Lanka.

    Science.gov (United States)

    Fernando, Neil; Suveendran, Thirupathy; de Silva, Chithramalee

    2017-04-01

    In the past, mental health services in Sri Lanka were limited to tertiary-care institutions, resulting in a large treatment gap. Starting in 2000, significant efforts have been made to reconfigure service provision and to integrate mental health services with primary health care. This approach was supported by significant political commitment to establishing island-wide decentralized mental health care in the wake of the 2004 tsunami. Various initiatives were consolidated in The mental health policy of Sri Lanka 2005-2015, which called for implementation of a comprehensive community-based, decentralized service structure. The main objectives of the policy were to provide mental health services of good quality at primary, secondary and tertiary levels; to ensure the active involvement of communities, families and service users; to make mental health services culturally appropriate and evidence based; and to protect the human rights and dignity of all people with mental health disorders. Significant improvements have been made and new cadres of mental health workers have been introduced. Trained medical officers (mental health) now provide outpatient care, domiciliary care, mental health promotion in schools, and community mental health education. Community psychiatric nurses have also been trained and deployed to supervise treatment adherence in the home and provide mental health education to patients, their family members and the wider community. A total of 4367 mental health volunteers are supporting care and raising mental health literacy in the community. Despite these important achievements, more improvements are needed to provide more timely intervention, combat myths and stigma, and further decentralize care provision. These, and other challenges, will be targeted in the new mental health policy for 2017-2026.

  1. THE FINANCING OF HEALTH CARE IN UKRAINE

    Directory of Open Access Journals (Sweden)

    Liliia Savchuk

    2016-03-01

    Full Text Available In the article the peculiarities of financing healthcare in Ukraine. Analyzed various sources of funding for the sector. Health expenditure per capita of the population in Ukraine and around the world have been investigated. On the basis of the analysis found that the size of budget financing are inefficient and do not meet the resource needs of the industry. Clarified the problems of resource provision of health care and the shortcomings of public Finance mechanisms. Asked to review the existing allocation mechanism of the industry and the rapid transition to a model of budgetary-insurance medicine. Keywords: realm healthcare, financing sources, government budget, expenditure, insurance medicine. JEL: H 51

  2. Decentralization of health care systems and health outcomes: Evidence from a natural experiment.

    Science.gov (United States)

    Jiménez-Rubio, Dolores; García-Gómez, Pilar

    2017-09-01

    While many countries worldwide are shifting responsibilities for their health systems to local levels of government, there is to date insufficient evidence about the potential impact of these policy reforms. We estimate the impact of decentralization of the health services on infant and neonatal mortality using a natural experiment: the devolution of health care decision making powers to Spanish regions. The devolution was implemented gradually and asymmetrically over a twenty-year period (1981-2002). The order in which the regions were decentralized was driven by political factors and hence can be considered exogenous to health outcomes. In addition, we exploit the dynamic effect of decentralization of health services and allow for heterogeneous effects by the two main types of decentralization implemented across regions: full decentralization (political and fiscal powers) versus political decentralization only. Our difference in differences results based on a panel dataset for the 50 Spanish provinces over the period 1980 to 2010 show that the lasting benefit of decentralization accrues only to regions which enjoy almost full fiscal and political powers and which are also among the richest regions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Health policy in Denmark: leaving the decentralized welfare path?

    Science.gov (United States)

    Vrangbaek, Karsten; Christiansen, Terkel

    2005-01-01

    In this article, we investigate developments in Danish health care policy. After a short presentation of its historical roots, we focus on the decades after the administrative reform of 1970, which shaped the current decentralized public health care system. Theories of path dependency and institutional inertia are used to explain the relative stability in the overall structure, and theories of policy process and reform are used to discuss gradual changes within the overall framework. Although comprehensive reforms have not taken place in Denmark, many gradual changes may pave the way for more radical changes in the future. The political climate currently seems to be more favorable toward structural reform than in the past.

  4. From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

    Science.gov (United States)

    Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

    2016-01-01

    Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

  5. Addressing the challenges to health sector decentralization in Nepal: an inquiry into the policy and implementation processes.

    Science.gov (United States)

    Dhakal, R; Ratanawijitrasin, S; Srithamrongsawat, S

    2009-09-01

    The objective of the study was to analyze the status and explore the challenges to decentralization policy implementation in Nepal. Thirty seven key informants rich in experience and knowledge, seven focus group discussions, observation of six health facilities and analysis of about 25 key policy documents provided the data for this study. The study identified the challenges to the implementation of decentralization reforms in the public health sector as: (i) centralised and weak management and programming practices of the government; (ii) weak legal and institutional framework; (iii) conflicting policy objectives; (iv) lack of implementation strategy; (v) poor financial and human resource management system; (vi) lack of adequate preparation for managing the reform; (vii) weak capacity at all levels; (viii) political instability. It was revealed that the implementation of the policy in Nepal was extremely poor as many of the important policy measures were either never initiated or they were only partially implemented. The challenges lie both at - policy design and implementation phase. Clear policy objectives, appropriate structure, sound planning, financing and human resources policy, adequate capacity, responsive information system, defined service packages, active participation of stakeholders and a conducive socio-political environment are considered imperative for successful implementation of the policy. Preparation for managing reform implementation at national and district levels is prerequisite for decentralization to work. Pushing for decentralization in a politically fragile environment may rather lead to further fragmentation, instead of strengthening government legitimacy.

  6. Federalism and decentralization: impact on international and Brazilian health policies.

    Science.gov (United States)

    Leite, Valéria Rodrigues; de Vasconcelos, Cipriano Maia; Lima, Kenio Costa

    2011-01-01

    This article discusses the implications of decentralization in the light of international and Brazilian federalism, and its effects on public health policy. In a comparative analysis among countries, the authors find there is no single model; rather, each country has a unique structure of institutions and norms that have important implications for the operation of its health system. Brazil shares some similarities with other countries that have adopted a decentralized system and is assuming features ever closer to U.S. federalism, with a complex web of relationships. The degree of inequality among Brazilian municipalities and states, along with the budgetary imbalances caused by the minimal levels of resource utilization, undermines Brazil's constitutional principles and, consequently, its federalism. To ensure the constitutional mandate in Brazil, it is essential, as in other countries, to create a stable source of funds and increase the volume and efficiency of spending. Also important are investing in the training of managers, improving information systems, strengthening the principles of autonomy and interdependence, and defining patterns of cooperation within the federation.

  7. Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization

    Directory of Open Access Journals (Sweden)

    Harahap Nida P

    2009-02-01

    Full Text Available Abstract Background In 2001 Indonesia embarked on a rapid decentralization of government finances and functions to district governments. One of the results is that government has less information about its most valuable resource, the people who provide the services. The objective of the work reported here is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. Methods We enumerated all health care providers (doctors, nurses and midwives, including information on their employment status and primary place of work, in each of 15 districts in Java. Data were collected by three teams, one for each province. Results Provider density (number of doctors, nurses and midwives/1000 population was low by international standards – 11 out of 15 districts had provider densities less than 1.0. Approximately half of all three professional groups were permanent public servants. Contractual employment was also important for both nurses and midwives. The private sector as the primary source of employment is most important for doctors (37% overall and increasingly so for midwives (10%. For those employed in the public sector, two-thirds of doctors and nurses work in health centres, while most midwives are located at village-level health facilities. Conclusion In the health system established after Independence, the facilities established were staffed through a period of obligatory service for all new graduates in medicine, nursing and midwifery. The last elements of that staffing system ended in 2007 and the government has not been able to replace it. The private sector is expanding and, despite the fact that it will be of increasing importance in the coming decades, government information about providers in private practice is decreasing. Despite the promise of decentralization to

  8. Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization.

    Science.gov (United States)

    Heywood, Peter F; Harahap, Nida P

    2009-02-03

    In 2001 Indonesia embarked on a rapid decentralization of government finances and functions to district governments. One of the results is that government has less information about its most valuable resource, the people who provide the services. The objective of the work reported here is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. We enumerated all health care providers (doctors, nurses and midwives), including information on their employment status and primary place of work, in each of 15 districts in Java. Data were collected by three teams, one for each province. Provider density (number of doctors, nurses and midwives/1000 population) was low by international standards--11 out of 15 districts had provider densities less than 1.0. Approximately half of all three professional groups were permanent public servants. Contractual employment was also important for both nurses and midwives. The private sector as the primary source of employment is most important for doctors (37% overall) and increasingly so for midwives (10%). For those employed in the public sector, two-thirds of doctors and nurses work in health centres, while most midwives are located at village-level health facilities. In the health system established after Independence, the facilities established were staffed through a period of obligatory service for all new graduates in medicine, nursing and midwifery. The last elements of that staffing system ended in 2007 and the government has not been able to replace it. The private sector is expanding and, despite the fact that it will be of increasing importance in the coming decades, government information about providers in private practice is decreasing. Despite the promise of decentralization to increase sectoral "decision space" at the district level, the

  9. Decentralization : Local Partnerships for Health Services in the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    However, the national decentralization program is having a hard time getting on track. In the face of day-to-day difficulties Zenü Network, a nongovernmental organization, would like to make a contribution to this social project. The Network would like to demonstrate that civil society can work with decentralized government ...

  10. Decentralization : Local Partnerships for Health Services in the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Cameroon, like most other sub-Saharan African countries, has adopted laws devolving various responsibilities to local administrations. In the local political discourse, decentralization is seen as bringing essential services closer to the users, especially those in greatest need. However, the national decentralization program ...

  11. [Decentralization of health care and medical teaching: the Chilean experience].

    Science.gov (United States)

    Goic, Alejandro; Armas, Rodolfo

    2003-07-01

    In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS). The NHS had outpatient clinics and hospitals all over the country and was responsible for health care and for the promotion of health and disease prevention programs. In 1954, the NHS and the School of Medicine set up Residencies and General Practitioners programs aimed at improving the distribution of specialists and general practitioners throughout the country. In 1979, the NHS was replaced with 27 autonomous Health Services headed by the Ministry of Health, while the administration of primary care outpatient clinics was transferred to the municipal government. However, sanitary programs were still managed at the central level. Higher education also expanded and was decentralized. There are currently 60 universities and 17 medical schools, compared to eight and six, respectively, in 1981. The number of students in higher education has increased by 370% in 20 years. At the present time, the Chilean health case system is a predominantly public system with a strong and sizeable private system. Sixty two percent of the population is covered by public health insurance, while 27% is covered by private insurance. New and well equipped private clinics have multiplied. Private non profit institutions manage the prevention and treatment of work related injuries and diseases. Chile's outstanding health indicators (fertility rate: 17.2 x 1,000; mortality: 5.4 x 1,000; maternal mortality: 2.3 x 10,000; neonatal mortality: 4.5 x 1,000; life expectancy: 76 years) are a direct consequence of the improved social, cultural and economic condition of the general populations as well as of the sanitary programs sustained over the past

  12. Emerging trends in health care finance.

    Science.gov (United States)

    Sterns, J B

    1994-01-01

    Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.

  13. Equity in Health and Health Financing: Building and Strengthening ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Equity in Health and Health Financing: Building and Strengthening Developing Country Networks. Equity in health is a pressing global concern. Disparities in health status and access to health care within and across countries are both a cause and a consequence of social inequality. Access to health services continues to ...

  14. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network

    Directory of Open Access Journals (Sweden)

    Prasad Vandana

    2009-07-01

    Full Text Available Abstract The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated

  15. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network.

    Science.gov (United States)

    Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R

    2009-07-20

    The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health

  16. India's Health Initiative: Financing Issues and Options

    OpenAIRE

    Deolalikar, Anil B.; Jamison, Dean T.; Laxminarayan, Ramanan

    2007-01-01

    In response to the challenge of sustaining the health gains achieved in the better-performing states and ensuring that the lagging states catch up with the rest of the country, the Indian government has launched the National Rural Health Mission. A central goal of the effort is to increase public spending on health from the current 1.1 percent of GDP to roughly 2–3 percent of GDP within the next five years. In this paper, we examine the current status of health financing in India, as well as ...

  17. Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders

    Directory of Open Access Journals (Sweden)

    Kolehmainen-Aitken Riitta-Liisa

    2004-05-01

    Full Text Available Abstract Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers. The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1 defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2 supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3 identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best

  18. Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders.

    Science.gov (United States)

    Kolehmainen-Aitken, Riitta-Liisa

    2004-05-14

    Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers.The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them

  19. Redistributive effects of Swedish health care finance.

    Science.gov (United States)

    Gerdtham, U G; Sundberg, G

    1998-01-01

    This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and 'reranking' segments for each of the four financial sources. The data used are based on probability samples of the Swedish population, from the Level of Living Survey (LNU) from 1981 and 1991. The paper concludes that the Swedish health care financing system is weakly progressive, although direct payments are regressive. There is some horizontal inequity and 'reranking', which mainly comes from the county council taxes, since those tax rates vary for each county council. The implication is that, to some extent, people with equal incomes are treated unequally.

  20. Health care financing: recent experience in Africa.

    Science.gov (United States)

    Dunlop, D W

    1983-01-01

    The economic realities of health sector development in Africa has been analyzed in this paper. Both the global and national macroeconomic context has been defined. Given the available data, it is clear that most African countries face increasingly serious economic realities, such as slow or even declining economic growth (per capita), a depressed food production situation, severe balance of payments crises, and increasing dependence on external financial assistance. Given the limited but increasingly available 1981 and 1982 data, the economic situation in many countries is more constrained than those indicated by the data contained in this paper. In this context, the potential competitive situation facing governmental health care systems was reviewed. In addition, the diversity in the sources of health expenditures between countries in Africa was highlighted. These data provide clear evidence that governments clearly do not finance the entire health care system and that individual payment for service in many countries represent an important source of revenue for many care providers in various health care systems operating in any given country. The potential for governments to finance either an expansion of or improvements to the government component of their health care systems is then reviewed. The highlights of this analysis include the following points. First, the tax structure in many African countries is highly dependent on export and import duties, which in turn creates dependency on sustained foreign demand for exports.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Equity in health care financing: The case of Malaysia

    OpenAIRE

    Sach Tracey H; Whynes David K; Yu Chai

    2008-01-01

    Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implication...

  2. Equity in health care financing: The case of Malaysia.

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2008-06-09

    Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help

  3. Equity in health care financing: The case of Malaysia

    Directory of Open Access Journals (Sweden)

    Sach Tracey H

    2008-06-01

    Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers

  4. Evolution and patterns of global health financing 1995-2014

    NARCIS (Netherlands)

    Dieleman, Joseph; Campbell, Madeline; Chapin, Abigail; Eldrenkamp, Erika; Fan, Victoria Y.; Haakenstad, Annie; Kates, Jennifer; Liu, Yingying; Matyasz, Taylor; Micah, Angela; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Sorensen, Reed; Evans, Tim; Evans, David; Kurowski, Christoph; Tandon, Ajay; Abbas, Kaja M.; Abera, Semaw Ferede; Ahmad Kiadaliri, Aliasghar; Ahmed, Kedir Yimam; Ahmed, Muktar Beshir; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, A.; Amini, Erfan; Ammar, Walid; Amrock, Stephen Marc; Antonio, Carl Abelardo T.; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Barac, Aleksandra; Bernal, Oscar Alberto; Beyene, Addisu Shunu; Beyene, Tariku Jibat; Birungi, Charles; Bizuayehu, Habtamu Mellie; Breitborde, Nicholas J.K.; Cahuana-Hurtado, Lucero; Castro, Ruben Estanislao; Catalá-López, Ferran; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; Jager, De Pieter; Dharmaratne, Samath D.; Dubey, Manisha; Sa Farinha, Carla Sofia E.; Faro, Andre; Feigl, Andrea B.; Fischer, Florian; Fitchett, Joseph Robert Anderson; Foigt, Nataliya; Giref, Ababi Zergaw; Gupta, Rahul; Hamidi, Samer; Harb, Hilda L.; Hay, Simon I.; Hendrie, Delia; Horino, Masako; Jürisson, Mikk; Jakovljevic, Mihajlo B.; Javanbakht, Mehdi; John, Denny; Jonas, Jost B.; Karimi, Seyed M.; Khang, Young Ho; Khubchandani, Jagdish; Kim, Yun Jin; Kinge, Jonas M.; Krohn, Kristopher J.; Kumar, G.A.; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Mohammed; Majeed, Azeem; Malekzadeh, Reza; Masiye, Felix; Meier, Toni; Meretoja, Atte; Miller, Ted R.; Mirrakhimov, Erkin M.; Mohammed, Shafiu; Nangia, Vinay; Olgiati, Stefano; Osman, Abdalla Sidahmed; Owolabi, Mayowa O.; Patel, Tejas; Paternina Caicedo, Angel J.; Pereira, David M.; Perelman, Julian; Polinder, Suzanne; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ram, Usha; Ranabhat, Chhabi Lal; Roba, Hirbo Shore; Salama, Joseph; Savic, Miloje; Sepanlou, Sadaf G.; Shrime, Mark G.; Talongwa, Roberto Tchio; Ao, Te Braden J.; Tediosi, Fabrizio; Tesema, Azeb Gebresilassie; Thomson, Alan J.; Tobe-Gai, Ruoyan; Topor-Madry, Roman; Undurraga, Eduardo A.; Vasankari, Tommi; Violante, Francesco S.; Werdecker, Andrea; Wijeratne, Tissa; Xu, Gelin; Yonemoto, Naohiro; Younis, Mustafa Z.; Yu, Chuanhua; Zaidi, Zoubida; Sayed Zaki, El Maysaa; Murray, Christopher J.L.

    2017-01-01

    Background: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this

  5. Paradoxos das políticas de descentralização de saúde no Brasil Paradoxes of health decentralization policies in Brazil

    Directory of Open Access Journals (Sweden)

    Dário Frederico Pasche

    2006-12-01

    Full Text Available The constitution of Brazil directs that the country’s health system, the Unified Health System (Sistema Único de Saúde, be politically and administratively decentralized. Nevertheless, handing over competencies, responsibilities, and resources to subnational levels, especially to municipal governments, has been a slow process, lasting almost two decades. Advances have been brought about by the Unified Health System, which, from a analytical perspective, is a public and universal system. Despite that, the decentralization process needs to overcome norms that keep all levels of management dependent on Brazil’s federal Government. The subnational levels have consistently faced difficulties in performing their macromanagement functions with autonomy, especially when it comes to financing and to the establishment or organization of health care networks. Boldness and responsibility will be needed to prevent Brazil’s health decentralization process from leading to fragmentation. New political agreements between different levels of government, with a reassignment of responsibilities and the enhancement of a culture of technical cooperation, are fundamental requisites to making the Unified Health System have a health policy that is truly public and universal.

  6. The Gateway Paper--financing health in Pakistan and its linkage with health reforms.

    Science.gov (United States)

    Nishtar, Sania

    2006-12-01

    Pakistan currently principally uses three modes of financing health--taxation, out of pocket payments and donor contributions of which the latter is the least significant in terms of size. Less than 3.6% of the employees are covered under the social security scheme and there is a limited social protection mechanism, which collectively serves the health needs of 3.4% of the population. The main issues in health financing include low spending, lack of attention to alternate sources of financing and issues with fund mobilization and utilization. With respect to the first, health reforms proposed as part of the Gateway Paper make a strong case for promoting the reallocation of tax-based revenues and developing sustainable alternatives to low levels of public spending on health. With respect to alternative sources of health financing, the Gateway Paper lays stress on exploring policy options for private health insurance, broadening the base of Employees Social Security, creating a Federal Employees Social Security Programme, developing social health insurance within the framework of a broad-based social protection strategy, which scopes beyond the formally employed sector, establishing a widely inclusive safety net for the poor; mainstreaming philanthropic grants as a major source of health financing; developing a conducive tax configuration; generating greater corporate support for social sector causes within the framework of the concept of Corporate Social Responsibility and developing cost-sharing programmes, albeit with safeguards. The Gateway Paper regards efficient fund utilization a priority and lays stress on striking a balance between minimizing costs, controlling costs and using resources more efficiently and equitably--in other words, getting the best value for the money, on the one hand, and increasing the pool of available resources, on the other. Specific interventions such as the promotion of transparent financial administration, budgeting and cost

  7. Bayelsa, in search of a sustainable health financing scheme ...

    African Journals Online (AJOL)

    Journal Home > Vol 23, No 1 (2017) > ... Background: A sustainable health care financing scheme has been difficult to ... These meagre allocations were because the same source that funds patient care services also funds health research, capital ... a sustainable health financing scheme will depend on a health system that ...

  8. Health care financing in Nigeria: Implications for achieving universal ...

    African Journals Online (AJOL)

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms.

  9. [Evolution and new perspectives of health care financing in developing countries].

    Science.gov (United States)

    Audibert, Martine; Mathonnat, Jacky; de Roodenbeke, Eric

    2003-01-01

    Over the last twenty five years, the perspective of health care financing has dramatically changed in developing countries. In this context, it is worth reviewing the literature and the experiences in order to understand the major shifts on this topic. During the sixties, health care policies focused on fighting major epidemics. Programs were dedicated to reduce the threat to population health. Financing related to the mobilization of resources for these programs and most of them were not managed within national administrations. The success of these policies was not sustainable. After Alma Ata, primary health care became a priority but it took some years before the management of the health care district was introduced as a major topic. In the eighties, with the district policy and the Bamako Initiative, the economic approach became a major part of all health care policies. At that time, most of health care financing was related to cost recovery strategies. All the attention was then drawn on how it worked: Fee policies, distribution of revenues, efficient use of resources and so on. In the second half of the nineties, cost recovery was relegated to the back scene, health care financing policy then becoming a major front scene matter. Two major reasons may explain this change in perspective: HIV which causes a major burden on the whole health system, and fighting poverty in relation with debts reduction. In most developing countries, with high HIV prevalence, access to care is no longer possible within the framework of the ongoing heath care financing scheme. Health plays a major role in poverty reduction strategies but health care officials must take into account every aspect of public financing. New facts also have to be taken into account: Decentralization/autonomy policies, the growing role of third party payment and the rising number of qualified health care professionals. All these facts, along with a broader emphasis given to the market, introduce a need for

  10. [External and internal financing in health care].

    Science.gov (United States)

    Henke, Klaus-Dirk

    2007-05-15

    The objective of this contribution is to characterize the functional and institutional features of the German health-care system. This takes place after a short introduction and examination of the ongoing debate on health care in Germany. External funding describes the form of revenue generation. Regarding external funding of the German health care system, one of the favored alternatives in the current debate is the possibility of introducing per capita payments. After a short introduction to the capitation option, focus is on the so-called health fund that is currently debated on and being made ready for implementation in Germany, actually a mixed system of capitation and contributions based on income. On the other hand, internal funding is the method of how different health-care services are purchased or reimbursed. This becomes a rather hot topic in light of new trends for integrated and networked care to patients and different types of budgeting. Another dominating question in the German health-care system is the liberalization of the contractual law, with its "joint and uniform" regulations that have to be loosened for competition gains. After a discussion of the consequences of diagnosis-related groups (DRGs) in Germany, the article is concluded by a note on the political rationality of the current health-care reform for increased competition within the Statutory Health Insurance and its players as exemplified by the health fund. To sum up, it has to be said that the complexity and specific features of how the German system is financed seem to require ongoing reform considerations even after realization of the currently debated health-care reform law which, unfortunately, is dominated by political rationalities rather than objective thoughts.

  11. Exploring alternatives for financing health care in Ethiopia: An ...

    African Journals Online (AJOL)

    In addition, the newly adopted health care financing strategy was looked at from the perspective of policy analysis. Results: Health financing has been a major challenge for Ethiopia. The prospect of relying solely on public resources seems impractical and the absolute total expenditure on health is quite a small fraction of ...

  12. Financing and funding health care: Optimal policy and political implementability.

    Science.gov (United States)

    Nuscheler, Robert; Roeder, Kerstin

    2015-07-01

    Health care financing and funding are usually analyzed in isolation. This paper combines the corresponding strands of the literature and thereby advances our understanding of the important interaction between them. We investigate the impact of three modes of health care financing, namely, optimal income taxation, proportional income taxation, and insurance premiums, on optimal provider payment and on the political implementability of optimal policies under majority voting. Considering a standard multi-task agency framework we show that optimal health care policies will generally differ across financing regimes when the health authority has redistributive concerns. We show that health care financing also has a bearing on the political implementability of optimal health care policies. Our results demonstrate that an isolated analysis of (optimal) provider payment rests on very strong assumptions regarding both the financing of health care and the redistributive preferences of the health authority. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. [Health care reform, decentralization, prevention and control of vector-borne diseases].

    Science.gov (United States)

    Schmunis, G A; Dias, J C

    2000-01-01

    Economic policies are changing Latin American health programs, particularly promoting decentralization. Numerous difficulties thus arise for the control of endemic diseases, since such activities traditionally depend on vertical, and centralized structures. Theoretical arguments in favor of decentralization notwithstanding, no such tradition exists at the county level. The lack of program expertise at peripheral levels, intensive staff turnover, and even corruption are additional difficulties. Hence, the simple bureaucratic transfer of activities from the Federal to county level is often irresponsible. The loss of priority for control of endemic diseases in Latin America may mean the inexorable extinction of traditional control services. Malaria, dengue fever, and Chagas disease programs are examples of the loss of expertise and effectiveness in Latin America. A better strategy for responsible decentralization is required. In particular, a shared transition involving all governmental levels is desirable to effectively modernize programs. Maintenance of regional reference centers to ensure supervision, surveillance, and training is suggested.

  14. Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience?

    Science.gov (United States)

    Tediosi, Fabrizio; Gabriele, Stefania; Longo, Francesco

    2009-05-01

    In many European countries, since the World War II, there has been a trend towards decentralization of health policy to lower levels of governments, while more recently there have been re-centralization processes. Whether re-centralization will be the new paradigm of European health policy or not is difficult to say. In the Italian National Health Service (SSN) decentralization raised two related questions that might be interesting for the international debate on decentralization in health care: (a) what sort of regulatory framework and institutional balances are required to govern decentralization in health care in a heterogeneous country under tough budget constraints? (b) how can it be ensured that the most advanced parts of the country remain committed to solidarity, supporting the weakest ones? To address these questions this article describes the recent trends in SSN funding and expenditure, it reviews the strategy adopted by the Italian government for governing the decentralization process and discusses the findings to draw policy conclusions. The main lessons emerging from this experience are that: (1) when the differences in administrative and policy skills, in socio-economic standards and social capital are wide, decentralization may lead to undesirable divergent evolution paths; (2) even in decentralized systems, the role of the Central government can be very important to contain health expenditure; (3) a strong governance of the Central government may help and not hinder the enforcement of decentralization; and (4) supporting the weakest Regions and maintaining inter-regional solidarity is hard but possible. In Italy, despite an increasing role of the Central government in steering the SSN, the pattern of regional decentralization of health sector decision making does not seem at risk. Nevertheless, the Italian case confirms the complexity of decentralization and re-centralization processes that sometimes can be paradoxically reinforcing each other.

  15. Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council

    Science.gov (United States)

    Frumence, Gasto; Nyamhanga, Tumaini; Mwangu, Mughwira; Hurtig, Anna-Karin

    2013-01-01

    Background During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers’ accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process. PMID:23993021

  16. City School District Reorganization: An Annotated Bibliography. Centralization and Decentralization in the Government of Metropolitan Areas with Special Emphasis on the Organization, Administration, and Financing of Large-City School Systems. Educational Research Series No. 1.

    Science.gov (United States)

    Rideout, E. Brock; Najat, Sandra

    As a guide to educational administrators working in large cities, abstracts of 161 books, pamphlets, papers, and journal articles published between 1924 and 1966 are classified into five categories: (1) Centralization versus decentralization, (2) local government, (3) metropolitan organization, (4) the financing of education, and (5) the…

  17. Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan.

    Science.gov (United States)

    Kutzin, Joseph; Ibraimova, Ainura; Jakab, Melitta; O'Dougherty, Sheila

    2009-07-01

    Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low- and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues - the main source of public funding for health - from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.

  18. EVALUATION OF THE SUB-NATIONAL DECENTRALIZATION OF THE HEALTH IN VENEZUELA INFANTILE MATERNAL PROGRAM

    Directory of Open Access Journals (Sweden)

    Maritza Ávila Urdaneta

    2009-11-01

    Full Text Available The work approaches the evaluation of the decentralization of the health at sub-national level in Venezuela, maternal program Infantile (PROMIN, period 1998-2004: Case of study, Estado Zulia. With the samples of ten Municipalities and Coordinators of Health (CH. Of the results and conclusions, it is appraised that in Venezuela with the Model of Integral Attention with respect to the PROMIN (1998-2004, the reason of Maternal Mortality RMM average for the country ascends to 60 by 100,000 NVR (OPS, 2003, whereas in Zulia was in 79,9; they emphasize the Municipalities: Cañada de Urdaneta with but the high one of 214.13, followed of Mara 149.44 by 100,000 NVR. Key words: Sub-national decentralization of the Health, Infantile Maternal Program, Indicating of Morbidity and Mortality, Coordination of the Municipal Health.

  19. Guest Editorial: Health financing lessons from Thailand for South ...

    African Journals Online (AJOL)

    Guest Editorial: Health financing lessons from Thailand for South Africa on the path towards universal health coverage. Mark Blecher, Anban Pillay, Walaiporn Patcharanarumol, Warisa Panichkriangkrai, Viroj Tangcharoensathien, Yot Teerawattananon, Supasit Pannarunothai, Jonatan Davén ...

  20. Equity in Irish health care financing: measurement issues.

    Science.gov (United States)

    Smith, Samantha

    2010-04-01

    This paper employs widely used analytic techniques for measuring equity in health care financing to update Irish results from previous analysis based on data from the late 1980s. Kakwani indices are calculated using household survey data from 1987/88 to 2004/05. Results indicate a marginally progressive financing system overall. However, interpretation of the results for the private sources of health financing is complicated. This problem is not unique to Ireland but it is argued that it may be relatively more important in the context of a complex health financing system, illustrated in this paper by the Irish system. Alternative options for improving the analysis of equity in health care financing are discussed.

  1. How federalism shapes public health financing, policy, and program options.

    Science.gov (United States)

    Ogden, Lydia L

    2012-01-01

    In the United States, fiscal and functional federalism strongly shape public health policy and programs. Federalism has implications for public health practice: it molds financing and disbursement options, including funding formulas, which affect allocations and program goals, and shapes how funding decisions are operationalized in a political context. This article explores how American federalism, both fiscal and functional, structures public health funding, policy, and program options, investigating the effects of intergovernmental transfers on public health finance and programs.

  2. U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization? Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis".

    Science.gov (United States)

    Bustamante, Arturo Vargas

    2016-06-07

    For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. © 2016 by Kerman University of Medical Sciences.

  3. Public funding of health at the district level in Indonesia after decentralization-sources, flows and contradictions.

    Science.gov (United States)

    Heywood, Peter; Harahap, Nida P

    2009-04-16

    During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. In contrast to the promise of decentralization there has been

  4. Innovative financing for health: what is truly innovative?

    Science.gov (United States)

    Atun, Rifat; Knaul, Felicia Marie; Akachi, Yoko; Frenk, Julio

    2012-12-08

    Development assistance for health has increased every year between 2000 and 2010, particularly for HIV/AIDS, tuberculosis, and malaria, to reach US$26·66 billion in 2010. The continued global economic crisis means that increased external financing from traditional donors is unlikely in the near term. Hence, new funding has to be sought from innovative financing sources to sustain the gains made in global health, to achieve the health Millennium Development Goals, and to address the emerging burden from non-communicable diseases. We use the value chain approach to conceptualise innovative financing. With this framework, we identify three integrated innovative financing mechanisms-GAVI, Global Fund, and UNITAID-that have reached a global scale. These three financing mechanisms have innovated along each step of the innovative finance value chain-namely resource mobilisation, pooling, channelling, resource allocation, and implementation-and integrated these steps to channel large amounts of funding rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. However, resources mobilised from international innovative financing sources are relatively modest compared with donor assistance from traditional sources. Instead, the real innovation has been establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and channel financial resources to low-income and middle-income countries and to create incentives to improve implementation and performance of national programmes. These mechanisms provide platforms for health funding in the future, especially as efforts to grow innovative financing have faltered. The lessons learnt from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low-income and middle

  5. Principles of Child Health Care Financing.

    Science.gov (United States)

    Hudak, Mark L; Helm, Mark E; White, Patience H

    2017-09-01

    health financing outlined in this statement. Espousing the core principle to do no harm, the AAP believes that the United States must not sacrifice any of the hard-won gains for our children. Medicaid, as the largest single payer of health care for children and young adults, should remain true to its origins as an entitlement program; in other words, future fiscal or regulatory reforms of Medicaid should not reduce the eligibility and scope of benefits for children and young adults below current levels nor jeopardize children's access to care. Proposed Medicaid funding "reforms" (eg, institution of block grant, capped allotment, or per-capita capitation payments to states) will achieve their goal of securing cost savings but will inevitably compel states to reduce enrollee eligibility, trim existing benefits (such as Early and Periodic Screening, Diagnostic, and Treatment), and/or compromise children's access to necessary and timely care through cuts in payments to providers and delivery systems. In fact, the AAP advocates for increased Medicaid funding to improve access to essential care for existing enrollees, fund care for eligible but uninsured children once they enroll, and accommodate enrollment growth that will occur in states that choose to expand Medicaid eligibility. The AAP also calls for Congress to extend funding for the Children's Health Insurance Program, a plan vital to the 8.9 million children it covered in fiscal year 2016, for a minimum of 5 years. Copyright © 2017 by the American Academy of Pediatrics.

  6. Minding the gaps: health financing, universal health coverage and gender.

    Science.gov (United States)

    Witter, Sophie; Govender, Veloshnee; Ravindran, T K Sundari; Yates, Robert

    2017-12-01

    In a webinar in 2015 on health financing and gender, the question was raised why we need to focus on gender, given that a well-functioning system moving towards Universal Health Coverage (UHC) will automatically be equitable and gender balanced. This article provides a reflection on this question from a panel of health financing and gender experts.We trace the evidence of how health-financing reforms have impacted gender and health access through a general literature review and a more detailed case-study of India. We find that unless explicit attention is paid to gender and its intersectionality with other social stratifications, through explicit protection and careful linking of benefits to needs of target populations (e.g. poor women, unemployed men, female-headed households), movement towards UHC can fail to achieve gender balance or improve equity, and may even exacerbate gender inequity. Political trade-offs are made on the road to UHC and the needs of less powerful groups, which can include women and children, are not necessarily given priority.We identify the need for closer collaboration between health economists and gender experts, and highlight a number of research gaps in this field which should be addressed. While some aspects of cost sharing and some analysis of expenditure on maternal and child health have been analysed from a gender perspective, there is a much richer set of research questions to be explored to guide policy making. Given the political nature of UHC decisions, political economy as well as technical research should be prioritized.We conclude that countries should adopt an equitable approach towards achieving UHC and, therefore, prioritize high-need groups and those requiring additional financial protection, in particular women and children. This constitutes the 'progressive universalism' advocated for by the 2013 Lancet Commission on Investing in Health. © The Author 2017. Published by Oxford University Press in association with The

  7. The logic of tax-based financing for health care.

    Science.gov (United States)

    Bodenheimer, T; Sullivan, K

    1997-01-01

    Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

  8. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  9. Organization And Financing Models Of Health Service In Selected Countries

    Directory of Open Access Journals (Sweden)

    Branimir Marković

    2009-07-01

    Full Text Available The introductory part of the work gives a short theoretical presentation regarding possible financing models of health services in the world. In the applicative part of the work we shall present the basic practical models of financing health services in the countries that are the leaders of classic methods of health services financing, e. g. the USA, Great Britain, Germany and Croatia. Working out the applicative part of the work we gave the greatest significance to analysis of some macroeconomic indicators in health services (tendency of total health consumption in relation to GDP, average consumption per insured person etc., to structure analysis of health insurance and just to the scheme of health service organization and financing. We presume that each model of health service financing contains certain limitations that can cause problem (weak organization, increase of expenses etc.. This is the reason why we, in the applicative part of the work, paid a special attention to analysis of financial difficulties in the health sector and pointed to the needs and possibilities of solving them through possible reform measures. The end part of the work aims to point out to advantages and disadvantages of individual financing sources through the comparison method (budgetary – taxes or social health insurance – contributions.

  10. Urgency of Capacity Building in Local Finance Management on Decentralization Era (The Dynamic of Parking Taxes Management at Banguntapan District, Bantul Region DI Yogyakarta Province

    Directory of Open Access Journals (Sweden)

    Bambang Sunaryo

    2014-12-01

    Full Text Available Capacity building of local finance management becomes important on decentralizations era. Empirically this research is aim to show that the parking tax management at glance seen as an administrative- procedural policy domain cannot release from phenomena on the existence of problematic pathology for regional financial management. District of Bantul Banguntapan characteristic as its suburbs form the main attraction in the selection of research because of the general locus in sub-urban area, began to metamorphose into a parking tax revenues from regions that contribute to the area though not as big financial contribution income tax parking tax in urban areas. The Banguntapan sub district was chosen as analysis unit in this research to represent the issue of parking tax management in sub urban area of Bantul. This was due to the characteristic of Bantul area as sub urban area that can be seen from the characteristics of sub urban in Banguntapan sub district. Moreover, the Banguntapan sub district is the only area in Bantul which has a parking tax subject that the cost is self-assessment and flat thus the dynamic of local finance managing problems can be observed and in-depth analysed in Banguntapan sub district to seek the comparison of those 2 parking tax collection systems.

  11. Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan.

    OpenAIRE

    Green, A.; Ali, B.; Naeem, A.; Ross, D.

    2000-01-01

    This paper identifies key political and technical issues involved in the development of an appropriate resource allocation and budgetary system for the public health sector, using experience gained in the Province of Balochistan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current systems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical...

  12. Health Financing, Equity and Poverty in Latin America | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Health financing has been a key entry point of reform initiatives in Chile, ... Call for proposals: Innovations for the economic inclusion of marginalized youth ... Findings from an IDRC-supported program figure prominently at the annual ...

  13. Sources of project financing in health care systems.

    Science.gov (United States)

    Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

    2000-01-01

    Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

  14. Health system performance at the district level in Indonesia after decentralization

    Directory of Open Access Journals (Sweden)

    Choi Yoonjoung

    2010-03-01

    Full Text Available Abstract Background Assessments over the last two decades have showed an overall low level of performance of the health system in Indonesia with wide variation between districts. The reasons advanced for these low levels of performance include the low level of public funding for health and the lack of discretion for health system managers at the district level. When, in 2001, Indonesia implemented a radical decentralization and significantly increased the central transfer of funds to district governments it was widely expected that the performance of the health system would improve. This paper assesses the extent to which the performance of the health system has improved since decentralization. Methods We measured a set of indicators relevant to assessing changes in performance of the health system between two surveys in three areas: utilization of maternal antenatal and delivery care; immunization coverage; and contraceptive source and use. We also measured respondents' demographic characteristics and their living circumstances. These measurements were made in population-based surveys in 10 districts in 2002-03 and repeated in 2007 in the same 10 districts using the same instruments and sampling methods. Results The dominant providers of maternal and child health in these 10 districts are in the private sector. There was a significant decrease in birth deliveries at home, and a corresponding increase in deliveries in health facilities in 5 of the 10 districts, largely due to increased use of private facilities with little change in the already low use of public facilities. Overall, there was no improvement in vaccination of mothers and their children. Of those using modern contraceptive methods, the majority obtained them from the private sector in all districts. Conclusions There has been little improvement in the performance of the health system since decentralization occurred in 2001 even though there have also been significant increases in

  15. Decentralized health care priority-setting in Tanzania

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San

    2010-01-01

    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...... care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents...... no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did...

  16. Finance

    OpenAIRE

    2013-01-01

    Voici la 17e édition du Rapport moral sur l’argent dans le monde, publié chaque année depuis 1994 par l’Association d’économie financière avec le soutien de la Caisse des Dépôts. Abordant une nouvelle fois les grands débats qui traversent actuellement le monde de la finance, il se consacre dans un premier temps à la lutte contre la criminalité et les délits financiers, et plus particulièrement à la lutte contre la corruption, la délinquance dans la finance et la fraude fiscale. Dans un second...

  17. Synthetic real estate: bringing corporate finance to health care.

    Science.gov (United States)

    Varwig, D; Smith, J

    1998-01-01

    The changing landscape of health care has caused hospitals, health care systems, and other health care organizations to look for ways to finance expansions and acquisitions without "tainting" their balance sheets. This search has led health care executives to a financing technique that has been already embraced by Fortune 500 companies for most of this decade and more recently adopted by high-tech companies: synthetic real estate. Select case studies provide examples of the more creative financial structures currently being employed to meet rapidly growing and increasingly complex funding needs.

  18. Finance

    OpenAIRE

    2011-01-01

    Ces deux ouvrages tirent les enseignements de l’impact de la crise de la finance mondiale sur l’économie réelle et se focalisent, dans ce contexte, sur le financement du Mittelstand. Le banquier JASCHINSKI, lorsqu’il passe en revue le système bancaire allemand, constate ainsi que si les moyennes entreprises trouvent les crédits nécessaires auprès de leurs solides partenaires de toujours que sont les Sparkassen, les grandes sociétés, internationales, que compte le Mittelstand n’ont pas de part...

  19. Assessing income redistributive effect of health financing in Zambia.

    Science.gov (United States)

    Mulenga, Arnold; Ataguba, John Ele-Ojo

    2017-09-01

    Ensuring an equitable health financing system is a major concern particularly in many developing countries. Internationally, there is a strong debate to move away from excessive reliance on direct out-of-pocket (OOP) spending towards a system that incorporates a greater element of risk pooling and thus affords greater protection for the poor. This is a major focus of the move towards universal health coverage (UHC). Currently, Zambia with high levels of poverty and income inequality is implementing health sector reforms for UHC through a social health insurance scheme. However, the way to identify the health financing mechanisms that are best suited to achieving this goal is to conduct empirical analysis and consider international evidence on funding universal health systems. This study assesses, for the first time, the progressivity of health financing and how it impacts on income inequality in Zambia. Three broad health financing mechanisms (general tax, a health levy and OOP spending) were considered. Data come from the 2010 nationally representative Zambian Living Conditions and Monitoring Survey with a sample size of 19,397 households. Applying standard methodologies, the findings show that total health financing in Zambia is progressive. It also leads to a statistically significant reduction in income inequality (i.e. a pro-poor redistributive effect estimated at 0.0110 (p taxes (0.0101 (p taxes. This points to areas where government policy may focus in attempting to reduce the high level of income inequality and to improve equity in health financing towards UHC in Zambia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Science.gov (United States)

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  1. The health financing transition: a conceptual framework and empirical evidence.

    Science.gov (United States)

    Fan, Victoria Y; Savedoff, William D

    2014-03-01

    Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 per cent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Analysis of health promotion and prevention financing mechanisms in Thailand.

    Science.gov (United States)

    Watabe, Akihito; Wongwatanakul, Weranuch; Thamarangsi, Thaksaphon; Prakongsai, Phusit; Yuasa, Motoyuki

    2017-08-01

    In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand's financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, and semi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0-9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand's health financing system for promotion and prevention is strategic and innovative due to the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC. © The Author 2016. Published by Oxford University Press.

  3. [Mental health financing in Chile: a pending debt].

    Science.gov (United States)

    Errázuriz, Paula; Valdés, Camila; Vöhringer, Paul A; Calvo, Esteban

    2015-09-01

    In spite of the high prevalence of mental health disorders in Chile, there is a significant financing deficit in this area when compared to the world's average. The financing for mental health has not increased in accordance with the objectives proposed in the 2000 Chilean National Mental Health and Psychiatry Plan, and only three of the six mental health priorities proposed by this plan have secure financial coverage. The National Health Strategy for the Fulfilment of Health Objectives for the decade 2011-2020 acknowledges that mental disorders worsen the quality of life, increase the risk of physical illness, and have a substantial economic cost for the country. Thus, this article focuses on the importance of investing in mental health, the cost of not doing so, and the need for local mental health research. The article discusses how the United States is trying to eliminate the financial discrimination suffered by patients with mental health disorders, and concludes with public policy recommendations for Chile.

  4. Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India.

    Science.gov (United States)

    Panda, Bhuputra; Thakur, Harshad P

    2016-10-31

    One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations

  5. Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

    Directory of Open Access Journals (Sweden)

    Bhuputra Panda

    2016-10-01

    Full Text Available Abstract Introduction One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc. through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results Evaluation of local decision making and its effect on health system performance has been

  6. Is health care financing in Uganda equitable? | Zikusooka | African ...

    African Journals Online (AJOL)

    Results: Uganda's health sector remains significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending. At 9.6 % of total government expenditure, public spending on health is far below the Abuja target of 15% that GoU committed to. Prepayments form a small proportion of ...

  7. Financing Reproductive and Child Health Services at the Local ...

    African Journals Online (AJOL)

    government became the main funding source for RH services (44.2%), partly reflecting government enhanced commitment to increase resources for maternal and child health, and due to exemption of pregnant women from paying for health care. Nevertheless, this commitment didn't last and the financing burden was borne ...

  8. Finance

    OpenAIRE

    Spremann, Klaus

    2007-01-01

    Bisher veröffentlicht unter dem Titel: "Modern Finance" Das Buch beinhaltet ebenso einige Portraits: Die didaktische Erfahrung lehrt, dass man sich wissenschaftliche Ergebnisse und Ansätze besser merken kann, wenn eine Assoziation zu jener Person bildlich konkret wird, der wir den betreffenden Denkansatz verdanken. Aus Fragen der Finanzierung und der Investitionsentscheidungen von Unternehmen ist in der Verschmelzung mit der Analyse von Kapitalmärkten ein grosses Gebiet entstanden, da...

  9. The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

    Science.gov (United States)

    Lega, Federico; Sargiacomo, Massimo; Ianni, Luca

    2010-11-01

    In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought - specifically on how governmentality and federalism should meet - to reshape the debate on decentralization in health care.

  10. Health financing revisited: a practitioner's guide

    National Research Council Canada - National Science Library

    Gottret, Pablo Enrique; Schieber, George J

    2006-01-01

    ... Population pyramids and global health expenditures by region and income group 39 vvi Contents 2 Collecting revenue, pooling risk, and purchasing services 45 Health financing functions: definitions...

  11. HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

    Science.gov (United States)

    Mutemwa, Richard I

    2006-01-01

    At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point

  12. Finance

    OpenAIRE

    2013-01-01

    Régulièrement au cœur de l'actualité, les trois agences de notation (Standard & Poor's, Moody's et Fitch) règnent sur le monde de la finance internationale. Mais quelles sont-elles et à qui appartiennent-elles véritablement ? Détenues par de puissants fonds d'investissements, elles ont progressivement renforcé leurs rôles et pouvoirs. L'auteur interpelle le citoyen sur un système dans lequel les fonds d'investissements profitent des agences de notation (et de leur rôle de « gardien des marché...

  13. Finance

    OpenAIRE

    2008-01-01

    Les investisseurs financiers et a fortiori les hedge fonds sont accusés de tous les maux. Ces « sauterelles » tomberaient sur les entreprises allemandes pour s’enrichir en les dépeçant. Un journaliste économique du quotidien des affaires Frankfurter Allgemeine Zeitung publie là un portrait objectif et factuel de ces « nouvelles stars » de la finance mondiale. Un portrait de branche, doublé d’une analyse de l’impact sur le « capitalisme rhénan » de la montée en puissance de ces nouveaux acteur...

  14. Policies to Spur Energy Access. Executive Summary; Volume 1, Engaging the Private Sector in Expanding Access to Electricity; Volume 2, Case Studies to Public-Private Models to Finance Decentralized Electricity Access

    Energy Technology Data Exchange (ETDEWEB)

    Walters, Terri [National Renewable Energy Lab. (NREL), Golden, CO (United States); Rai, Neha [International Institute for Environment and Development (IIED), London (England); Esterly, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cox, Sadie [National Renewable Energy Lab. (NREL), Golden, CO (United States); Reber, Tim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Muzammil, Maliha [Univ. of Oxford (United Kingdom); Mahmood, Tasfiq [International Center for Climate Change and Development, Baridhara (Bangladesh); Kaur, Nanki [International Institute for Environment and Development (IIED), London (England); Tesfaye, Lidya [Echnoserve Consulting (Ethiopia); Mamuye, Simret [Echnoserve Consulting (Ethiopia); Knuckles, James [Univ. of London (England). Cass Business School; Morris, Ellen [Columbia Univ., New York, NY (United States); de Been, Merijn [Delft Univ. of Technology (Netherlands); Steinbach, Dave [International Institute for Environment and Development (IIED), London (England); Acharya, Sunil [Digo Bikas Inst. (Nepal); Chhetri, Raju Pandit [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bhushal, Ramesh [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    Government policy is one of the most important factors in engaging the private sector in providing universal access to electricity. In particular, the private sector is well positioned to provide decentralized electricity products and services. While policy uncertainty and regulatory barriers can keep enterprises and investors from engaging in the market, targeted policies can create opportunities to leverage private investment and skills to expand electricity access. However, creating a sustainable market requires policies beyond traditional electricity regulation. The report reviews the range of policy issues that impact the development and expansion of a market for decentralized electricity services from establishing an enabling policy environment to catalyzing finance, building human capacity, and integrating energy access with development programs. The case studies in this report show that robust policy frameworks--addressing a wide range of market issues--can lead to rapid transformation in energy access. The report highlights examples of these policies in action Bangladesh, Ethiopia, Mali, Mexico, and Nepal.

  15. Public support for social financing of health care in Switzerland.

    Science.gov (United States)

    Perneger, Thomas V; Hudelson, Patricia M

    2005-01-01

    The purpose of this study was to identify factors associated with the public's preference for financing health care according to people's ability to pay. The authors compared voters' support in 26 Swiss cantons for a legislative proposal to replace regionally rated health insurance premiums (current system) with premiums proportional to income and wealth, and co-financed through the value added tax. The vote took place in May 2003, and the initiative was rejected, with only 27 percent of support nationwide. However, support varied more than threefold, from 13 to 44 percent, among cantons. In multivariate analysis, support was most strongly correlated with the approval rate of the 1994 law on health insurance, which strengthened solidarity between the sick and the healthy. More modest associations were seen between support for the initiative and the health insurance premium of 2003, and proportions of elderly and urban residents in the population. Hence support for more social financing of health care was best explained by past preference for a social health insurance system in the local community.

  16. Health care financing in Malaysia: A way forward

    Directory of Open Access Journals (Sweden)

    Ashutosh Kumar Verma

    2015-01-01

    Full Text Available Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO. SOCSO and Employee Provident Fund provide some coverage to private-sector employees. There are several challenges in pure Bismarckian model (private insurance etc. like smaller portion of total population will be "economically active," international competition to attract firms, and maintain/increase employment will put downward pressure on labor taxes. How to sustain universal coverage in this context? In a population setting where unemployment is high informal sector, payroll taxes will not be a major source of funds. However, it is possible to create a universal health financing system by transforming the role of budget funding from directly subsidizing provision to subsidizing the purchase of services on behalf of the entire population. The integration of services between the public and private sector is very much needed, at a cost the people can afford. At present, there is no national health insurance scheme in place. Although there are many models proposed, the main question that the policymakers need to be aware of is that of the equity of access to holistic health services for all Malaysians.

  17. The cost conundrum: financing the business of health care insurance.

    Science.gov (United States)

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  18. Alternative mechanisms of state public health institutions financing in Ukraine

    Directory of Open Access Journals (Sweden)

    Hural, Anastasiya

    2011-05-01

    Full Text Available BACKGROUND. The main source of state public health institutions financing in Ukraine is budgetary funding. In order to overcome the underfunding, the idea of multichannel health financing was proposed in the late 1990s. The main forms of extrabudgetary financial support of public health institutions in Ukraine are voluntary health insurance, non-profit self-financing, charity and sponsorship. The study aims to deeper understand the nature of alternative financing mechanisms of state public health institutions in Ukraine and peculiarities of their use in practice.METHODS. The proposed study is exploratory. Case-study was selected as research method. Nine unstructured interviews were conducted in six health care facilities that have agreed to participate in the study. All studied facilities were in-patient.RESULTS. The sources of financial revenues of the studied institutions were as follows: reimbursement for treatment of insured patients, reimbursement for treatment of sickness funds members, payments for services (medical examinations, counseling, transportation to the hospital, rental of premises, payment for internship from the students of paid forms of medical education, charitable contributions, contracts with companies, contracts with private clinics based in public institutions’ premises (limited liability companies, private entrepreneurs, sponsorship, grants, gifts, payments for services for foreigners, and in-kind revenues. Major health facilities expenditures were the following: salaries (not covered from extrabudgetary revenues; ranged from 70% to 92% of the funds provided to the institutions from state (municipal, regional budget, energy carriers (partially covered from extrabudgetary funds, patients nutrition, medicines, materials, household expenditures, reparation of premises, and purchase of equipment (mostly covered from extrabudgetary revenues. In the studied cases, funds raised by alternative funding mechanisms amounted from

  19. Health financing for universal coverage and health system performance: concepts and implications for policy.

    Science.gov (United States)

    Kutzin, Joseph

    2013-08-01

    Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

  20. Institutional arrangements for decentralized water and health services delivery in rural Tanzania: differences and constraints

    NARCIS (Netherlands)

    Masanyiwa, Z.S.; Niehof, A.; Termeer, C.J.A.M.

    2013-01-01

    In recent years, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving public services although opinion is divided on the link between decentralization and service delivery. This article reviews recent literature and research

  1. PROMISING FINANCING SCHEME OF HEALTH INSURANCE IN UKRAINE

    Directory of Open Access Journals (Sweden)

    Martha Slavitych

    2016-11-01

    Full Text Available The promising financing scheme of health insurance in Ukraine should be found at the present stage of its development. The health care system in Ukraine is cumbersome and outdated. It is based on the Semashko model with rigid management and financing procedures. The disadvantages accumulated in the national health care system due to lack of modernization, disregard of the population needs, non-use of modern global trends, the inefficient operation of the system and the high level of corruption cause the underlying situation. The decision of new government policy in the sector is introduction of new financial mechanisms, in order to ensure human rights in the health sector. Methodology. The study is based on a comparison of systems of financing of medicine in Ukraine and in other countries, provided advantages and disadvantages of each model. Results showed that the availability of medical services is the key problem in any society. The availability of health care services is primarily determined by the proportion of services guaranteed by the government (government guarantees. In some countries such as the United States, practically the whole medicine is funded by voluntary health insurance (VHI. In Europe the mandatory health insurance (MHI and government funding are the most significant source of funds. Practical importance. The improvement of the demographic situation, the preservation and improvement of public health, improvement of social equity and citizens' rights in respect of medical insurance. Value/originality. Premiums for health insurance are the source of funding. Based on the new model requirements it is necessary to create an appropriate regulation, which would determine its organizational and regulatory framework. This process is primarily determined by identification and setting rules governing the relationship between patients, health care providers and insurers, creation of the conditions and the implementation of quality

  2. Financing reform and structural change in the health services industry.

    Science.gov (United States)

    Higgins, C W; Phillips, B U

    1986-08-01

    This paper reviews the major trends in financing reform, emphasizing their impact on those characteristics of the market for health services that economists have viewed as monopolistic, and discusses the implications of structural change for the allied health professions. Hopefully, by understanding the fundamental forces of change and responding to uncertainty with flexibility and imagination, the allied health professions can capitalize on the opportunities afforded by structural change. Overall, these trends should result in the long-term outlook for use of allied health services to increase at an average annual rate of 9% to 10%. Allied health professionals may also witness an increase in independent practice opportunities. Finally, redistribution of jobs will likely occur in favor of outpatient facilities, home health agencies, and nontraditional settings. This in turn will have an impact on allied health education, which will need to adapt to these types of reforms.

  3. The political economy of decentralization of health and social services in Canada.

    Science.gov (United States)

    Tsalikis, G

    1989-01-01

    A trend to decentralization in Canada's 'welfare state' has received support from the Left and from the Right. Some social critics of the Left expect decentralization to result in holistic services adjusted to local needs. Others, moreover, feel we are in the dawn of a new epoch in which major economic transformations are to bring about, through new class alliances and conflict, decentralization of power and a better quality of life in communities. These assumptions and their theoretical pitfalls are discussed here following an historical overview of the centralization/decentralization issue in Canadian social policy. It is argued that recent proposals of decentralization are a continuation of reactionary tendencies to constrain social expenditures, but not a path to better quality of life.

  4. Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

    Science.gov (United States)

    Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

    2016-03-01

    In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in

  5. Insurance Accounts: The Cultural Logics of Health Care Financing.

    Science.gov (United States)

    Mulligan, Jessica

    2016-03-01

    The financial exuberance that eventually culminated in the recent world economic crisis also ushered in dramatic shifts in how health care is financed, administered, and imagined. Drawing on research conducted in the mid-2000s at a health insurance company in Puerto Rico, this article shows how health care has been financialized in many ways that include: (1) privatizing public services; (2) engineering new insurance products like high deductible plans and health savings accounts; (3) applying financial techniques to premium payments to yield maximum profitability; (4) a managerial focus on shareholder value; and (5) prioritizing mergers and financial speculation. The article argues that financial techniques obfuscate how much health care costs, foster widespread gaming of reimbursement systems that drives up prices, and "unpool" risk by devolving financial and moral responsibility for health care onto individual consumers. © 2015 by the American Anthropological Association.

  6. U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”

    Directory of Open Access Journals (Sweden)

    Arturo Vargas Bustamante

    2016-09-01

    Full Text Available For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.

  7. Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

    Science.gov (United States)

    Talib, Zohray; van Schalkwyk, Susan; Couper, Ian; Pattanaik, Swaha; Turay, Khadija; Sagay, Atiene S; Baingana, Rhona; Baird, Sarah; Gaede, Bernhard; Iputo, Jehu; Kibore, Minnie; Manongi, Rachel; Matsika, Antony; Mogodi, Mpho; Ramucesse, Jeremais; Ross, Heather; Simuyeba, Moses; Haile-Mariam, Damen

    2017-12-01

    African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

  8. Improving equity in health care financing in China during the progression towards Universal Health Coverage.

    Science.gov (United States)

    Chen, Mingsheng; Palmer, Andrew J; Si, Lei

    2017-12-29

    China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. The overall Kakwani index (KI) of China's health care financing system is 0.0444. For general tax KI was -0.0241 (95% confidence interval (CI): -0.0315 to -0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident's Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), -0.1737 (95% CI: -0.2166 to -0.1308), and -0.5598 (95% CI: -0.5830 to -0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China's health care finance system. China's health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China's progression towards UHC.

  9. Decentralized Wastewater Management Solutions for Improved Public Health Protection and Reclamation: Optimization and Application

    OpenAIRE

    Naik, Kartiki Shirish

    2014-01-01

    Centralized wastewater treatment, widely practiced in developed areas, involves transporting wastewater from large urban or industrial areas to a large capacity plant using a single network of sewers. Alternatively, the concept of wastewater collection, treatment and reuse at or near its point of generation is called decentralized wastewater treatment. Smaller decentralized plants with energy-efficient reclaimed water pumping, modularization of expansion and minimum capital investment can mee...

  10. Organization and Finance of China’s Health Sector

    Directory of Open Access Journals (Sweden)

    Hui Li PhD

    2016-01-01

    Full Text Available China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP. Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of

  11. The coming changes in tax-exempt health care finance.

    Science.gov (United States)

    Carlile, L L; Serchuk, B M

    1995-01-01

    On December 30, 1994, the Internal Revenue Service (IRS) published proposed regulations (Proposed Regulations) that if enacted would significantly change the climate and rules of federal income tax law controlling the issuance and maintenance of tax-exempt bonds for governmental and 501(c)(3) health care borrowers. This article (1) summarizes the aspects of the Proposed Regulations dealing with private activity tests, management contracts, allocation and accounting rules, change in use of financed facilities, and antiabuse rules, and (2) summarizes the possible interrelationship of the IRS's audit program for tax-exempt bonds and the Proposed Regulations. The article reviews features of the Proposed Regulations that will affect either the costs or administrative burdens of managing the federal tax compliance of future tax-exempt health care borrowings.

  12. Call for a Spatial Classification of Banking Systems through the Lens of SME Finance - Decentralized versus Centralized Banking in Germany as an Example

    OpenAIRE

    Gärtner, Stefan; Flögel, Franz

    2014-01-01

    We are calling for comparisons of banking and banking systems from a spatial perspective. Therefore, this paper develops a classification identifying decentralized and centralized banking according to two characteristics: geographical market orientation (regional vs. supraregional) – to determine whether banks facilitate regional savings-investment cycles – and place of decision-making (proximity vs. distance) – to identify whether the flow of soft information is supported in SME lending. The...

  13. Decision Space and Capacities in the Decentralization of Health Services in FijiComment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis".

    Science.gov (United States)

    Bossert, Thomas J

    2016-05-08

    The study of decentralization in Fiji shows that increasing capacities is not necessarily related to increasing decision space of local officials, which is in contrast with earlier studies in Pakistan. Future studies should address the relationship among decision space, capacities, and health system performance. © 2016 by Kerman University of Medical Sciences.

  14. Public health services and systems research: current state of finance research.

    Science.gov (United States)

    Ingram, Richard C; Bernet, Patrick M; Costich, Julia F

    2012-11-01

    There is a growing recognition that the US public health system should strive for efficiency-that it should determine the optimal ways to utilize limited resources to improve and protect public health. The field of public health finance research is a critical part of efforts to understand the most efficient ways to use resources. This article discusses the current state of public health finance research through a review of public health finance literature, chronicles important lessons learned from public health finance research to date, discusses the challenges faced by those seeking to conduct financial research on the public health system, and discusses the role of public health finance research in relation to the broader endeavor of Public Health Services and Systems Research.

  15. Health financing: Who pays for equitable health systems? | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2012-10-24

    Oct 24, 2012 ... Countries rich and poor face difficult choices in funding quality health care for ... while 31 member states of the World Health Organization pay less than ... on how poor families are benefiting from services – or being excluded.

  16. MACROECONOMIC IMPACT OF DECENTRALIZATION

    Directory of Open Access Journals (Sweden)

    Emilia Cornelia STOICA

    2014-05-01

    Full Text Available The concept of decentralization has a variety of expressions, but the meaning generally accepted refers to the transfer of authority and responsibility of the public functions from central government to sub-national public entities or even to the private sector. Decentralization process is complex, affecting many aspects of social and economic life and public management, and its design and implementation cover several stages, depending on the cyclical and structural developments of the country. From an economic perspective, decentralization is seen as a means of primary importance in terms of improving the effectiveness and efficiency of public services and macroeconomic stability due to the redistribution of public finances while in a much closer logic of the government policy objectives. But the decentralization process behaves as well some risks, because it involves the implementation of appropriate mechanisms for the establishment of income and expenditure programming at the subnational level, which, if is not correlated with macroeconomic policy imperatives can lead to major imbalances, both financially as in termes of economic and social life. Equally, ensuring the balance of the budget at the local level is imperative to fulfill, this goal imposing a legal framework and specific procedures to size transfers of public funds, targeted or untargeted. Also, public and local authorities have to adopt appropriate laws and regulations such that sub-national public entities can access loans - such as bank loans or debentures from domestic or external market - in terms of a strict monitoring national financial stability. In all aspects of decentralization - political, administrative, financial -, public authorities should develop and implement the most effective mechanisms to coordinate macroeconomic objectives and both sectoral and local interests and establish clear responsibilities - exclusive or shared - for all parties involved in the

  17. From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

    Science.gov (United States)

    Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John G

    2017-01-01

    Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group. PMID:29177101

  18. From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

    Science.gov (United States)

    Till, Brian M; Peters, Alexander W; Afshar, Salim; Meara, John

    2017-01-01

    Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

  19. Human Rights and the Political Economy of Universal Health Care: Designing Equitable Financing.

    Science.gov (United States)

    Rudiger, Anja

    2016-12-01

    Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good.

  20. National Health Accounts: A Framework For Understanding Health Care Financing.

    Science.gov (United States)

    Waldo, Daniel

    2018-03-01

    Over the course of the past century, the challenges facing the United States in its consumption of health care goods and services have not changed very much. What is being consumed, who is paying for it, and how much is affordable are questions that arise in every cycle of the debate-if they ever go dormant. National Health Accounts are one tool to use in the search for answers to these questions and to the challenges behind the questions. The accounts cannot (and do not pretend to) address every aspect of the debate, but they provide an important context. In this article I briefly review the history of the health accounts and discuss their strengths and weaknesses in the context of the present debate over spending.

  1. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

    OpenAIRE

    Hamidi, Samer

    2015-01-01

    Samer Hamidi School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates Introduction: A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Duba...

  2. Health financing in Africa: overview of a dialogue among high level policy makers.

    Science.gov (United States)

    Sambo, Luis Gomes; Kirigia, Joses Muthuri; Ki-Zerbo, Georges

    2011-06-13

    Even though Africa has the highest disease burden compared with other regions, it has the lowest per capita spending on health. In 2007, 27 (51%) out the 53 countries spent less than US$50 per person on health. Almost 30% of the total health expenditure came from governments, 50% from private sources (of which 71% was from out-of-pocket payments by households) and 20% from donors. The purpose of this article is to reflect on the proceedings of the African Union Side Event on Health Financing in the African continent. Methods employed in the session included presentations, panel discussion and open public discussion with ministers of health and finance from the African continent. The current unsatisfactory state of health financing was attributed to lack of clear vision and plan for health financing; lack of national health accounts and other evidence to guide development and implementation of national health financing policies and strategies; low investments in sectors that address social determinants of health; predominance of out-of-pocket spending; underdeveloped prepaid health financing mechanisms; large informal sectors vis-à-vis small formal sectors; and unpredictability and non-alignment of majority of donor funds with national health priorities.Countries need to develop and adopt a comprehensive national health policy and a costed strategic plan; a comprehensive evidence-based health financing strategy; allocate at least 15% of the national budget to health development; use GFATM and PEPFAR funds for health systems strengthening; strengthen intersectoral collaboration to address health determinants; advocate among donors to implement the Paris Declaration on Aid Effectiveness and its Accra Agenda for Action; ensure universal access to health services for pregnant women, lactating mothers and children aged under five years; strengthen financial management capacities; and develop prepaid health financing systems, especially health insurance to complement tax

  3. Health status and health systems financing in the MENA region: roadmap to universal health coverage.

    Science.gov (United States)

    Asbu, Eyob Zere; Masri, Maysoun Dimachkie; Kaissi, Amer

    2017-01-01

    Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage. Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages. Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care. The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP

  4. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Directory of Open Access Journals (Sweden)

    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.  Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a

  5. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Directory of Open Access Journals (Sweden)

    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.   Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.  Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care.  Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore

  6. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Science.gov (United States)

    Myklebust, Lars Henrik; Olstad, Reidun; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf; Sørgaard, Knut

    2011-01-01

    Background The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims To study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. Method The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion Inpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative

  7. New insights into health financing: First results of the international data collection under the System of Health Accounts 2011 framework.

    Science.gov (United States)

    Mueller, Michael; Morgan, David

    2017-07-01

    International comparisons of health spending and financing are most frequently carried out using datasets of international organisations based on the System of Health Accounts (SHA). This accounting framework has recently been updated and 2016 saw the first international data collection under the new SHA 2011 guidelines. In addition to reaching better comparability of health spending figures and greater country coverage, the updated framework has seen changes in the dimension of health financing leading to important consequences when analysing health financing data. This article presents the first results of health spending and financing data collected under this new framework and highlights the areas where SHA 2011 has become a more useful tool for policy analysis, by complementing data on expenditure of health financing schemes with information about their revenue streams. It describes the major conceptual changes in the scope of health financing and highlights why comprehensive analyses based on SHA 2011 can provide for a more complete description and comparison of health financing across countries, facilitate a more meaningful discussion of fiscal sustainability of health spending by also analysing the revenues of compulsory public schemes and help to clarify the role of governments in financing health care - which is generally much bigger than previously documented. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

    Science.gov (United States)

    Fryatt, Robert; Mills, Anne; Nordstrom, Anders

    2010-01-30

    Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. Obligations of low income countries in ensuring equity in global health financing.

    Science.gov (United States)

    Barugahare, John; Lie, Reidar K

    2015-09-08

    Despite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries' obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels. Achieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country (LIC) governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing. Although achieving justice in global health will depend on fulfillment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic

  10. Implementing health financing reform: lessons from countries in transition

    National Research Council Canada - National Science Library

    Kutzin, Joseph; Cashin, Cheryl; Jakab, Melitta

    2010-01-01

    Since 1990, the social and economic policies of the transition countries of central and eastern Europe, the Caucasus and central Asia have diverged, including the way they have reformed the financing...

  11. Health Care Finance Executive Personalities Revisited: A 10-Year Follow-up Study.

    Science.gov (United States)

    Lieneck, Cristian; Nowicki, Michael

    2015-01-01

    A dynamic health care industry continues to call upon health care leaders to possess not one but multiple competencies. Inherent personality characteristics of leaders often play a major role in personal as well as organizational success to include those in health care finance positions of responsibility. A replication study was conducted to determine the Myers-Briggs personality-type differences between practicing health care finance professionals in 2014, as compared with a previous 2003 study. Results indicate a significant shift between both independent samples of health care finance professionals over the 10-year period from original high levels of introversion to that of extraversion, as well as higher sensing personality preferences, as compared with the original sample's high level of intuition preferences. Further investigation into the evolving role of the health care finance manager is suggested, while continued alignment of inherent, personal characteristics is suggested to meet ongoing changes in the industry.

  12. Decentralized electricity production. v. 1 and 2

    International Nuclear Information System (INIS)

    1991-01-01

    The first part of the symposium is concerned with market analysis, case studies and prospectives for the decentralized production of electricity in France: cogeneration, heat networks, municipal waste incineration, etc. Financing systems and microeconomical analysis are presented. The second part is devoted to macroeconomical outlooks (France and Europe mainly) on decentralized electricity production (cogeneration, small-scale hydroelectric power plants), to other countries experience (PV systems connected to the grid, cogeneration, etc.) and to price contracts and regulations

  13. Distressed financing of household out-of-pocket health care payments in India: incidence and correlates.

    Science.gov (United States)

    Joe, William

    2015-07-01

    Out-of-pocket (OOP) health care payments financed through borrowings or sale of household assets are referred to as distressed health care financing. This article expands this concept (to include contributions from friends or relatives) and examines the incidence and correlates of distressed health care financing in India. The analysis finds a decisive influence of distressed financing in India as over 60 and 40% of hospitalization cases from rural and urban areas, respectively, report use of such coping strategies. Altogether, sources such as borrowings, sale of household assets and contributions from friends and relatives account for 58 and 42% share in total OOP payments for inpatient care in rural and urban India, respectively. Further, the results show significant socioeconomic gradient in the distribution of distressed financing with huge disadvantages for marginalized sections, particularly females, elderly and backward social groups. Multivariate logistic regression informs that households are at an elevated risk of indebtedness while seeking treatment for non-communicable diseases, particularly cancer. Evidence based on intersectional framework reveals that, despite similar socioeconomic background, males are more likely to use borrowings for health care financing than females. In conclusion, the need for social protection policies and improved health care coverage is emphasized to curtail the incidence of distressed health care financing in India. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  14. Financing national policy on oral health in Brazil in the context of the Unified Health System

    Directory of Open Access Journals (Sweden)

    Gilberto Alfredo Pucca Junior

    2010-01-01

    Full Text Available This article discusses the model of oral health care implemented in the Unified Health System of Brazil in the last decade. This model was conceived as a sub-sector policy that, over the years, has sought to improve the quality of life of the Brazilian population. Through a chronological line, the study presents the National Policy on Oral Health as a counter-hegemonic patient care model for the dentistry practices existing in the country before this policy was implemented. The reorganization of the levels of oral health care, the creation of reference facilities for secondary and tertiary care, through Centers of Dental Specialties and Regional Dental Prosthesis Laboratories, and the differential funding and decentralized management of financial resources were able to expand the actions of oral health for more than 90 million inhabitants. The evolution shown after the deployment of the National Oral Health Policy, as of 2004, demonstrates the greater integration of oral health care under the Unified Health System and provides feedback information to help this policy to continue to be prioritized by the Federal Government and receive more support from the state and local levels in the coming years.

  15. Private finance of services covered by the National Health Insurance package of benefits in Israel.

    Science.gov (United States)

    Engelchin-Nissan, Esti; Shmueli, Amir

    2015-01-01

    Private health expenditure in systems of national health insurance has raised concern in many countries. The concern is mainly about the accessibility of care to the poor and the sick, and inequality in use and in health. The concern thus refers specifically to the care financed privately rather than to private health expenditure as defined in the national health accounts. To estimate the share of private finance in total use of services covered by the national package of benefits. and to relate the private finance of use to the income and health of the users. The Central Bureau of Statistics linked the 2009 Health Survey and the 2010 Incomes Survey. Twenty-four thousand five hundred ninety-five individuals in 7175 households were included in the data. Lacking data on the share of private finance in total cost of care delivered, we calculated instead the share of uses having any private finance-beyond copayments-in total uses, in primary, secondary, paramedical and total care. The probability of any private finance in each type of care is then related, using random effect logistic regression, to income and health state. Fifteen percent of all uses of care covered by the national package of benefits had any private finance. This rate ranges from 10 % in primary care, 16 % in secondary care and 31 % in paramedical care. Twelve percent of all uses of physicians' services had any private finance, ranging from 10 % in family physicians to 20 % in pulmonologists, psychiatrists, neurologists and urologists. Controlling for health state, richer individuals are more likely to have any private finance in all types of care. Controlling for income, sick individuals (1+ chronic conditions) are 30 % in total care and 60 % in primary care more likely to have any private finance compared to healthy individuals (with no chronic conditions). The national accounts' "private health spending" (39 % of total spending in 2010) is not of much use regarding equity of and

  16. Innovative financing for late-stage global health research and development: the Global Health Investment Fund.

    Science.gov (United States)

    Fitchett, Joseph Robert; Fan Li, Julia; Atun, Rifat

    2016-01-01

    Innovative financing strategies for global health are urgently needed to reinvigorate investment and new tools for impact. Bottleneck areas along the research and development (R&D) pipeline require particular attention, such as the transitions from preclinical discovery to clinical study, and product development to implementation and delivery. Successful organizations mobilizing and disbursing resources through innovating financing mechanisms include UNITAID, the Global Fund, and Gavi, the Vaccine Alliance. Although precise numbers are poorly documented, estimated investment in low-income settings falls seriously short of local need. This commentary discusses the newly established Global Health Investment Fund as a case study to support late-stage global health R&D. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Understanding the working relationships between National Health Service clinicians and finance staff.

    Science.gov (United States)

    Minogue, Virginia; McCaffry, Rebecca

    2017-03-13

    Purpose The Department of Health and the National Health Service (NHS) Future Focused Finance (FFF) programme promotes effective engagement between clinical and finance staff. Surveys undertaken by the Department of Health between 2013 and 2015 found few NHS Trusts reported high levels of engagement. The purpose of this paper is to gain a better understanding of current working relationships between NHS clinical and finance professionals and how they might be supported to become more effective. Design/methodology/approach Ipsos MORI were commissioned by the NHS FFF programme to undertake an online survey of NHS clinical and finance staff between June and August 2015. Findings The majority of clinicians had a member of a finance team linked to their speciality or directorate. Clinical and finance professionals have a positive view of joint working preferring face-to-face contact. Clinician's confidence in their understanding of finance was generally good and finance staff felt they had a good understanding of clinical issues. Effective working relationships were facilitated by face-to-face contact, a professional relationship, and the availability of clear, well presented finance and activity data. Research limitations/implications Data protection issues limited the accessibility of the survey team to NHS staff resulting in a relatively low-response rate. Other forms of communication, including social media, were utilised to increase access to the survey. Originality/value The FFF programme is a unique programme aimed at making the NHS finance profession fit for the future. The close partnering work stream brings together the finance and clinical perspective to share knowledge, evidence, training, and to develop good practice and engagement.

  18. How to do (or not to do) … a health financing incidence analysis

    Science.gov (United States)

    Asante, Augustine D; Limwattananon, Supon; Wiseman, Virginia

    2018-01-01

    Abstract Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low- and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system. PMID:29346547

  19. How to do (or not to do) … a health financing incidence analysis.

    Science.gov (United States)

    Ataguba, John E; Asante, Augustine D; Limwattananon, Supon; Wiseman, Virginia

    2018-04-01

    Financing incidence analysis (FIA) assesses how the burden of health financing is distributed in relation to household ability to pay (ATP). In a progressive financing system, poorer households contribute a smaller proportion of their ATP to finance health services compared to richer households. A system is regressive when the poor contribute proportionately more. Equitable health financing is often associated with progressivity. To conduct a comprehensive FIA, detailed household survey data containing reliable information on both a cardinal measure of household ATP and variables for extracting contributions to health services via taxes, health insurance and out-of-pocket (OOP) payments are required. Further, data on health financing mix are needed to assess overall FIA. Two major approaches to conducting FIA described in this article include the structural progressivity approach that assesses how the share of ATP (e.g. income) spent on health services varies by quantiles, and the effective progressivity approach that uses indices of progressivity such as the Kakwani index. This article provides some detailed practical steps for analysts to conduct FIA. This includes the data requirements, data sources, how to extract or estimate health payments from survey data and the methods for assessing FIA. It also discusses data deficiencies that are common in many low- and middle-income countries (LMICs). The results of FIA are useful in designing policies to achieve an equitable health system.

  20. Health financing and integration of urban and rural residents' basic medical insurance systems in China.

    Science.gov (United States)

    Zhu, Kun; Zhang, Luying; Yuan, Shasha; Zhang, Xiaojuan; Zhang, Zhiruo

    2017-11-07

    China is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents' basic medical insurance system (URBMI) into the urban and rural residents' basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents' medical insurance systems. Financing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. "Ability to pay" was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents. URBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade. The scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund

  1. A fuzzy logic approach toward solving the analytic enigma of health system financing.

    Science.gov (United States)

    Chernichovsky, Dov; Bolotin, Arkady; de Leeuw, David

    2003-09-01

    Improved health, equity, macroeconomic efficiency, efficient provision of care, and client satisfaction are the common goals of any health system. The relative significance of these goals varies, however, across nations, communities and with time. As for health care finance, the attainment of these goals under varying circumstances involves alternative policy options for each of the following elements: sources of finance, allocation of finance, payment to providers, and public-private mix. The intricate set of multiple goals, elements and policy options defies human reasoning, and, hence, hinders effective policymaking. Indeed, "health system finance" is not amenable to a clear set of structural relationships. Neither is there a universe that can be subject to statistical scrutiny: each health system is unique. "Fuzzy logic" models human reasoning by managing "expert knowledge" close to the way it is handled by human language. It is used here for guiding policy making by a systematic analysis of health system finance. Assuming equal welfare weights for alternative goals and mutually exclusive policy options under each health-financing element, the exploratory model we present here suggests that a German-type health system is best. Other solutions depend on the welfare weights for system goals and mixes of policy options.

  2. Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health's hospitals from 2008-2012.

    Science.gov (United States)

    Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

    2015-07-18

    Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from health insurance. This allowed public hospitals more flexibility in hiring additional staff. Financial measures and incentives such as special allowances for non-private practice and additional payments for remote staff have been implemented to attract and retain them. To understand the distributional effect of such change in health workforce financing, this study evaluates the equity in health workforce financing for 838 hospitals under the Ministry of Public Health across all 75 provinces from 2008-2012. Data were collected from routine reports of public hospital financing from the Ministry of Public Health with specific identification on health workforce spending. The components and sources of health workforce financing were descriptively analysed based on the geographic location of the hospitals, their size and the core hospital functions. Inequalities in health workforce financing across provinces were assessed. We calculated the Gini coefficient and concentration index to explore horizontal and vertical inequity in the public sector health workforce financing in Thailand. Separate analyses were carried out for funding from government budget and funding from hospital revenue to understand the difference between the two financial sources. Health workforce financing accounted for about half of all hospital non-capital expenses in 2012, about a 30 % increase from the level of spending in 2008. Almost one third of the workforce financing came from hospital revenue, an increase from only one

  3. [25 years of the DRG-based health-financing system in Hungary].

    Science.gov (United States)

    Babarczy, Balázs; Gyenes, Péter; Imre, László

    2015-07-19

    After a thourough development phase, a new system of health financing was introduced in Hungary in 1993. One of the cornerstones of the system was the financing of acute hospital care through Diagnosis-Related Groups (DRGs). This method was part of a comprehensive healthcare model, elaborated and published around 1990 by experts of Gyógyinfok, a public institute. The health financing system that was finally introduced reflcted in large part this theoretical model, while the current Hungarian system differs from it in some important respects. The objective of this article is to identify these points of divergence.

  4. How changes to Irish healthcare financing are affecting universal health coverage.

    Science.gov (United States)

    Briggs, Adam D M

    2013-11-01

    In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. Health in Southeast Asia 6 Health-financing reforms in southeast Asia: challenges in achieving universal coverage

    OpenAIRE

    Tangcharoensathien, V; Patcharanarumol, W; Ir, P; Aljunid, SM; Mukti, AG; Akkhavong, K; Banzon, E; Huong, DB; Thabrany, H; Mills, A

    2011-01-01

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for natio...

  6. Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

    Science.gov (United States)

    Ebeigbe, P N

    2013-06-01

    Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

  7. Finance and Management Services

    Science.gov (United States)

    Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile health care provider about vitamin D and the risks and benefits of supplementation. Finance and Management Services The Division of Finance and Management Services (FMS) provides financial, administrative

  8. The role of ethical banks in health care policy and financing in Spain.

    Science.gov (United States)

    Salvador-Carulla, Luis; Solans, Josep; Duaigues, Mónica; Balot, Jordi; García-Gutierrez, Juan Carlos

    2009-01-01

    Ethical, social, or civic banks, constitute a secondary source of financing, which is particularly relevant in Southern and Central Europe. However there is no information on the scientific literature on this source of health care financing. We review the characteristics of saving banks in Spain and illustrate the contribution of one institution "Obra Social Caixa Catalunya" (OS-CC) to the health care financing in Spain. Savings bank health care funding was equivalent to 3 percent of the public health expenditure for 2008. The programs developed by OS-CC illustrate the complex role of savings banks in health financing, provision, training, and policy, particularly in the fields of integrated care and innovation. Financing is a basic tool for health policy. However, the role of social banking in the development of integrated care networks has been largely disregarded, in spite of its significant contribution to complementary health and social care in Southern and Central Europe. Decision makers both at the public health agencies and at the social welfare departments of savings banks should become aware of the policy implications and impact of savings bank activities in the long-term care system.

  9. Personal Health and Finance Quiz: A Tool for Outreach, Research, and Evaluation

    Directory of Open Access Journals (Sweden)

    Barbara O'Neill

    2015-02-01

    Full Text Available Rutgers Cooperative Extension developed an online self-assessment tool called the Personal Health and Finance Quiz available at http://njaes.rutgers.edu/money/health-finance-quiz/. Believed to be among the first public surveys to simultaneously query users about their health and personal finance practices, the quiz is part of Small Steps to Health and Wealth™ (SSHW, a Cooperative Extension program developed to motivate Americans to take action to improve both their health and personal finances (see http://njaes.rutgers.edu/sshw/. Respondents indicate one of four frequencies for performance of 20 daily activities and receive a Health, Finance, and Total score indicating their frequency of performing activities that health and financial experts recommend. In addition to providing users with personalized feedback, the quiz collects data for research about the health and financial practices of Americans to inform future Extension outreach and can be used as a pre-/post-test to evaluate the impact of SSHW programs. Initial research analyses are planned for 2015.

  10. Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing.

    Science.gov (United States)

    Molla, Azaher Ali; Chi, Chunhuei

    2017-09-06

    The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the 'ability-to-pay' principle developed by O'Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

  11. A study on satisfaction with publicly financed health services in China.

    Science.gov (United States)

    Zhai, Shaoguo; Wang, Pei; Wang, Anli; Dong, Quanfang; Cai, Jiaoli; Coyte, Peter C

    2017-08-28

    With implementation of Chinese universal healthcare, the performance of urban and rural residents' healthcare and the degree of satisfaction with publicly financed health services have become a hot issue in assessing health reforms in China. An evaluation model of health services in community and evaluation indexes of health-system performance have been put forward in related researches. This study examines variation in satisfaction with publicly financed health services among urban and rural residents in five Chinese cities and assesses their determinants. The data are derived from a survey of 1198 urban and rural residents from five nationally representative regions concerning their perceptions of satisfaction with China's publicly financed health services. The respondents assessed their degree of satisfaction with publicly financed health services on a 5-point Likert scale. It is a kind of questionaire scale that features the answers for 1-5 points labeled very unsatisfied, unsatisfied, neither unsatisfied nor satisfied, satisfied and very satisfied linking to each factor or variable, where a score of 1 reflects the lowest degree of satisfaction and a score of 5 represents the highest degree. The logistic regression methods are used to identify the variables into its determining components. The overall satisfaction degree representing satisfaction of all factors (variables) is 3.02, which is at the middle level of a 1-5 Likert scale, inferring respondents' neutral attitude to publicly financed health services. According to the correlation test, the factors with characteristic root greater than 0.5 are chosen to take the factor analysis and 12 extracted factors can explain 77.97% of original 18 variables' total variance. Regression analysis based on the survey data finds that health records, vaccinations, pediatric care, elder care, and mental health management are the main factors accounting for degree of satisfaction with publicly financed health services for

  12. Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

    Science.gov (United States)

    Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

    2017-09-01

    Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

  13. Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.

    Science.gov (United States)

    Shishkin, S

    1999-06-01

    This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined.

  14. Towards a coherent global framework for health financing: recommendations and recent developments.

    Science.gov (United States)

    Ottersen, Trygve; Elovainio, Riku; Evans, David B; McCoy, David; Mcintyre, Di; Meheus, Filip; Moon, Suerie; Ooms, Gorik; Røttingen, John-Arne

    2017-04-01

    The articles in this special issue have demonstrated how unprecedented transitions have come with both challenges and opportunities for health financing. Against the background of these challenges and opportunities, the Working Group on Health Financing at the Chatham House Centre on Global Health Security laid out, in 2014, a set of policy responses encapsulated in 20 recommendations for how to make progress towards a coherent global framework for health financing. These recommendations pertain to domestic financing of national health systems, global public goods for health, external financing for national health systems and the cross-cutting issues of accountability and agreement on a new global framework. Since the Working Group concluded its work, multiple events have reinforced the group's recommendations. Among these are the agreement on the Addis Ababa Action Agenda, the adoption of the Sustainable Development Goals, the outbreak of Ebola in West Africa and the release of the Panama Papers. These events also represent new stepping stones towards a new global framework.

  15. [Decentralization and how to conduct it as a revolution or an evolution? County public health and management capacity building as a prerequisite for successful decentralization in the Republic of Croatia].

    Science.gov (United States)

    Sogorić, Selma; Dzakula, Aleksandar; Polasek, Ozren; Grozić-Zivolić, Sonja; Lang, Slobodan

    2010-12-01

    Based on the results of the first phase of the County Public Health Capacity Building Program named Health-Plan for It, implemented in the Republic of Croatia during the 2002-2008 period, this article analyzes the relationship between training of the county teams and their ability to develop health policy. Our hypothesis was that decentralized model of health planning and management would not occur just by changing legislation alone. Counties in Croatia needed educational support (learning-by-doing training) in order to improve public health practices at the county level. During the 2002-2005 period, the first 15 county teams (so-called first cycle counties) completed their training. The teams consisted of 12 to 15 members, representatives of political and executive component, technical component (public health professionals, representatives of health and social welfare institutions) and community members (non-government sector and media). Teams were trained in cohorts. Three counties passed together through the six-month process of modular training (four education modules, with four days of intensive training and "homework" between modules) at the time. The remaining 5 counties (second-cycle counties) completed the same kind of training in 2007-2008. The Public Health Performance Matrix (the Local Public Health Practice Performance Measures instrument developed by the US CDC Public Health Practice Program Office) was used as an evaluation instrument. Each county team had to fill it out at the beginning of education. Comparison of the Public Health Performance Matrices of first cycle counties (training in 2002-2005) with those of the second cycle counties (trained several years later) yielded no differences. Although training materials were publicly available (accessible through the Croatian Healthy Cities web pages) for years, the second cycle counties did not spontaneously (without training) increase their county-level capacities for participative health needs

  16. A Study on Sources of Health Financing in Nigeria: Implications for Health care Marketers and Planners

    Directory of Open Access Journals (Sweden)

    Rotimi Ayodele Gbadeyan

    2016-01-01

    Full Text Available There have been increasing difficulties in providing qualitative health care services to the public in Nigeria. The development has called for the need to examine ways through which government and other stakeholders resolve these crises in the health sector. The objective of this paper is to examine the level of Government spending to total Health expenditures in Nigeria. This study basically employs secondary data for analysis. The secondary data are provided from the World Bank Development indicators and Internet. The data was analyzed using the Pearson Correlation Coefficient Statistical technique. The result revealed a strong positive Correlation (r = 0.634 between Government Health Spending and Total Health Spending. This indicates that Government Health Spending constitutes a significant proportion of the Total Health Expenditures in Nigeria; despite complains about inadequate health financing. In conclusion, the Nigerian Health sector would become more vibrant, if the Government and the Private sector are ready to give the necessary commitments required to achieve the laudable objective of qualitative health for all. The study recommends for more Government Health funding towards tackling the prevalence of some chronic diseases such as HIV, Asthma, Tuberculosis, Meningitis and Paralysis, etc.

  17. [The federal government discourse during the political decentralization process and the obstacles to implement the Brazilian Public Health Care System].

    Science.gov (United States)

    Pellegrini, Bárbara

    2007-01-01

    A discourse analysis carried out on basic operating standard Norma Operacional Básica do Sistema Unico de Saúde (NOB-SUS 01/96) of the Brazilian public health care system aiming at locating signs that could allow to identify lines of thought which have influenced health care policies prioritized by the federal administration. The author points out a peculiarity in the kind of discourse employed by the ministry directive: its structure is based on isolated aspects of legislation and on ideas advocated by other discourse communities, articulated with redefined legal principles - an effort towards authorizing the official reasoning in favor of the relevance in keeping the decentralization process under the control of the federal administration. The analysis concludes that an infra-legal standard can neither grant state and federal administrations a hierarchical superiority (mediation function) over municipal administrations, nor can it transfer the legal responsibilities pertaining to Health Councils over to inter-administration commissions (Comissões Intergestores) , thus making the former mere decision ratifiers. This study found that granting privileges not contemplated in the legislation to state and federal administrations surfaced again and more strongly so in 2001 in yet another operating standard.

  18. Health care financing in South Africa: moving towards universal ...

    African Journals Online (AJOL)

    Advances in Health Economics and Health. Services Research. Bingley, UK: Emerald Group. Publishing Limited, 2009: 133-156. 16. Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ 2002; 80: 97-105. 17. WHO. Macroeconomics and Health: Investing in Health for Economic Development. Geneva:.

  19. [Financing, organization, costs and services performance of the Argentinean health sub-systems.

    Science.gov (United States)

    Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

    2016-01-01

    To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

  20. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.

    Directory of Open Access Journals (Sweden)

    Augustine Asante

    Full Text Available Health financing reforms in low- and middle- income countries (LMICs over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA and/or financing incidence analysis (FIA as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance

  1. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.

    Science.gov (United States)

    Asante, Augustine; Price, Jennifer; Hayen, Andrew; Jan, Stephen; Wiseman, Virginia

    2016-01-01

    Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The

  2. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

    Science.gov (United States)

    Price, Jennifer; Hayen, Andrew; Jan, Stephen; Wiseman, Virginia

    2016-01-01

    Introduction Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Methods and Findings Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Conclusion Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal

  3. Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

    2011-03-05

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

    Directory of Open Access Journals (Sweden)

    Orem Juliet

    2010-10-01

    Full Text Available Abstract Background Uganda is proposing introduction of the National Health Insurance scheme (NHIS in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. Methods We reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. Results The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms. Conclusion Under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending

  5. Health Care Financing in Ethiopia: Implications on Access to Essential Medicines.

    Science.gov (United States)

    Ali, Eskinder Eshetu

    2014-09-01

    The Ethiopian health care system is under tremendous reform. One of the issues high on the agenda is health care financing. In an effort to protect citizens from catastrophic effects of the clearly high share of out-of-pocket expenditure, the government is currently working to introduce health insurance. This article aims to highlight the components of the Ethiopian health care financing reform and discuss its implications on access to essential medicines. A desk review of government policy documents and proclamations was done. Moreover, a review of the scientific literature was done via PubMed and search of other local journals not indexed in PubMed. Revenue retention by health facilities, systematizing the fee waiver system, standardizing exemption services, outsourcing of nonclinical services, user fee setting and revision, initiation of compulsory health insurance (community-based health insurance and social health insurance), establishment of a private wing in public hospitals, and health facility autonomy were the main components of the health care financing reform in Ethiopia. Although limited, the evidence shows that there is increased health care utilization, access to medicines, and quality of services as a result of the reforms. Encouraging progress has been made in the implementation of health care financing reforms in Ethiopia. However, there is shortage of evidence on the effect of the health care financing reforms on access to essential medicines in the country. Thus, a clear need exists for well-organized research on the issue. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Equity during an economic crisis: financing of the Argentine health system.

    Science.gov (United States)

    Cavagnero, Eleonora; Bilger, Marcel

    2010-07-01

    This article analyses the redistributive effect caused by health financing and the distribution of healthcare utilization in Argentina before and during the severe 2001/2002 economic crisis. Both dramatically changed during this period: the redistributive effect became much more positive and utilization shifted from pro-poor to pro-rich. This clearly demonstrates that when utilization is contingent on financing, changes can occur rapidly; and that an integrated approach is required when monitoring equity. From a policy perspective, the Argentine health system appears vulnerable to economic downturns mainly due to high reliance on out-of-pocket payments and the strong link between health insurance and employment.

  7. Measuring the Impact of the Human Rights on Health in Global Health Financing.

    Science.gov (United States)

    Davis, Sara L M

    2015-12-10

    In response to new scientific developments, UNAIDS, WHO, and global health financing institutions have joined together to promote a "fast-track" global scale-up of testing and treatment programs. They have set ambitious targets toward the goal of ending the three diseases by 2030. These numerical indicators, based on infectious disease modeling, can assist in measuring countries' progressive realization of the right to health. However, they only nominally reference the catastrophic impact that human rights abuses have on access to health services; they also do not measure the positive impact provided by law reform, legal aid, and other health-related human rights programs. Drawing on experience at the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has incorporated expanded stakeholder consultation and human rights programming into its grants, the article argues that addressing human rights barriers to access is often an ad hoc activity occurring on the sidelines of a health grantmaking process that has focused on the scale-up of biomedical programs to meet global health indicators. To ensure that these biomedical programs have impact, UN agencies and health financing mechanisms must begin to more systematically and proactively integrate human rights policy and practice into their modeling and measurement tools. Copyright © 2015 Davis. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  8. National health financing policy in Eritrea: a survey of preliminary considerations

    Directory of Open Access Journals (Sweden)

    Kirigia Joses

    2012-08-01

    Full Text Available Abstract Background The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. Methods This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. Results The key findings were as follows: the response rate was 84.2% (16/19; 37.5% (6/16 and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP should include the phrases ‘equitable and accessible quality health services’ and ‘improve efficiency or reduce waste’ respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight, revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of

  9. National health financing policy in Eritrea: a survey of preliminary considerations.

    Science.gov (United States)

    Kirigia, Joses Muthuri; Zere, Eyob; Akazili, James

    2012-08-28

    The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. The key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases 'equitable and accessible quality health services' and 'improve efficiency or reduce waste' respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost

  10. Presence and use of legislative guidelines for the distribution of decentralized decision making authority in the jimma zone health system, southwest ethiopia.

    Science.gov (United States)

    Woldie, Mirkuzie; Jirra, Challi; Azene, Girma

    2011-08-01

    Decentralization ultimately involves the execution of most health care activities at lower levels of the health system. However, when poorly implemented, decentralization can create confusion about roles and responsibilities. Therefore, the objective of this study was to assess the presence and use of legislative guidelines depicting the distribution of decentralized authority for decision making in the Jimma Zone health system, Southwest Ethiopia. A cross sectional study employing both qualitative and quantitative methods was undertaken from 16(th) January to 15(th) March 2007 in Jimma Zone. Health managers at relevant departments of the Federal Ministry of Health, Oromia Regional Health Bureau (RHB), Jimma Zonal Health Department, 13 Woreda Health Offices of Jimma Zone and the health centers and health posts in these districts were included in the study. Data was collected using interview guides and self administered structured questionnaires prepared for each level of the health system. Tape-recorded qualitative data was transcribed and analyzed using thematic framework approach while SPSS for windows version 12.0.1 was used to analyze the quantitative data obtained. According to the regional guidelines, ensuring achievement of regional health service targets is the responsibility of the RHB. This was clear to 97 (97.9%) of the health managers included in this study. However, almost equivalent proportion of the respondents, 95 (95.9%) agreed that the FMOH should be responsible for this. Similarly, 71 (73.9%) of the health managers knew that approval of health budgets and efforts for local resource generation is the responsibility of the Woreda Administrative Council while the remaining 27.1% were uncertain or disagreed about this regional direction. Such confusions were observed in almost every functional area. Moreover, legislative guidelines were not available in most of the district health offices and health facilities. Legislative guidelines depicting the

  11. The effects of Global Fund financing on health governance in Brazil

    Science.gov (United States)

    2012-01-01

    Objectives The impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work will need to explore how

  12. The effects of Global Fund financing on health governance in Brazil

    Directory of Open Access Journals (Sweden)

    Gómez Eduardo J

    2012-07-01

    Full Text Available Abstract Objectives The impact of donors, such as national government (bi-lateral, private sector, and individual financial (philanthropic contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs; while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work

  13. The effects of Global Fund financing on health governance in Brazil.

    Science.gov (United States)

    Gómez, Eduardo J; Atun, Rifat

    2012-07-16

    The impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund's financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Global Fund financing can help deepen health governance at multiple levels. Future work will need to explore how the financing of civil society by the

  14. Inequity in Health Care Financing in Iran: Progressive or Regressive Mechanism?

    Science.gov (United States)

    Rad, Enayatollah Homaie; Khodaparast, Marzie

    2016-06-01

    Having progressive health finance mechanism is very important to decrease inequity in health systems. Revenue collection is one of the aspects of health care financing. In this study, taxation system and health insurance contribution of Iranians were assessed. Data of 2012 household expenditures survey were used in this study, and payments of the families for health insurances and tax payments were extracted from the study. Kakwani index was calculated for assessing the progressivity of these payments. At the end, a model was designed to find the effective factors. We found that taxation mechanism was progressive, but insurance contribution mechanism was very regressive. The portion of people living in urban regions was higher in the payments of insurance and tax. Less educated families had lower contribution in health insurance and families with more aging persons paid more for health insurance. Policy makers must pay more attention to the health insurance contribution and change the laws in favour of the poor.

  15. An elective course in personal finance for health care professionals.

    Science.gov (United States)

    Chui, Michelle A

    2009-02-19

    To create, implement, and assess an elective course on the principles and applications of personal finance. A 1.5 unit (15 hours total) elective course was designed using active-learning pedagogy, lecture, and group discussion. Homework assignments were designed to provide practical tools and materials that students could individualize and apply to their personal financial goals. Student satisfaction, using a standard course evaluation form, revealed consistent high ratings. Student enrollment increased from 19 students in its initial year to 90 students in its fourth year. Student knowledge, assessed using the Jump$tart Financial Literacy Survey, indicated significant knowledge acquisition. Many pharmacy students are ill equipped to effectively handle the complex financial decisions they face after graduation. This course provides students with practical tools to identify appropriate ways to achieve their financial goals and critically evaluate financial advice and advisors.

  16. U.S. physicians' views on financing options to expand health insurance coverage: a national survey.

    Science.gov (United States)

    McCormick, Danny; Woolhandler, Steffie; Bose-Kolanu, Anjali; Germann, Antonio; Bor, David H; Himmelstein, David U

    2009-04-01

    Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. To assess physician views on financing options for expanding health care coverage and on access to health care. Nationally representative mail survey conducted between March 2007 and October 2007 of U.S. physicians engaged in direct patient care. Rated support for reform options including financial incentives to induce individuals to purchase health insurance and single-payer national health insurance; rated views of several dimensions of access to care. 1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance. The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

  17. Towards Establishing Fiscal Legitimacy Through Settled Fiscal Principles in Global Health Financing.

    Science.gov (United States)

    Waris, Attiya; Latif, Laila Abdul

    2015-12-01

    Scholarship on international health law is currently pushing the boundaries while taking stock of achievements made over the past few decades. However despite the forward thinking approach of scholars working in the field of global health one area remains a stumbling block in the path to achieving the right to health universally: the financing of heath. This paper uses the book Global Health Law by Larry Gostin to reflect and take stock of the fiscal support provided to the right to health from both a global and an African perspective. It then sets out the key fiscal challenges facing global and African health and proposes an innovative solution for consideration: use of the domestic principles of tax to design the global health financing system.

  18. Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil.

    Science.gov (United States)

    Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes

    2016-10-01

    We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. The results of the present study demonstrated the importance of referral centers in support of basic health services within the decentralization strategy. But, the success of the program depends on the advent of new developmental tools to augment diagnostic accuracy for leprosy. However, it should be emphasized that for new diagnostic methods to be developed, a greater commitment on the part of the health care system regarding research is urgently needed.

  19. Equity and financing for sexual and reproductive health service delivery: current innovations.

    Science.gov (United States)

    Montagu, Dominic; Graff, Maura

    2009-07-01

    National and international decisions on financing for sexual and reproductive health (SRH) services have profound effects on the type, unit costs and distribution of SRH commodities and services produced, and on their availability and consumption. Much international and national funding is politically driven and is doing little for equity and quality improvement. Financing remains a significant challenge in most developing countries and demands creative responses. While no "one-size-fits-all" solution exists, there are numerous ongoing examples of successful innovations, many of which are focusing on resource pooling and on purchasing or subsidising SRH services. In this article we have used interviews, grey literature and presentations made at a range of recent public fora to identify new and innovative ways of financing SRH services so as to increase equity in developing countries. Because SRH services are often of low value as a personal good but high value as a public good, we summarise the issues from a societal perspective, highlighting the importance of financing and policy decisions for SRH services. We provide a structured overview of what novel approaches to financing appear to have positive effects in a range of developing countries. Targeting, government payment mechanisms, subsidy delivery and co-financing for sustainability are highlighted as showing particular promise. Examples are used throughout the article to illustrate innovative strategies.

  20. Investigating client perception and attitude to decentralization of HIV/AIDS treatment services to primary health centres in three Nigerian states.

    Science.gov (United States)

    Onwujekwe, Obinna; Chikezie, Ifeanyi; Mbachu, Chinyere; Chiegil, Robert; Torpey, Kwasi; Uzochukwu, Benjamin

    2016-10-01

    The opinions of consumers in decentralization provide insights into possible levels of improvement in access and uptake of services. The study examined clients' perception and attitude towards decentralization of antiretroviral treatment services from central hospitals to primary health centres (PHCs). A cross-sectional survey was undertaken in three states in Nigeria. A total of 1265 exit interviews were conducted with HIV/AIDS clients in nine health facilities. About a third of all the respondents were not comfortable with receiving ART services in a PHC facility close to where they live. The reasons given by 385 respondents who would not want their treatment centres near were as follows: fear of disclosure, 299 (80.4%); fear of being discriminated against, 278 (74.3%); and satisfaction with care received at current facility, 278 (74.3%). However, more than 90% of respondents in all three states felt that decentralization of ART services to PHCs would be beneficial in controlling HIV/AIDS in Nigeria; the difference in respondents' perception across the three state was found to be statistically significant (P < 0.001). The findings imply that scaling-up of treatment services to PHCs would be widely accepted, and probably result in increased uptake. However, this must be accompanied by targeted behaviour change interventions for clients who for the fear of disclosure and stigma would still not access care from proximate facilities. © 2015 The Authors. Health Expectations. Published by John Wiley & Sons Ltd.

  1. Health Financing and Benefit Incidence Analysis in Uganda and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project will attempt to assess the performance health systems in Uganda and ... the impoverishing effect of out-of-pocket payment for catastrophic health events. ... IDRC and key partners will showcase critical work on adaptation and ...

  2. Progressivity of health care financing and incidence of service benefits in Ghana.

    Science.gov (United States)

    Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

    2012-03-01

    The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

  3. Moving from ideas to action - developing health financing systems towards universal coverage in Africa

    Directory of Open Access Journals (Sweden)

    Musango Laurent

    2012-11-01

    Full Text Available Abstract Background Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. Summary The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Discussion Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget

  4. Moving from ideas to action - developing health financing systems towards universal coverage in Africa.

    Science.gov (United States)

    Musango, Laurent; Orem, Juliet Nabyonga; Elovainio, Riku; Kirigia, Joses

    2012-11-08

    Accelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used. The discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies. Based on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget allocations for health can be solved with a more evidence based

  5. The incidence of health financing in South Africa: findings from a recent data set.

    Science.gov (United States)

    Ataguba, John E; McIntyre, Di

    2018-01-01

    There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.

  6. The German Central Health Fund-recent developments in health care financing in Germany.

    Science.gov (United States)

    Göpffarth, Dirk; Henke, Klaus-Dirk

    2013-03-01

    In 2009, Germany's Statutory Health Insurance System underwent a major financing reform. A uniform contribution rate set by government was introduced. Sickness funds retain only limited autonomy in charging additional premiums. A dynamic subsidy from general revenue was introduced. The aims of the reform were: (1) intensifying competition, (2) gearing competition towards quality and efficiency, and (3) increasing financial sustainability. This article describes the reform, presents the experiences made, and evaluates whether the policy aims have been met. Experiences have been mixed: on the one hand, the new arrangement showed a high level of flexibility in dealing with the severe recession in 2009. On the other hand, the new system of price differentiation has proven to be dysfunctional. Payments to sickness funds are based on predictions. But predictions have been of limited accuracy, and this has led to an accumulation of liquidity in the system. Price competition has been effectively eliminated. The intended surge in quality and product competition failed to appear, as sickness funds remain concerned mainly with their short term financial outlook. SHI finance has become more linked to the federal budget, leading to a higher level of political interventions. These arrangements will need a new reform - probably after the next general election in autumn 2013. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. [Sources of finance for provincial occupational health services. Theory and practice].

    Science.gov (United States)

    Rydlewska-Liszkowska, I; Jugo, B

    1999-01-01

    The financing of occupational health services (OHS) at the provincial level is an important issue in view of the transformation process going on not only in OHS but also in the overall health care system in Poland. New principles of financing must be now based on the cost and effects analyses. Thus, the question arises on how to provide financial means adequate to needs of health care institutions resulting from their tasks and responsibilities. The gaps existing in the information system have encouraged us to examine the situation in regard to the structure of financing and internal allocation of financial means. The objectives were formulated as follows: to characterise the sources of financial means received by provincial OHS centres; to analyse the structure of financial means derived from various sources, taking into account forms of financial administration, using the data provided by selected centres; to define the relation between the financial means being at the disposal of OHS centres and the scope of their activities; The information on the financing system was collected using a questionnaire mailed to directors of selected OHS centres. The information collected proved to be a valuable source of knowledge on the above mentioned issues as well as on how far the new system of financing associated with a new form of financial administration--an independent public health institution--has already been implemented. The studies indicated that at the present stage of the OHS system transformation it is very difficult to formulate conclusions on the financing administration in provincial OHS centres.

  8. Impact of GDP and tax revenue on health care financing: An empirical investigation from Indian states

    OpenAIRE

    Deepak Kumar BEHERA; Umakant DASH

    2017-01-01

    This paper investigates the long run impact of GDP and tax revenue on public health care expenditure using panel FMOLS and DOLS models for sixteen major states of India over the period 1980-2013. This study is more relevant in order to measure the progress in universal health care financing across the states of India because states are heterogeneous in terms of health care spending, associated with low tax bases and low level of GDP growth. The empirical result shows that healt...

  9. The Dynamics of Catastrophic and Impoverishing Health Spending in Indonesia: How Well Does the Indonesian Health Care Financing System Perform?

    Science.gov (United States)

    Aji, Budi; Mohammed, Shafiu; Haque, Md Aminul; Allegri, Manuela De

    2017-09-01

    Our study examines the incidence and intensity of catastrophic and impoverishing health spending in Indonesia. A panel data set was used from 4 waves of the Indonesian Family Life Surveys 1993, 1997, 2000, and 2007. Catastrophic health expenditure was measured by calculating the ratio of out-of-pocket payments to household income. Then, we calculated poverty indicators as a measure of impoverishing spending in the health care financing system. Head count, overshoot, and mean positive overshoot for each given threshold in 2000 were lower than other surveyed periods; otherwise, fraction headcount in 2007 of households were the higher. Between 1993 and 2007, the percentage of households in poverty decreased, both in gross and net of health payments. However, in each year, the percentages of households in poverty using net health payments were higher than the gross. The estimates of poverty gap, normalized poverty gap, and normalized mean positive gap decreased across the survey periods. The health care financing system performance has shown positive evidence for financial protection offerings. A sound relationship between improvements of health care financing performance and the existing health reform demonstrated a mutual reinforcement, which should be maintained to promote equity and fairness in health care financing in Indonesia.

  10. Financing the health care in the Czech Republic: some comparisons with Austria

    Czech Academy of Sciences Publication Activity Database

    Vavrejnová, Marie; Rack, H. M.

    2008-01-01

    Roč. 17, č. 1 (2008), s. 54-73 ISSN 1210-0455 Institutional research plan: CEZ:AV0Z70850503 Keywords : health care financing * international comparison * reform measures Subject RIV: AH - Economics http://www.vse.cz/pep/abstrakt.php3?IDcl=319

  11. Progressivity, horizontal equity and reranking in health care finance: a decomposition analysis for the Netherlands

    NARCIS (Netherlands)

    A. Wagstaff (Adam); E.K.A. van Doorslaer (Eddy)

    1997-01-01

    textabstractThis paper employs the method of Aronson et al. (1994) to decompose the redistributive effect of the Dutch health care financing system into three components: a progressivity component, a classical horizontal equity component and a reranking component. Results are presented for the

  12. The inequity of the Swiss health care system financing from a federal state perspective

    Science.gov (United States)

    2014-01-01

    Introduction Previous studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data. Methods Following the methodology proposed by Wagstaff et al. (JHE 11:361–387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures. The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005. Results The empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity. Conclusions The significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity. PMID

  13. FINANCING HEALTH IN LATIN AMERICA • Volume 1

    International Development Research Centre (IDRC) Digital Library (Canada)

    © arte i diseño 2012

    Health Sector Reform Project at the World Bank. He was a national ...... Guerrero R, Gallego AI, Becerril-Montekio V, Vásquez J. (2011). Sistema de ..... unemployed members of the household (Sauerborn, Adams, & Hien, 1996). Pradhan and ...

  14. Financing the Canterbury Health System post-disaster.

    Science.gov (United States)

    Reid, Matthew; Pink, Ramon

    2016-12-16

    The Canterbury Health System has invested substantially in its transformation to a patient-centred, integrated system, enabling improved performance despite the significant and long-term impacts of the Christchurch earthquakes in 2010 and 2011. Questions have been raised about whether this transformation is sustainable and affordable. We argue that there is a need for a post-disaster health funding strategy that takes into account the challenge of following population movements after a large natural disaster, and higher costs resulting from the disruption and the effect on the population. Such a strategy should also provide stability in an unstable environment. However, funding for health in Canterbury has followed a 'business as usual' model using the population-based funding formula, which we view as problematic. Additionally, increases in funding using that formula have been below the national average, which we believe is perverse. Canterbury has received an additional $84 million government in deficit funding since 2010/11, and this has covered part of the extra cost attributable to the earthquake. However, without system-wide integration and innovation that was underway before, and that has continued since the earthquakes, it is likely the Canterbury Health System would not have been able to meet the health needs of its population. If health funding for Canterbury had continued to increase at the average rate applied across New Zealand over the past five years, deficit funding would not have been required.

  15. [Financing of regional occupational health service centers: structure and financial criteria in years 2000-2001].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2003-01-01

    The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.

  16. Innovative financing instruments for global health 2002-15: a systematic analysis.

    Science.gov (United States)

    Atun, Rifat; Silva, Sachin; Knaul, Felicia M

    2017-07-01

    Development assistance for health (DAH), the value of which peaked in 2013 and fell in 2015, is unlikely to rise substantially in the near future, increasing reliance on domestic and innovative financing sources to sustain health programmes in low-income and middle-income countries. We examined innovative financing instruments (IFIs)-financing schemes that generate and mobilise funds-to estimate the quantum of financing mobilised from 2002 to 2015. We identified ten IFIs, which mobilised US$8·9 billion (2·3% of overall DAH) in 2002-15. The funds generated by IFIs were channelled mostly through GAVI and the Global Fund, and used for programmes for new and underused vaccines, HIV/AIDS, malaria, tuberculosis, and maternal and child health. Vaccination programmes received the largest amount of funding ($2·6 billion), followed by HIV/AIDS ($1080·7 million) and malaria ($1028·9 million), with no discernible funding targeted to non-communicable diseases. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  17. Innovative financing instruments for global health 2002–15: a systematic analysis

    Directory of Open Access Journals (Sweden)

    Prof Rifat Atun, FRCP

    2017-07-01

    Full Text Available Development assistance for health (DAH, the value of which peaked in 2013 and fell in 2015, is unlikely to rise substantially in the near future, increasing reliance on domestic and innovative financing sources to sustain health programmes in low-income and middle-income countries. We examined innovative financing instruments (IFIs—financing schemes that generate and mobilise funds—to estimate the quantum of financing mobilised from 2002 to 2015. We identified ten IFIs, which mobilised US$8·9 billion (2·3% of overall DAH in 2002–15. The funds generated by IFIs were channelled mostly through GAVI and the Global Fund, and used for programmes for new and underused vaccines, HIV/AIDS, malaria, tuberculosis, and maternal and child health. Vaccination programmes received the largest amount of funding ($2·6 billion, followed by HIV/AIDS ($1080·7 million and malaria ($1028·9 million, with no discernible funding targeted to non-communicable diseases.

  18. A roadmap to parity in mental health financing: the case of Lebanon.

    Science.gov (United States)

    Yehia, Farah; Nahas, Ziad; Saleh, Shadi

    2014-09-01

    Inadequate access to mental health (MH) services in Lebanon, where prevalence is noteworthy, is a concern. Although a multitude of factors affects access to services, lack of financial coverage of MH services is one that merits further investigation. This study aims at providing a systematic description of MH financing systems with a special focus on Lebanon, presenting stakeholder viewpoints on best MH financing alternatives/strategies and recommending options for enhancing financial coverage. A comprehensive review of existing literature on MH financing systems was conducted, with a focus on the system in Lebanon. In addition, key stakeholders were interviewed to assess MH organizational and financing arrangements. Finally, a national round table was organized with the aim of discussing findings (from the review and interviews) and developing an action roadmap. Taxation and out-of-pocket payments are the most common MH financing sources worldwide and in the Eastern Mediterranean Region. In Lebanon, all funding entities, except private insurance and mutual funds, cover inpatient and outpatient MH services, albeit with inconsistencies in levels of coverage. The national roundtable recommended two main MH financing enhancements: (i) creating a knowledge-sharing committee between insurers and MH specialists, and (ii) convincing labor unions/representatives to lobby for MH coverage as part of the negotiated benefit package. There are concerns regarding the equity, effectiveness and efficiency of the MH financing system in Lebanon. The fragmented system in Lebanon leads to differences in MH coverage across different financing intermediaries, which is inequitable. The fact that one out of four Lebanese suffer a mental disorder throughout their lives and very low percentages of those obtain treatment signals a problem in effectiveness. As for efficiency, the inefficient fragmentation of MH financing among seven intermediaries is a problematic characteristic of the

  19. Challenges facing the finance reform of the health system in Chile.

    Science.gov (United States)

    Herrera, Tania

    2014-05-28

    Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

  20. The Economics of New Health Technologies Incentives, Organization, and Financing

    CERN Document Server

    Costa-Font, Joan; McGuire, Alistair

    2009-01-01

    Technological change in healthcare has led to huge improvements in health services and the health status of populations. It is also pinpointed as the main driver of healthcare expenditure. Although offering remarkable benefits, changes in technology are not free and often entail significant financial, as well as physical or social risks. These need to be balanced out in the setting of government regulations, insurance contracts, and individuals' decisions to use and consume certaintechnologies. With this in mind, this book addresses the following important objectives: to provide a detailed ana

  1. Capital finance and ownership conversions in health care.

    Science.gov (United States)

    Robinson, J C

    2000-01-01

    This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.

  2. Intrahousehold Health Care Financing Strategy and the Gender Gap: Empirical Evidence from India

    OpenAIRE

    Abay Asfaw; Stephan Klasen; Francesca Lamanna

    2008-01-01

    The 'missing women' dilemma in India has sparked interest in investigating gender discrimination in the provision of health care in the country. No studies, however, have directly examined this discrimination in relation to household behavior in health care financing. We hypothesize that households who face tight budget constraints are more likely to spend their meager resources on hospitalization of boys rather than girls. We use the 60th Indian National Sample Survey and a multinomial logit...

  3. Health systems financing: putting together the “back office”

    OpenAIRE

    Dare, Lola; Reeler, Anne

    2005-01-01

    Strengthening healthcare systems has been identified as central to Africa achieving global and regional development targets, including the millennium development goals. Lola Dare and Anne Reeler present case studies on issues that can contribute to improved integration and lead to better performance of health systems in Africa

  4. Defining care products to finance health care in the Netherlands

    NARCIS (Netherlands)

    M. Westerdijk (MacHiel); J.J. Zuurbier (Joost); M. Ludwig (Martijn); S. Prins (Sarah)

    2012-01-01

    textabstractA case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the

  5. Health-care provision meets microcredit finance in Argentina.

    Science.gov (United States)

    Lashley, Kai

    2008-01-01

    Microcredit loans have transformed the lives of impoverished people in many countries by allowing them to start businesses. But increasingly microcredit banks are realizing that providing some kind of health coverage in tandem with the loans is essential if they want to fulfil their mission to improve lives.

  6. Ability to Pay for Future National Health Financing Scheme among Malaysian Households.

    Science.gov (United States)

    Aizuddin, Azimatun Noor; Aljunid, Syed Mohamed

    Malaysia is no exception to the challenging health care financing phenomenon of globalization. The objective of the present study was to assess the ability to pay among Malaysian households as preparation for a future national health financing scheme. This was a cross-sectional study involving representative samples of 774 households in Peninsular Malaysia. A majority of households were found to have the ability to pay for their health care. Household expenditure on health care per month was between MYR1 and MYR2000 with a mean (standard deviation [SD]) of 73.54 (142.66), or in a percentage of per-month income between 0.05% and 50% with mean (SD) 2.74 (5.20). The final analysis indicated that ability to pay was significantly higher among younger and higher-income households. Sociodemographic and socioeconomic statuses are important eligibility factors to be considered in planning the proposed national health care financing scheme to shield the needed group from catastrophic health expenditures. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

  7. Micro-level analysis of distributional changes in health care financing in Finland.

    Science.gov (United States)

    Klavus, J; Häkkinen, U

    1998-01-01

    In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

  8. Financing the World Health Organisation: global importance of extrabudgetary funds.

    Science.gov (United States)

    Vaughan, J P; Mogedal, S; Kruse, S; Lee, K; Walt, G; de Wilde, K

    1996-03-01

    From 1948, when WHO was established, the Organisation has relied on the assessed contributions of its member states for its regular budget. However, since the early 1980s the WHO World Health Assembly has had a policy of zero real growth for the regular budget and has had to rely increasingly, therefore, on attracting additional voluntary contributions, called extrabudgetary funds (EBFs). Between 1984-85 and 1992-93 the real value of the EBFs apparently increased by more than 60% and in the 1990-91 biennium expenditure of extrabudgetary funds exceeded the regular budget for the first time. All WHO programmes, except the Assembly and the Executive Board, receive some EBFs. However, three cosponsored and six large regular programmes account for about 70% of these EBFs, mainly for vertically managed programmes in the areas of disease control, health promotion and human reproduction. Eighty percent of all EBFs received by WHO for assisted activities have been contributed by donor governments, with the top 10 countries (in Europe, North America and Japan) contributing about 90% of this total, whereas the UN funds and the World Bank have donated only about 6% of the total to date. By contrast, about 70% of the regular budget expenditure has been for organisational expenses and for the support of programmes in the area of health systems. Despite the fact that the more successful programmes are heavily reliant on EBFs, there are strong indications that donors, particularly donor governments, are reluctant to maintain the current level of funding without major reforms in the leadership and management of the Organisation. This has major implications for WHO's international role as the leading UN specialised agency for health.

  9. Evaluating the federal role in financing health-related research.

    Science.gov (United States)

    Garber, A M; Romer, P M

    1996-11-12

    This paper considers the appropriate role for government in the support of scientific and technological progress in health care; the information the federal government needs to make well-informed decisions about its role; and the ways that federal policy toward research and development should respond to scientific advances, technology trends, and changes in the political and social environment. The principal justification for government support of research rests upon economic characteristics that lead private markets to provide inappropriate levels of research support or to supply inappropriate quantities of the products that result from research. The federal government has two basic tools for dealing with these problems: direct subsidies for research and strengthened property rights that can increase the revenues that companies receive for the products that result from research. In the coming years, the delivery system for health care will continue to undergo dramatic changes, new research opportunities will emerge at a rapid pace, and the pressure to limit discretionary federal spending will intensify. These forces make it increasingly important to improve the measurement of the costs and benefits of research and to recognize the tradeoffs among alternative policies for promoting innovation in health care.

  10. Budget and financing of mental health services: baseline information on 89 countries from WHO's project atlas.

    Science.gov (United States)

    Saxena, Shekhar; Sharan, Pratap; Saraceno, Benedetto

    2003-09-01

    Very little information is available on budget and financing of mental health services in the world. During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries. The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of drugs). The results showed that 32% of 191 countries did not have a specified budget for mental health. Of the 89 countries that supplied the requisite information 36% spent less than 1% of their total health budget on mental health. Many countries from Africa (79%) and the South East Asia (63%) were in this subgroup. Comparison with the Global Burden of Disease data showed a marked disparity between burden and resources. Lower income countries allocated a lesser proportion of their health budget on mental health in comparison to higher income countries. The primary method of financing mental health care in most countries was tax-based (60.2%), but many low-income countries depended on out-of-pocket expenditure (16.4%). The presence of mental health policies and programmes in general was not associated with the proportion of health budget allocated to mental health. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of

  11. Health financing to promote access in low income settings-how much do we know?

    Science.gov (United States)

    Palmer, Natasha; Mueller, Dirk H; Gilson, Lucy; Mills, Anne; Haines, Andy

    In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.

  12. [Psychiatric reform, federalism, and the decentralization of the public health in Brazil].

    Science.gov (United States)

    Costa, Nilson do Rosário; Siqueira, Sandra Venâncio; Uhr, Deborah; Silva, Paulo Fagundes da; Molinaro, Alex Alexandre

    2011-12-01

    This study examines the relationships between Brazilian psychiatric reform, the adoption of the Centers for Psychosocial Care (CAPS) and the development of the Unified Health System (SUS). The adherence of municipal governments was a variable determinant for the spread of reform, especially due to the continental scale and fragmentation of the Brazilian federation. The article demonstrates the institutional stability of psychiatric reform in Brazil over two decades. The institutional nature of the decision-making process in the public arena has permitted the implementation of new organizational formats through imitation and financial incentives. The psychiatric reform was successful in defending the advantages of CAPS in relation to the asylum and hospital model dominant in past decades. The inductive policies, strengthened and upheld by Law 10.216/2001, transformed the agenda of psychiatric reform, limited to pioneering cities in a national public policy.

  13. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand.

    Science.gov (United States)

    Patcharanarumol, Walaiporn; Panichkriangkrai, Warisa; Sommanuttaweechai, Angkana; Hanson, Kara; Wanwong, Yaowaluk; Tangcharoensathien, Viroj

    2018-01-01

    Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants. The Comptroller General Department (CGD) of Ministry of Finance manages CSMBS as one among civil servant welfare programmes. Their purchasing is passive. Fee for service payment for outpatient care has resulted in rapid cost escalation and overspending of their annual budget. In contrast, National Health Security Office (NHSO) manages purchasing for UCS, which undertakes a range of strategic purchasing actions, including applying closed ended provider payment, promoting primary healthcare's gate keeping functions, exercising collective purchasing power and engaging views of members in decision making process. This difference in purchasing arrangements resulted in expenditure per CSMBS member being 4 times higher than UCS in 2014. The governance of the purchaser organization, the design of the purchasing arrangements including incentives and use of information, and the institutional capacities to implement purchasing functions are essential for effective strategic purchasing which can improve health system efficiency as a whole.

  14. A SWOT analysis of the organization and financing of the Danish health care system.

    Science.gov (United States)

    Christiansen, Terkel

    2002-02-01

    The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of Strengths, Weaknesses, Opportunities and Threats) by a panel of five members with a background in health economics. The present paper describes the methods and materials used for the evaluation: selection of panel members, structure of the evaluation task according to the health care triangle model, selection of background material consisting of documents and literature on the Danish health care system, and a 1-week study visit.

  15. Integrated Decentralized Training for Health Professions Education at the University of KwaZulu-Natal, South Africa: Protocol for the I-DecT Project

    Science.gov (United States)

    2018-01-01

    Background The Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately. Objective The study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN. Methods Key role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process. Results The study was designed to fit within the existing structures, and

  16. Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform.

    Science.gov (United States)

    Sun, Jing; Liabsuetrakul, Tippawan; Fan, Yancun; McNeil, Edward

    2015-12-01

    To compare the incidences of catastrophic health expenditure (CHE) and impoverishment, the risk protection offered by two health financial reforms and to explore factors associated with CHE and impoverishment among patients with cardiovascular diseases (CVDs) in rural Inner Mongolia, China. Cross-sectional study conducted in 2014 in rural Inner Mongolia, China. Patients with CVDs aged over 18 years residing in the sample areas for at least one year were eligible. The definitions of CHE and impoverishment recommended by WHO were adopted. The protection of CHE and impoverishment was compared between the New Cooperative Medical Scheme (NCMS) alone and NCMS plus National Essential Medicines Scheme (NEMS) using the percentage change of incidences for CHE and impoverishment. Logistic regression was used to explore factors associated with CHE and impoverishment. The incidences of CHE and impoverishment under NCMS plus NEMS were 11.26% and 3.30%, respectively, which were lower than those under NCMS alone. The rates of protection were higher among households with patients with CVDs covered by NCMS plus NEMS (25.68% and 34.65%, respectively). NCMS plus NEMS could protect the poor households more from CHE but not impoverishment. NCMS plus NEMS protected more than one-fourth of households from CHE and more than one-third from impoverishment. NCMS plus NEMS was more effective at protecting households with patients with CVDs from CHE and impoverishment than NCMS alone. An integration of NCMS with NEMS should be expanded. However, further strategies to minimise catastrophic health expenditure after this health finance reform are still needed. © 2015 John Wiley & Sons Ltd.

  17. Defining care products to finance health care in the Netherlands.

    Science.gov (United States)

    Westerdijk, Machiel; Zuurbier, Joost; Ludwig, Martijn; Prins, Sarah

    2012-04-01

    A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes.

  18. Mudanças significativas no processo de descentralização do sistema de saúde no Brasil Significant changes in the health system decentralization process in Brazil

    Directory of Open Access Journals (Sweden)

    Ana Luiza d'Ávila Viana

    2002-01-01

    Full Text Available O artigo discute as tendências e os limites do processo de descentralização da política de saúde no Brasil, identificando os três elementos constitutivos da indução estratégica conduzida pelo gestor nacional, nos preceitos das Normas Operacionais do SUS: racionalidade sistêmica, financiamento intergovernamental e dos prestadores de serviço e modelo de atenção à saúde. Os efeitos das regulações federais são analisados com base nos resultados da Pesquisa de Avaliação da Instituição da Gestão Plena do Sistema Municipal. A estratégia de descentralização, induzida pela Norma Operacional Básica 96, vem conseguindo melhorar as condições institucionais, de autonomia gerencial e de oferta ­ aferidas pelos recursos financeiros federais transferidos, capacidade instalada, produção e cobertura dos serviços ambulatoriais e hospitalares ­ nos sistemas de saúde dos municípios habilitados em gestão plena, sem alterar os padrões de iniqüidade existentes na distribuição dos recursos para os municípios mais carentes.This article discusses the trends and limits of the Brazilian health system decentralization process, identifying the three elements that constitute the strategic induction performed by the national system administrator in accordance with the guidelines contained in the Operational Norms of the Unified National Health System: systemic rationality, intergovernmental and service provider financing, and health care model. The effects of the Federal regulations are analyzed based on the results of the evaluation study focused on the implementation of the full management scheme at the Municipal level. The decentralization strategy induced by Basic Operational Norm 96 has succeeded in improving institutional conditions, management autonomy, and supply, as measured by the Federal resources transferred, installed capacity, production, and coverage of outpatient and hospital services, with the Municipalities authorized

  19. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Hamidi S

    2015-02-01

    Full Text Available Samer Hamidi School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates Introduction: A national health account (NHA provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD. Methods: The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA. Results: In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE. Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita, compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion: The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of

  20. Decentralization and Distribution Primary Education Access in Indonesia 2014

    OpenAIRE

    Benita, Novinaz

    2016-01-01

    This paper examines decentralisation and distribution of access to primary school in Indonesia. Data come from Indonesia National Socio Economic Survey 2014, and statistic reports from Ministry of education, Ministry Of Finance, and General Election Commision. Descriptive statistic is used to describe spatial distribution of decentralization in primary education system and distribution of primary education access. The results show there are districts disparities in decentralization of primary...

  1. Corruption, accountability, and decentralization: theory and evidence from Mexico

    OpenAIRE

    Goodspeed, Timothy J.

    2011-01-01

    One of the fundamental tenets of fiscal federalism is that, absent various sorts of externalities, decentralized governments that rely on own-source revenues should be more fiscally efficient than decentralized governments that rely on grant financing. The argument relies in part on the idea that sub-national governments, being closer to the people, are more accountable to its citizens. Accountability to citizens is also important in understanding the presence of corruption in government. Thi...

  2. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

    Science.gov (United States)

    Hamidi, Samer

    2015-01-01

    Introduction A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). Methods The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). Results In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers. PMID:25750545

  3. Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates.

    Science.gov (United States)

    Hamidi, Samer

    2015-01-01

    A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers.

  4. Decentralized Software Architecture

    National Research Council Canada - National Science Library

    Khare, Rohit

    2002-01-01

    .... While the term "decentralization" is familiar from political and economic contexts, it has been applied extensively, if indiscriminately, to describe recent trends in software architecture towards...

  5. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40.

    Science.gov (United States)

    2018-05-05

    Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4-5·1) per year, followed by lower-middle-income countries (4·0%, 3·6-4·5) and low-income countries (2·2%, 1·7-2·8). Despite global growth, per capita health spending was projected to range from only $40 (24-65) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $1699 (711-3423) in lower-middle-income countries. Globally, the share of health spending

  6. Economic context analysis in mental health care. Usability of health financing and cost of illness studies for international comparisons.

    Science.gov (United States)

    Salvador-Carulla, L; Hernández-Peña, P

    2011-03-01

    This paper discusses an integrated approach to mental health studies on Financing of Illness (FoI) and health accounting, Cost of Illness (CoI) and Burden of Disease (BoD). In order to expand the mental health policies, the following are suggested: (a) an international consensus on the standard scope, methods to collect and to analyse mental health data, as well as to report comparative information; (b) mathematical models are also to be validated and tested in an integrated approach, (c) a better knowledge transfer between clinicians and knowledge engineers, and between researchers and policy makers to translate economic analysis into practice and health planning.

  7. NGO management and health care financing approaches in the Eastern Democratic Republic of the Congo.

    Science.gov (United States)

    Dijkzeul, D; Lynch, C A

    2006-01-01

    The role of cost-sharing in health care is a crucial, yet contentious issue. In conflict situations, cost-sharing becomes even more controversial as health and other institutions are failing. In such situations, NGOs manage health programmes which aim to aid populations in crisis and improve or at least sustain a deteriorating health system. This study looks at the issue of cost-sharing in the wider context of utilization rates and management approaches of three NGOs in the chronic, high-mortality crisis of the eastern DRC. Approaches to increase access to health care were found to exist, yet cost-recovery, even on the basis of maximum utilization rates, would only partially sustain the health system in the eastern DRC. Factors external to the direct management of NGO health programs, such as the wider economic and security situation, local management structures, and international donor policies, need to be taken into account for establishing more integrated management and financing approaches.

  8. Using evidence to strengthen accountability for health financing in Sierra Leone.

    Science.gov (United States)

    Lebbie, Sowo A; Le Voir, Rosanna; Tom-Kargbo, Joanna; Yilla, Mohamed Drissa; Kamara, Abu Bakarr; Nam, Sara L

    2016-12-01

    In 2012, the government of Sierra Leone cut the national budget allocation to the health sector. Civil society organizations planned a nationwide health budget advocacy campaign, coinciding with the 2012 general elections, to hold future leaders to account on financing for women's and children's health. As part of the campaign, Evidence for Action produced district health budget tracking scorecards. The scorecards presented Ministry of Finance data on the allocation and disbursement of health funds in each district. The data were communicated using simple, non-technical language so that citizens could understand the key messages and take action. A total of 5600 scorecards were shared at district electoral forums attended by political candidates, community members, and health activists. Since the election, the proportion of the total government budget allocated to health increased from 7.4% in 2012 to 11.2% in 2014. However, transforming politicians' commitments and pledges into implementation has been challenging, confirming that accountability is a long-term process. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  9. HEALTH & FINANCE

    African Journals Online (AJOL)

    He has vast experience in human resources and general ... receiving attention, service or being informed. This is ... There are different groups of people playing a role in the ... and should therefore not be engaged in the business of a ... medical schemes without having gained registration under the .... (cutting-edge) practice.

  10. New evidence on financing equity in China's health care reform - A case study on Gansu province, China

    Science.gov (United States)

    2012-01-01

    Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban) and −0.0281 (rural) in 2002, and −0.0177 (urban) and −0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,–0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably

  11. New evidence on financing equity in China's health care reform - A case study on Gansu province, China

    Directory of Open Access Journals (Sweden)

    Chen Mingsheng

    2012-12-01

    Full Text Available Abstract Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households and the second in 2008 (12,973 individuals in 3958 households. Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban and −0.0281 (rural in 2002, and −0.0177 (urban and −0.0097 (rural in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,���0.1436 in 2007.. Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve

  12. New evidence on financing equity in China's health care reform--a case study on Gansu province, China.

    Science.gov (United States)

    Chen, Mingsheng; Chen, Wen; Zhao, Yuxin

    2012-12-18

    In the transition from a planned economy to a market-oriented economy, China's state funding for health care declined and traditional coverage plans collapsed, leaving China's poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were -0.0024 (urban) and -0.0281 (rural) in 2002, and -0.0177 (urban) and -0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: -0.0615 in 2002,-0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably. Optimizing benefit packages in public health insurance is

  13. Financiamiento del sistema de salud chileno The Chilean health system financing

    Directory of Open Access Journals (Sweden)

    Marcos Vergara-Iturriaga

    2006-12-01

    Full Text Available OBJETIVO: Explorar el financiamiento del sistema de salud chileno sobre la base de los datos más recientes disponibles. MATERIAL Y MÉTODOS: Se utiliza el marco teórico de los sistemas de salud del informe de salud del mundo del año 2000 de la Organización Mundial de la Salud (OMS para analizar el financiamiento del sistema de salud chileno, con especial énfasis en los esquemas de aseguramiento existentes. RESULTADOS: En el sistema de salud chileno hay una gran proporción de personas cubiertas por los seguros de salud existentes (alrededor de 88%; sin embargo, se presenta una tendencia importante hacia la segmentación de la población, sea por riesgo o por ingreso. Se observan esfuerzos, en especial por parte del Fondo Nacional de Salud (FONASA, orientados a realizar una compra estratégica de servicios de salud. CONCLUSIONES: Existe aún mucho espacio para mejorar el financiamiento del sistema de salud chileno, sobre todo en cuanto a pooling y compra estratégica.OBJECTIVE: To explore the Chilean health system financing based on the most recent available data. MATERIAL AND METHODS: Using the WHO World Health Report 2000 framework, this paper analyzes the Chilean health system financing, with special emphasis on insurance schemes. RESULTS: The analysis shows that a great proportion of people is covered by the existing health insurance schemes (about 88%. However, there is a tendency towards segmentation of the population in terms of risk and income. Additionally, efforts have been made, especially by FONASA (National Health Fund, to perform a strategic purchasing of healthcare. CONCLUSIONS: There still is a need for improving the Chilean health system financing in terms of pooling and strategic purchasing.

  14. Allocating external financing for health: a discrete choice experiment of stakeholder preferences.

    Science.gov (United States)

    Grépin, Karen A; Pinkstaff, Crossley B; Hole, Arne Risa; Henderson, Klara; Norheim, Ole Frithjof; Røttingen, John-Arne; Ottersen, Trygve

    2018-02-01

    Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics. Using an online discrete choice experiment designed to elicit preferences over country characteristics to guide decisions about the allocation of external financing for health, we find that stakeholders assign a great deal of importance to health inequalities and the burden of disease but put very little weight on income per capita. We also find considerable variation in preferences across stakeholders, with people from low- and middle-income countries putting more weight on the burden of disease and people from high-income countries putting more weight on health inequalities. These findings suggest that stakeholders put more weight on burden of disease and health inequalities than on income per capita in evaluating which countries should received external financing for health and that that people living in aid recipient may have different preferences than people living in donor countries. Donors may wish to take these differences in preferences in mind if they are reconsidering their aid allocation policies. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Financing of health care in four Caribbean territories: a comparison with reforms in Europe.

    Science.gov (United States)

    Rutten, F; Lapré, R; Antonius, R; Dokoui, S; Haqq, E; Roberts, R; Mills, A

    2002-10-01

    This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries, to which these territories are historically linked. European health care reforms are aimed at making resource allocation in health care more efficient and more responsive to consumers' demands and preferences. These reforms in Europe have been continuing without appearing to have influenced the developments in the Caribbean very much, except in Martinique. In Trinidad and Tobago current reform entails delegation of responsibility for providing services to four regional health authorities and no purchaser/provider split at the regional or facility level as in the UK has been implemented. In the Bahamas, managed care arrangements are likely to emerge given the proximity of the United States. Recent universal coverage reform in Martinique was aimed at harmonisation of finance by bringing social security and social aid functions together under one management structure and may provide more opportunities for contracting and other initiatives towards greater efficiency. The first priority in Suriname is to restore proper functioning of the current system. Reforms in the four Caribbean territories have a largely administrative character and affect the organisation of the third party role in health care rather than fundamentally changing the relationship between this third party and the various other parties in health care.

  16. Decentralization in Air Transportation

    NARCIS (Netherlands)

    Udluft, H.

    2017-01-01

    In this work,we demonstrate that decentralized control can result in stable, efficient, and robust operations in the Air Transportation System. We implement decentralized control for aircraft taxiing operations and use Agent-Based Modeling and Simulation to analyze the resulting system behavior

  17. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.

    Science.gov (United States)

    Mills, Anne; Ataguba, John E; Akazili, James; Borghi, Jo; Garshong, Bertha; Makawia, Suzan; Mtei, Gemini; Harris, Bronwyn; Macha, Jane; Meheus, Filip; McIntyre, Di

    2012-07-14

    Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. European Union and International Development Research Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. [Challenges to decentralization and local participation within the health rights protection framework: Experience of the SUSALUD Northern Macro-regional Intendance].

    Science.gov (United States)

    Rebaza-Iparraguirre, Henry; Vela-López, Miguel; Villegas-Ortega, José; Lozada-Urbano, Michelle; Munares-García, Oscar

    2016-01-01

    In Peru, health protection rights and the National Health Authority (SUSALUD) coexist with the aim to ensure that every Peruvian may exercise his/her rights. According to the L.D. (Spanish: Decreto legislativo) N° 1158, strategies must be deployed to ensure effective decentralization and ensure compliance with user rights. As a result, the Northern Macro-regional Intendance (IMRN) was created, with headquarters in the city of Chiclayo, and a coverage area including Lambayeque, Tumbes, Piura, Cajamarca, La Libertad, and Amazonas. The northern macro-region promotes information dissemination, coordination, and local participation in health activities, with an emphasis on handling complaints and claims as well as implementation and operation support of user boards (JUS). After 6 months, implementation of the IMRN experience is undergoing consolidation.

  19. Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

    Science.gov (United States)

    Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

    2014-12-30

    In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

  20. Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia.

    Science.gov (United States)

    Homedes, N

    2001-12-01

    Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries.

  1. Does decentralization influence efficiency of health units? A study of opinion and perception of health workers in Odisha

    Directory of Open Access Journals (Sweden)

    Bhuputra Panda

    2016-10-01

    Full Text Available Abstract Background Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU; examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance. Methods Following a cross-sectional, comparative study design, 130 health workers from 30 institutions were selected through a multi-stage stratified random sampling. A semi-structured questionnaire was administered to assess perception and opinion of health workers about influence of RKS on efficiency of decision making at local level, motivation and performance of staff, and availability of funds; improvement of quality of services, and coordination among co-workers; and participation of community in local decision making. Three districts with highest infant mortality rate (IMR, one each, from 3 zones of Odisha and 3 with lowest IMR were selected on the basis of IMR estimates of 2011. The former constituted priority districts (PD and the latter, non-priority districts (NPD. Composite scores were developed and compared between PD and NPD. Adjusted linear regression was conducted to identify predictors of satisfaction at work. Results A majority of respondents felt that RKS was efficient in decision making that resulted in improvement of all critical parameters of health service delivery, including quality; this was significantly higher in PD. Further, higher proportion of

  2. Modelling the affordability and distributional implications of future health care financing options in South Africa.

    Science.gov (United States)

    McIntyre, Di; Ataguba, John E

    2012-03-01

    South Africa is considering introducing a universal health care system. A key concern for policy-makers and the general public is whether or not this reform is affordable. Modelling the resource and revenue generation requirements of alternative reform options is critical to inform decision-making. This paper considers three reform scenarios: universal coverage funded by increased allocations to health from general tax and additional dedicated taxes; an alternative reform option of extending private health insurance coverage to all formal sector workers and their dependents with the remainder using tax-funded services; and maintaining the status quo. Each scenario was modelled over a 15-year period using a spreadsheet model. Statistical analyses were also undertaken to evaluate the impact of options on the distribution of health care financing burden and benefits from using health services across socio-economic groups. Universal coverage would result in total health care spending levels equivalent to 8.6% of gross domestic product (GDP), which is comparable to current spending levels. It is lower than the status quo option (9.5% of GDP) and far lower than the option of expanding private insurance cover (over 13% of GDP). However, public funding of health services would have to increase substantially. Despite this, universal coverage would result in the most progressive financing system if the additional public funding requirements are generated through a surcharge on taxable income (but not if VAT is increased). The extended private insurance scheme option would be the least progressive and would impose a very high payment burden; total health care payments on average would be 10.7% of household consumption expenditure compared with the universal coverage (6.7%) and status quo (7.5%) options. The least pro-rich distribution of service benefits would be achieved under universal coverage. Universal coverage is affordable and would promote health system equity, but

  3. Equity in health care financing in Palestine: the value-added of the disaggregate approach.

    Science.gov (United States)

    Abu-Zaineh, Mohammad; Mataria, Awad; Luchini, Stéphane; Moatti, Jean-Paul

    2008-06-01

    This paper analyzes the redistributive effect and progressivity associated with the current health care financing schemes in the Occupied Palestinian Territory, using data from the first Palestinian Household Health Expenditure Survey conducted in 2004. The paper goes beyond the commonly used "aggregate summary index approach" to apply a more detailed "disaggregate approach". Such an approach is borrowed from the general economic literature on taxation, and examines redistributive and vertical effects over specific parts of the income distribution, using the dominance criterion. In addition, the paper employs a bootstrap method to test for the statistical significance of the inequality measures. While both the aggregate and disaggregate approaches confirm the pro-rich and regressive character of out-of-pocket payments, the aggregate approach does not ascertain the potential progressive feature of any of the available insurance schemes. The disaggregate approach, however, significantly reveals a progressive aspect, for over half of the population, of the government health insurance scheme, and demonstrates that the regressivity of the out-of-pocket payments is most pronounced among the worst-off classes of the population. Recommendations are advanced to improve the performance of the government insurance schemes to enhance its capacity in limiting inequalities in health care financing in the Occupied Palestinian Territory.

  4. Plansalud: Plan sectorial concertado y descentralizado para el desarrollo de capacidades en salud, Perú 2010 - 2014 Plansalud: Decentralized and agreed sector plan for the capacity development in health, Peru 2010-2014

    Directory of Open Access Journals (Sweden)

    Lizardo Huamán-Angulo

    2011-06-01

    Full Text Available Los recursos humanos son el eje del accionar del sector salud; sin embargo, no necesariamente son el aspecto mejor atendido, por ello el Ministerio de Salud del Perú (MINSA conjuntamente con los gobiernos regionales generó el Plan Sectorial Concertado y Descentralizado para el Desarrollo de Capacidades en Salud 2010-2014 (PLANSALUD con el propósito de fortalecer las capacidades de los Recursos Humanos en Salud (RHUS y contribuir para que la atención de salud se desarrolle con eficiencia, calidad, pertinencia, equidad e interculturalidad en el marco de la descentralización, el Aseguramiento Universal de la Salud (AUS y las políticas de la salud. Con ese objeto se han propuesto tres componentes (asistencia técnica, capacitación y articulación educación - salud que agrupan a un conjunto importante de intervenciones, las cuales son planteadas y definidas de acuerdo al contexto nacional, regional y local, contribuyendo de ese modo a la mejora de las capacidades de gobierno, de gestión por competencias y la prestación de servicios de salud. El presente artículo muestra una primera aproximación de PLANSALUD, incluyendo aspectos relacionados a su planificación, gestión, financiamiento, estructura y funcionamiento, así como las medidas de monitoreo y evaluación.Human resources are the backbone of health sector actions; however, they are not necessarily the area with the greatest attention, therefore, the Ministry of Health of Peru (MINSA together with regional governments, led the Decentralized and Agreed Sector Plan for the Capacity Development in Health 2010-2014 (PLANSALUD with the aim of strengthening the capacities of Human Resources for Health (HRH and contribute to health care efficient development, quality, relevance, equity and multiculturalism, in the context of descentralization, the Universal Health Insurance (AUS and health policies. To achieve this goal, they have proposed three components (technical assistance, joint

  5. Descentralización de los servicios de salud: estudios de caso en seis estados mexicanos Decentralization of health services: case studies in six Mexican states

    Directory of Open Access Journals (Sweden)

    Nuria Homedes

    2011-12-01

    Full Text Available OBJETIVO: Este artículo presenta los resultados de la segunda descentralización de la Secretaría de Salud de México (1994-2000. MATERIAL Y MÉTODOS: Además de revisar documentos oficiales y de archivo, estadísticas de salud y de productividad, se realizaron observaciones en los centros asistenciales y 232 entrevistas de profundidad en los estados de Baja California Sur, Colima, Guanajuato, Nuevo León, Sonora y Tamaulipas con directivos de las secretarías de salud estatales y jurisdiccionales, dirigentes de sindicatos, prestadores de servicios y representantes de la sociedad civil. RESULTADOS: Se identifican los problemas que los estados tuvieron que enfrentar para implementar la descentralización. CONCLUSIONES: No se alcanzaron los objetivos trazados por los promotores de la descentralización.OBJECTIVE: This article discusses the effects of the second decentralization of the Mexican Ministry of Health (1994-2000. MATERIAL AND METHODS: It is based on a review of official and archival documents, health and productivity statistics, observations in clinics and hospitals, and 232 in-depth interviews in the states of Baja California Sur, Colima, Guanajuato, Nuevo León, Sonora and Tamaulipas. The interviewees included high-level administrators of state and district health systems, leaders of workers unions, health providers and representatives of civil society. RESULTS: The article identifies the problems that offices of health at state level had to overcome to implement the decentralization. CONCLUSIONS: Descentralizacion failed to achieve the objectives stated by its promoters.

  6. Public and private health-care financing with alternate public rationing rules.

    Science.gov (United States)

    Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

    2012-02-01

    We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

  7. Evaluation of the organization and financing of the Danish health care system.

    Science.gov (United States)

    Janssen, Richard

    2002-02-01

    The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on the reading of an extensive range of documents and literature on the Danish health care system, and a 1-week visit to health care authorities, providers and key persons. The present paper describes the main findings of one of the panel members. A quality assessment approach is combined with the principles of a SWOT analysis to assess the main features of the Danish health care system. In addition, a public health perspective has been used in judging the coherence of the subsystems of the health systems. It is concluded that the macro-efficiency of the health care system could be increased by improving the cooperation between the subsystems. The relatively high mortality rates suggest that greater input into health education programs could significantly improve the health status of the Danish population. Finally, it is suggested that the steering power of the public board be strengthened by transferring ownership of health care institutions to other hands (privatization).

  8. Restructuring brain drain: strengthening governance and financing for health worker migration.

    Science.gov (United States)

    Mackey, Tim K; Liang, Bryan A

    2013-01-15

    Health worker migration from resource-poor countries to developed countries, also known as ''brain drain'', represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

  9. Multitarget survey on the Finance Police personnel: assessment of the health condition.

    Science.gov (United States)

    Barraco, Giancarlo; Pagano, Stefano; Lupoli, Grazia; Dolci, Alessandro; Colagrosso, Beniamino

    2014-01-01

    Over the past 10-15 years, Italy has undergone a social transformation, and the class of employees and workers has become more economically stable with a higher buying power. Along with the increased expectations of patients on the quality of life, it has now become a priority to make health and social services ready to face users bearing new requirements and different needs. To provide a description of the state of health of the operating personnel of the Finance Police (Guardia di Finanza), including elements for planning the most appropriate interventions for health promotion and prevention. The study analyzed the health condition of a group of soldiers (178 subjects, divided into different age classes) by evaluating the effectiveness of a training and information program and subsequently the level of benefit. The study population showed a good state of health correlated to the quality of life. Although the population voluntarily submitted to health assessment, the rigour of the calls and briefings carried out in the military health unit and the attention of the group to follow instructions on prevention underlined a positive trend, even in behaviours considered as health-risky. Socio-cultural components and the work environment influence the quality of life. In the case of military health care, the specific military organization was useful to monitor the health condition of the population, maximizing the effectiveness of services, enhancing the information and carrying out prevention strategies and demand of care, which should be an example for the public health services.

  10. Restructuring brain drain: strengthening governance and financing for health worker migration

    Directory of Open Access Journals (Sweden)

    Tim K. Mackey

    2013-01-01

    Full Text Available Background: Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Methods: Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Results: Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. Conclusions: In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

  11. Setting performance-based financing in the health sector agenda: a case study in Cameroon.

    Science.gov (United States)

    Sieleunou, Isidore; Turcotte-Tremblay, Anne-Marie; Fotso, Jean-Claude Taptué; Tamga, Denise Magne; Yumo, Habakkuk Azinyui; Kouokam, Estelle; Ridde, Valery

    2017-08-01

    More than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon. The research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis. By 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change. The policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers' actions and choices.

  12. The Financing Mechanism of the Social Health Insurance System in Romania and in other European Countries

    Directory of Open Access Journals (Sweden)

    Constantin AFANASE

    2010-08-01

    Full Text Available The social insurance system is part of the social security system and it works based on the payment of a contribution through which risks and services defined by the law are insured. The social security system, independent of the structure or political and economical order of a state, has the attribution of giving help to those in conditions of social helplessness, as well as preventing such circumstances. In this paper we made a comparative analysis of the financing mechanism of the social health insurance system in Romania with other European countries.

  13. Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process

    NARCIS (Netherlands)

    Sidze, E.M.; Pradhan, J.; Beekink, E.; Maina, T.M.; Maina, B.W.

    2013-01-01

    Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the

  14. Innovative financing for health: what are the options for South Africa?

    Directory of Open Access Journals (Sweden)

    Robert J. Fryatt

    2012-10-01

    Full Text Available The paper assesses the options for additional innovative financing that could be considered in South Africa, covering both raising new funds and linking funds to results. New funds could come from: i the private sector, including the mining and mobile phone industry; ii from voluntary sources, through charities and foundations; iii and through further expanding health (sin levies on products such as tobacco, alcohol and unhealthy food and drinks. As in other countries, South Africa could earmark some of these additional sources for investment in interventions and research to reduce unhealthy behaviors and influence the determinants of health. South Africa could also expand innovative linking of funds to improve overall performance of the health sector, including mitigating the risks for non-state investment and exploring different forms of financial incentives for providers and patients. All such innovations would require rigorous monitoring and evaluation to assess whether intended benefits are achieved and to look for unintended consequences.

  15. Organizational decentralization in radiology.

    Science.gov (United States)

    Aas, I H Monrad

    2006-01-01

    At present, most hospitals have a department of radiology where images are captured and interpreted. Decentralization is the opposite of centralization and means 'away from the centre'. With a Picture Archiving and Communication System (PACS) and broadband communications, transmitting radiology images between sites will be far easier than before. Qualitative interviews of 26 resource persons were performed in Norway. There was a response rate of 90%. Decentralization of radiology interpretations seems less relevant than centralization, but several forms of decentralization have a role to play. The respondents mentioned several advantages, including exploitation of capacity and competence. They also mentioned several disadvantages, including splitting professional communities and reduced contact between radiologists and clinicians. With the new technology decentralization and centralization of image interpretation are important possibilities in organizational change. This will be important for the future of teleradiology.

  16. Decentralization: Another Perspective

    Science.gov (United States)

    Chapman, Robin

    1973-01-01

    This paper attempts to pursue the centralization-decentralization dilemma. A setting for this discussion is provided by noting some of the uses of terminology, followed by a consideration of inherent difficulties in conceptualizing. (Author)

  17. Decentralized portfolio management

    OpenAIRE

    Coutinho, Paulo; Tabak, Benjamin Miranda

    2003-01-01

    We use a mean-variance model to analyze the problem of decentralized portfolio management. We find the solution for the optimal portfolio allocation for a head trader operating in n different markets, which is called the optimal centralized portfolio. However, as there are many traders specialized in different markets, the solution to the problem of optimal decentralized allocation should be different from the centralized case. In this paper we derive conditions for the solutions to be equiva...

  18. Who pays and who benefits from health care? An assessment of equity in health care financing and benefit distribution in Tanzania.

    Science.gov (United States)

    Mtei, Gemini; Makawia, Suzan; Ally, Mariam; Kuwawenaruwa, August; Meheus, Filip; Borghi, Josephine

    2012-03-01

    Little is known about health system equity in Tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. This study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socio-economic groups. A system-wide analysis of benefits was undertaken, including benefits from all providers irrespective of ownership. The analysis used the household budget survey (HBS) from 2001, the most recent nationally representative survey data publicly available at the time, to analyse the distribution of health care payments through user fees, health insurance contributions [from the National Health Insurance Fund (NHIF) for the formal sector and the Community Health Fund (CHF), for the rural informal sector] and taxation. Due to lack of information on NHIF and CHF contributions in the HBS, a primary survey was administered to estimate CHF enrollment and contributions; assumptions were used to estimate NHIF contributions within the HBS. Data from the same household survey, administered to 2224 households in seven districts/councils, was used to analyse the distribution of health care benefits across socio-economic groups. The health financing system was mildly progressive overall, with income taxes and NHIF contributions being the most progressive financing sources. Out-of-pocket payments and contributions to the CHF were regressive. The health benefit distribution was fairly even but the poorest received a lower share of benefits relative to their share of need for health care. Public primary care facility use was pro-poor, whereas higher level and higher cost facility use was generally pro-rich. We conclude that health financing reforms can improve equity, so long as integration of health insurance schemes is promoted along with cross-subsidization and greater reliance on general taxation to finance health care for the poorest.

  19. The other crisis: the economics and financing of maternal, newborn and child health in Asia.

    Science.gov (United States)

    Anderson, Ian; Axelson, Henrik; Tan, B-K

    2011-07-01

    The Global Financial Crisis (GFC) of 2008/2009 was the largest economic slowdown since the Great Depression. It undermined the growth and development prospects of developing countries. Several recent studies estimate the impact of economic shocks on the poor and vulnerable, especially women and children. Infant and child mortality rates are still likely to continue to decline, but at lower rates than would have been the case in the absence of the GFC. Asia faces special challenges. Despite having been the fastest growing region in the world for decades, and even before the current crisis, this region accounted for nearly 34% of global deaths of children under 5, more than 40% of maternal deaths and 60% of newborn deaths. Global development goals cannot be achieved without much faster and deeper progress in Asia. Current health financing systems in much of Asia are not well placed to respond to the needs of women and their children, or the recent global financial and economic slowdown. Public expenditure is often already too low, and high levels of out-of-pocket health expenditure are an independent cause of inequity and impoverishment for women and their children. The GFC highlights the need for reforms that will improve health outcomes for the poor, protect the vulnerable from financial distress, improve public expenditure patterns and resource allocation decisions, and so strengthen health systems. This paper aims to highlight the most recent assessments of how economic shocks, including the GFC, affect the poor in developing countries, especially vulnerable women and children in Asia. It concludes that conditional cash transfers, increasing taxation on tobacco and increasing the level, and quality, of public expenditure through well-designed investment programmes are particularly relevant in the context of an economic shock. That is because these initiatives simultaneously improve health outcomes for the poor and vulnerable, protect them from further financial

  20. Summary of the SWOT panel's evaluation of the organisation and financing of the Danish health care system.

    Science.gov (United States)

    Christiansen, Terkel

    2002-02-01

    The organisation and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. This paper systematically summarises the panel's assessments, within the framework of the triangular model of health care. The members of the panel are in agreement on a number of aspects, while their views on other aspects differ. In general they find many strength in the way the system is organised and financed more so in the primary sector than in the hospital sector.

  1. U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?

    Science.gov (United States)

    Bustamante, Arturo Vargas

    2016-01-01

    For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. PMID:27694684

  2. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand.

    Science.gov (United States)

    Seeberg, Jens; Pannarunothai, Supasit; Padmawati, Retna Siwi; Trisnantoro, Laksono; Barua, Nupur; Pandav, Chandrakant S

    2014-02-01

    This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment.

    Science.gov (United States)

    Li, Hui; Hilsenrath, Peter

    2016-01-01

    China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China's shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China's evolution, adding another layer of complexity to policy. © The

  4. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

    NARCIS (Netherlands)

    Wees, P.J. van der; Wammes, J.J.G.; Westert, G.P.; Jeurissen, P.P.T.

    2015-01-01

    BACKGROUND: Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered) and depth of coverage (the proportion

  5. Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System.

    Science.gov (United States)

    Faleiros, Daniel Resende; Acurcio, Francisco de Assis; Álvares, Juliana; Nascimento, Renata Cristina Rezende Macedo do; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Guerra, Augusto Afonso

    2017-11-13

    To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF - Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. We found serious deficiencies in the public financing of

  6. A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

    Science.gov (United States)

    Hierro, Luis A; Gómez-Álvarez, Rosario; Atienza, Pedro

    2014-01-01

    In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands. Copyright © 2013 John Wiley & Sons, Ltd.

  7. Mental health research in Brazil: policies, infrastructure, financing and human resources

    Directory of Open Access Journals (Sweden)

    Mari Jair de Jesus

    2006-01-01

    Full Text Available The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4 was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2% and the Ministry of Education (CAPES, 30.2%. The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing, with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year and 637 articles were published in Institute for Scientic Information (ISI-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.

  8. Tax levy financing for local public health: fiscal allocation, effort, and capacity.

    Science.gov (United States)

    Riley, William J; Gearin, Kimberly J; Parrotta, Carmen D; Briggs, Jill; Gyllstrom, M Elizabeth

    2013-12-01

    Local health departments (LHDs) rely on a wide variety of funding sources, and the level of financing is associated with both LHD performance in essential public health services and population health outcomes. Although it has been shown that funding sources vary across LHDs, there is no evidence regarding the relationship between fiscal allocation (local tax levy); fiscal effort (tax capacity); and fiscal capacity (community wealth). The purpose of this study is to analyze local tax levy support for LHD funding. Three research questions are addressed: (1) What are tax levy trends in LHD fiscal allocation? (2) What is the role of tax levy in overall LHD financing? and (3) How do local community fiscal capacity and fiscal effort relate to LHD tax levy fiscal allocation? This study focuses on 74 LHDs eligible for local tax levy funding in Minnesota. Funding and expenditure data for 5 years (2006 to 2010) were compiled from four governmental databases, including the Minnesota Department of Health, the State Auditor, the State Demographer, and the Metropolitan Council. Trends in various funding sources and expenditures are described for the time frame of interest. Data were analyzed in 2012. During the 2006-2010 time period, total average LHD per capita expenditures increased 13%, from $50.98 to $57.63. Although the overall tax levy increase in Minnesota was 25%, the local tax levy for public health increased 5.6% during the same period. There is a direct relationship between fiscal effort and LHD expenditures. Local funding reflects LHD community priorities and the relative importance in comparison to funding other local programs with tax dollars. In Minnesota, local tax levy support for local public health services is not keeping pace with local tax support for other local government services. These results raise important questions about the relationship between tax levy resource effort, resource allocation, and fiscal capacity as they relate to public health

  9. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova.

    Science.gov (United States)

    Kutzin, Joseph; Jakab, Melitta; Shishkin, Sergey

    2009-01-01

    The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing. The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden. The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments. The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and

  10. Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica.

    Science.gov (United States)

    Gordon-Strachan, Georgiana; Cunningham-Myrie, Colette; Fox, Kristin; Kirton, Claremont; Fraser, Raphael; McLeod, Georgia; Forrester, Terrence

    2015-01-01

    To determine whether there was a difference in wealth and cardiovascular disease (CVD) risk between microcredit loan beneficiaries and community-matched non-beneficiaries (controls). Seven hundred and twenty-six households of microcredit loan beneficiaries were matched with 726 controls by age, sex and community. A standardised interviewer administered questionnaire was used to collect data on health and household expenditure. Weights, heights, waist circumference and blood pressure measurements were taken for an adult and one child (6-16 years) from each household. Amongst adults, there was no difference in the prevalence of pre-hypertension and hypertension. More male (68.1% vs. 47.8%) and female beneficiaries (84.5% vs. 77.9%) were overweight/obese. More male (17.2% vs. 7.1%; P Microcredit financing is positively associated with wealth acquisition but worsened cardiovascular risk status. © 2014 John Wiley & Sons Ltd.

  11. Decentralization and Governance in Indonesia

    NARCIS (Netherlands)

    Holzhacker, Ronald; Wittek, Rafael; Woltjer, Johan

    2016-01-01

    I. Theoretical Reflections on Decentralization and Governance for Sustainable Society 1. Decentralization and Governance for Sustainable Society in Indonesia Ronald Holzhacker, Rafael Wittek and Johan Woltjer 2. Good Governance Contested: Exploring Human Rights and Sustainability as Normative Goals

  12. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?

    Science.gov (United States)

    Kastor, Anshul; Mohanty, Sanjay K

    2018-01-01

    Rising non-communicable diseases (NCDs) coupled with increasing injuries have resulted in a significant increase in health spending in India. While out-of-pocket expenditure remains the major source of health care financing in India (two-thirds of the total health spending), the financial burden varies enormously across diseases and by the economic well-being of the households. Though prior studies have examined the variation in disease pattern, little is known about the financial risk to the families by type of diseases in India. In this context, the present study examines disease-specific out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and distress health financing. Unit data from the 71st round of the National Sample Survey Organization (2014) was used for this study. OOPE is defined as health spending on hospitalization net of reimbursement, and CHE is defined as household health spending exceeding 10% of household consumption expenditure. Distress health financing is defined as a situation when a household has to borrow money or sell their property/assets or when it gets contributions from friends/relatives to meet its health care expenses. OOPE was estimated for 16 selected diseases and across three broad categories- communicable diseases, NCDs and injuries. Multivariate logistic regression was used to understand the determinants of distress financing and CHE. Mean OOPE on hospitalization was INR 19,210 and was the highest for cancer (INR 57,232) followed by heart diseases (INR 40,947). About 28% of the households incurred CHE and faced distress financing. Among all the diseases, cancer caused the highest CHE (79%) and distress financing (43%). More than one-third of the inpatients reported distressed financing for heart diseases, neurological disorders, genito urinary problems, musculoskeletal diseases, gastro-intestinal problems and injuries. The likelihood of incurring distress financing was 3.2 times higher for those hospitalized

  13. Modelling the impact of raising tobacco taxes on public health and finance.

    Science.gov (United States)

    Goodchild, Mark; Perucic, Anne-Marie; Nargis, Nigar

    2016-04-01

    To investigate the potential for tobacco tax to contribute to the 2030 agenda for sustainable development by reducing tobacco use, saving lives and generating tax revenues. A model of the global cigarette market in 2014--developed using data for 181 countries--was used to quantify the impact of raising cigarette excise in each country by one international dollar (I$) per 20-cigarette pack. All currencies were converted into I$ using purchasing power parity exchange rates. The results were summarized by income group and region. According to our model, the tax increase would lead the mean retail price of cigarettes to increase by 42%--from 3.20 to 4.55 I$ per 20-cigarette pack. The prevalence of daily smoking would fall by 9%--from 14.1% to 12.9% of adults--resulting in 66 million fewer smokers and 15 million fewer smoking-attributable deaths among the adults who were alive in 2014. Cigarette excise revenue would increase by 47%--from 402 billion to 593 billion I$--giving an extra 190 billion I$s in revenue. This, in turn, could help create the fiscal space required to finance development priorities. For example, if the extra revenue was allocated to health budgets, public expenditure on health could increase by 4% globally. Tobacco taxation can prevent millions of smoking-attributable deaths throughout the world and contribute to achieving the sustainable development goals. There is also potential for tobacco taxation to create the fiscal space needed to finance development, particularly in low- and middle-income countries.

  14. Modelling the impact of raising tobacco taxes on public health and finance

    Science.gov (United States)

    Perucic, Anne-Marie; Nargis, Nigar

    2016-01-01

    Abstract Objective To investigate the potential for tobacco tax to contribute to the 2030 agenda for sustainable development by reducing tobacco use, saving lives and generating tax revenues. Methods A model of the global cigarette market in 2014 – developed using data for 181 countries – was used to quantify the impact of raising cigarette excise in each country by one international dollar (I$) per 20-cigarette pack. All currencies were converted into I$ using purchasing power parity exchange rates. The results were summarized by income group and region. Findings According to our model, the tax increase would lead the mean retail price of cigarettes to increase by 42% – from 3.20 to 4.55 I$ per 20-cigarette pack. The prevalence of daily smoking would fall by 9% – from 14.1% to 12.9% of adults – resulting in 66 million fewer smokers and 15 million fewer smoking-attributable deaths among the adults who were alive in 2014. Cigarette excise revenue would increase by 47% – from 402 billion to 593 billion I$ – giving an extra 190 billion I$s in revenue. This, in turn, could help create the fiscal space required to finance development priorities. For example, if the extra revenue was allocated to health budgets, public expenditure on health could increase by 4% globally. Conclusion Tobacco taxation can prevent millions of smoking-attributable deaths throughout the world and contribute to achieving the sustainable development goals. There is also potential for tobacco taxation to create the fiscal space needed to finance development, particularly in low- and middle-income countries. PMID:27034518

  15. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

    Science.gov (United States)

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-07-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

  16. Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

    Science.gov (United States)

    Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

    2017-09-01

    Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

  17. Development and formative evaluation of a visual e-tool to help decision makers navigate the evidence around health financing.

    Science.gov (United States)

    Skordis-Worrall, Jolene; Pulkki-Brännström, Anni-Maria; Utley, Martin; Kembhavi, Gayatri; Bricki, Nouria; Dutoit, Xavier; Rosato, Mikey; Pagel, Christina

    2012-12-21

    There are calls for low and middle income countries to develop robust health financing policies to increase service coverage. However, existing evidence around financing options is complex and often difficult for policy makers to access. To summarize the evidence on the impact of financing health systems and develop an e-tool to help decision makers navigate the findings. After reviewing the literature, we used thematic analysis to summarize the impact of 7 common health financing mechanisms on 5 common health system goals. Information on the relevance of each study to a user's context was provided by 11 country indicators. A Web-based e-tool was then developed to assist users in navigating the literature review. This tool was evaluated using feedback from early users, collected using an online survey and in-depth interviews with key informants. The e-tool provides graphical summaries that allow a user to assess the following parameters with a single snapshot: the number of relevant studies available in the literature, the heterogeneity of evidence, where key evidence is lacking, and how closely the evidence matches their own context. Users particularly liked the visual display and found navigating the tool intuitive. However there was concern that a lack of evidence on positive impact might be construed as evidence against a financing option and that the tool might over-simplify the available financing options. Complex evidence can be made more easily accessible and potentially more understandable using basic Web-based technology and innovative graphical representations that match findings to the users' goals and context.

  18. Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

    Science.gov (United States)

    Qin, Xianjing; Luo, Hongye; Feng, Jun; Li, Yanning; Wei, Bo; Feng, Qiming

    2017-09-29

    Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. Our study

  19. Local Currency Financing--The Next Frontier for MDBs?

    OpenAIRE

    Hoschka, Tobias C.

    2005-01-01

    This paper surveys the issues involved in local currency financing by multilateral development banks (MDBs). While MDBs have traditionally provided financing in foreign currency to their borrowers, greater sensitivity by borrowers to potential currency mismatches, political decentralization, and the development of local capital markets have recently led MDBs to consider providing financing in local currency. While still small in comparison to MDBs' foreign currency financing, this paper argue...

  20. Rethinking Decentralization in Education in terms of Administrative Problems

    Directory of Open Access Journals (Sweden)

    Vasiliki Papadopoulou

    2013-11-01

    Full Text Available The general purpose of this study is to thoroughly examine decentralization in education according to the literature and previous research, and to discuss the applicability of educational decentralization practices in Turkey. The literature was reviewed for the study and findings reported. It has been observed that decentralization in education practices were realized in many countries after the 1980’s. It is obvious that the educational system in Turkey has difficulty in meeting the needs, and encounters many problems due to its present centralist state. Educational decentralization can provide effective solutions for stakeholder engagement, educational financing and for problems in decision making and operation within the education system. However, the present state of local governments, the legal framework, geographical, cultural and social features indicate that Turkey’s conditions are not ready for decentralization in education. A decentralization model realized in the long run according to Turkey’s conditions, and as a result of a social consensus, can help resolve the problems of the Turkish education system.

  1. FISCAL DECENTRALIZATION IN THE DRC: EVIDENCE OFREVENUE ASSIGNMENT

    Directory of Open Access Journals (Sweden)

    Angelita Kithatu-Kiwekete

    2017-07-01

    Full Text Available The rationalefor central government to devolve resources for service provisionhas been debated in decentralization literature. Decentralization enhancesdemocracy,encouragesparticipation in local development initiativesandpromotes local political accountability.This discourse has been complemented bythe implementation of fiscal decentralization to increase the ability of sub-nationalgovernment in financing municipal service delivery. Fiscal decentralization hasoften been adopted by African statessince the onset ofthe New PublicManagement erain an effortto improvethe standard ofgovernance. The concernis that African states have taken minimal steps to adopt fiscal devolution thatpromotes revenue assignment which in turn limits sub-nationalgovernments’ability to generate own source revenues.This article examines the revenue assignment function of fiscal decentralization inthe Democratic Republic of Congo(DRCinthelight of decentralizationconcerns that have been raised by civil society, as the country charts its course todemocracy. The article is a desktop study that will consider documents andpoliciesin theDRCon thenational, provincialand locallevel as far asstaterevenue sourcesare concerned. Revenue assignment should enable DRC’sprovinces and local authoritiestogeneratesignificantrevenueindependently.However, post-conflict reconstruction and development efforts in the Great Lakesregion and in the DRC have largely isolated decentralization which wouldotherwise entrench local fiscalautonomy infinancing for local services anddevelopment. The article concludes that revenue generation for local authoritiesandtheprovinces in the DRC is still very centralised by the national government.Thearticleproposes policy recommendations that will be useful for the country toensurethatdecentralization effortsinclude fiscal devolution toenhance thefinancing for local development initiatives.

  2. Restructuring American health care financing: first of all, do no harm!

    Science.gov (United States)

    Berk, P D

    1993-07-01

    Health care costs are climbing throughout the western world. Aging populations and the costs of advanced technology are the principal forces behind much of this global increase. No country has yet succeeded in containing these growing costs other than by some form of rationing. A variety of experimental strategies, including managed competition, are being considered or tested, but none is clearly effective. American health care expenditures differ, not in that they are rising, but in their enormously high starting point. Among other things, our higher costs reflect administrative costs of more than 20%, double those of Canada and nearly triple the European average; a malpractice system that, whatever its possible advantages, costs more than 10 times as much as it pays out to the injured; the enormous medical costs of poverty; maldistribution of physician specialties and incomes; and reimbursement systems that eliminate consumer input and oversight. Restructuring the system of health care financing to bring administrative costs in line with those of other nations could save at least $70 billion annually; another $25 billion or more could be saved by replacing the malpractice system with more cost-effective alternatives. These savings could defray the costs of insuring all those not now covered, without increasing either costs to the middle class, through taxation of benefits, or total health care expenditures. With all Americans covered, the necessary restructuring of the system of health care delivery could be conducted without the current pressure for immediate drastic reform, which carries with it the risk of serious error. In dealing with the sick, physicians are taught to apply two maxims: "primum non nocere" or "first of all, do no harm!"; and the rule of therapeutic restraint. The latter states that a severe chronic illness may respond better, and with fewer complications, to gradual corrective measures than to highly aggressive therapy. Both rules could well

  3. Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso

    Directory of Open Access Journals (Sweden)

    Maria Steenland

    2017-12-01

    Full Text Available Performance-based financing (PBF programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS. Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446–4.225], 2.1 more deliveries (95% CI [0.034–4.069] and 9.5 more postnatal care visits (95% CI [6.099, 12.903] each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.

  4. Medicare: Reviews of Quality of Care at Participating Hospitals. Report to the Administrator, Health Care Financing Administration.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…

  5. Decentralized control: An overview

    Czech Academy of Sciences Publication Activity Database

    Bakule, Lubomír

    2008-01-01

    Roč. 32, č. 1 (2008), s. 87-98 ISSN 1367-5788 R&D Projects: GA AV ČR(CZ) IAA200750802; GA MŠk(CZ) LA 282 Institutional research plan: CEZ:AV0Z10750506 Keywords : decentralized control * large-scale systems * decomposition Subject RIV: BC - Control Systems Theory Impact factor: 1.109, year: 2008

  6. Decentralized control and communication

    Czech Academy of Sciences Publication Activity Database

    Bakule, Lubomír; Papík, Martin

    2012-01-01

    Roč. 36, č. 1 (2012), s. 1-10 ISSN 1367-5788 R&D Projects: GA MŠk(CZ) LG12014 Institutional research plan: CEZ:AV0Z10750506 Keywords : decentralization * communication * large-scale complex systems Subject RIV: BC - Control Systems Theory Impact factor: 1.289, year: 2012

  7. The Rhetoric of Decentralization

    Science.gov (United States)

    Ravitch, Diane

    1974-01-01

    Questions the rationale for and possible consequences of political decentralization of New York City. Suggests that the disadvantages--reduced level of professionalism, increased expense in multiple government operation, "stabilization" of residential segregation, necessity for budget negotiations because of public disclosure of tax…

  8. Decentralized Blended Acquisition

    NARCIS (Netherlands)

    Berkhout, A.J.

    2013-01-01

    The concept of blending and deblending is reviewed, making use of traditional and dispersed source arrays. The network concept of distributed blended acquisition is introduced. A million-trace robot system is proposed, illustrating that decentralization may bring about a revolution in the way we

  9. The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach.

    Science.gov (United States)

    Zakeri, Mohammadreza; Olyaeemanesh, Alireza; Zanganeh, Marziee; Kazemian, Mahmoud; Rashidian, Arash; Abouhalaj, Masoud; Tofighi, Shahram

    2015-01-01

    The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.

  10. New systems of care for substance use disorders: treatment, finance, and technology under health care reform.

    Science.gov (United States)

    Pating, David R; Miller, Michael M; Goplerud, Eric; Martin, Judith; Ziedonis, Douglas M

    2012-06-01

    This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed “stigmatization” and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more “mainstream,” is to not comfortably feel that general slogans like “Treatment Works,” as promoted by Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and

  11. Health Care Performance and Health Financing Systems in Countries from Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    Sorin Gabriel ANTON

    2012-02-01

    Full Text Available A common feature of all health systems from emerging economies is the shortage of financial resources. This fact is currently exacerbated by the economic crisis that has led many governments to reconsider the level of public spending in the health sector. Starting from the Romanian experience, the paper aims to highlight the linkage between the performance of the health system and the total health spending for selected countries from Central and Eastern Europe. Romania has the lowest level of health expenditure as percentage of GDP in Europe, even if its growth rate for 2003-2008 was the highest. In addition, empirical evidence shows that these resources are used inefficiently. Despite the increasing resources allocated to the health sector, statistical analysis shows that health system efficiency, as measured by under-5 (child mortality rate, is still low. We use regression analysis based on crosssection data in order to explain the differences in health expenditure and their implication on the system efficiency. Health data have been provided by international organizations. Crosssection regression results suggest that totalhealth spending and GDP per capita are the most important factors explaining differences in health status across Central and Eastern European countries, though other lifestyle factors could play important roles.

  12. Removal of helminth eggs by centralized and decentralized wastewater treatment plants in South Africa and Lesotho: health implications for direct and indirect exposure to the effluents.

    Science.gov (United States)

    Amoah, Isaac Dennis; Reddy, Poovendhree; Seidu, Razak; Stenström, Thor Axel

    2018-05-01

    Wastewater may contain contaminants harmful to human health; hence, there is the need for treatment before discharge. Centralized wastewater treatment systems are the favored treatment options globally, but these are not necessarily superior in reduction of pathogens as compared to decentralized wastewater treatment systems (collectively called DEWATS). This study was therefore undertaken to assess the soil-transmitted helminth (STH) and Taenia sp. egg reduction efficiency of selected anaerobic baffled reactors and planted gravel filters compared to centralized wastewater treatment plants in South Africa and Lesotho. The risk of ascariasis with exposure to effluents from the centralized wastewater treatment plants was also assessed using the quantitative microbial risk assessment (QMRA) approach. Eggs of Ascaris spp., hookworm, Trichuris spp., Taenia spp., and Toxocara spp. were commonly detected in the untreated wastewater. The DEWATS plants removed between 95 and 100% of the STH and Taenia sp. eggs, with centralized plants removing between 67 and 100%. Helminth egg concentrations in the final effluents from the centralized wastewater treatment plants were consistently higher than those in the WHO recommended guideline (≤ 1 helminth egg/L) for agricultural use resulting in higher risk of ascariasis. Therefore, in conclusion, DEWATS plants may be more efficient in reducing the concentration of helminth eggs in wastewater, resulting in lower risks of STH infections upon exposure.

  13. Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

    Directory of Open Access Journals (Sweden)

    Elisabeth Paul

    2018-01-01

    Full Text Available Background Performance-based financing (PBF is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC followed suit through a health system strengthening (HSS project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms, as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and

  14. DECENTRALIZATION IN THE SYSTEM OF NATIONAL ECONOMY MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Stepaniuk Nataliia

    2018-03-01

    Full Text Available Introduction. Article deals with the investigation of the theoretical approaches to the notion of decentralization in the system of management of the national economy. Purpose. It has been found that for the effective functioning of the state it is necessary to achieve a rational relationship between centralization and decentralization, change the role, responsibility and powers for local self-government and executive authority. Results. t is substantiated that most of the scientific works are devoted to the study of the issue of decentralization of power, the implementation of reform of public finances, the transfer of power to the place as a guarantee of the development of the national economy. It is emphasized that the main idea of decentralization is to transfer competence to local government to address local needs issues. Consequently, decentralization is closely linked to the organization of public administration, promotes the building of effective relations between state authorities and local government. The main advantages of decentralization are: simplified management on the local area, establishing closer connection with civil society, increasing transparency of managerial decisions and raising the level of responsibility to the territorial community. Considered organizational and legal aspects of introduction of decentralization in Ukraine. It is noted that the course on decentralization outlines both prospects and implementation problems. Among the main risks of decentralization are the inconsistencies of the development of separate territorial units and strategic goals, the loss of state mobility, reduction of workplaces of the state apparatus, risks of complication of coordination between levels of management. Conclusions. It has been determined that for efficiency and effectiveness of the reform decentralization principles are necessary for wide introduction in the administrative, political, budgetary, financial and social spheres

  15. Financing health care for all insurance the first step? is national h-ealth

    African Journals Online (AJOL)

    1990-08-04

    Aug 4, 1990 ... supplemented by a national health insurance scheme, rather than through simply ... duals and families, and often unaffordable to individuals if they have to pay the .... Employees' contributions may be matched by employers.

  16. Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

    Science.gov (United States)

    2017-05-20

    An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP

  17. Are health workers motivated by income? Job motivation of Cambodian primary health workers implementing performance-based financing.

    Science.gov (United States)

    Khim, Keovathanak

    2016-01-01

    Financial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers' incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process. This study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income. A cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression. PHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores. Financial incentives used in the reform formed a significant part of health workers' income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system.

  18. An examination of contemporary financing practices and the global financial crisis on nonprofit multi-hospital health systems.

    Science.gov (United States)

    Stewart, Louis J; Smith, Pamela C

    2011-01-01

    This study examines the impact of the 2008 global financial crisis on large US nonprofit health systems. We proceed from an analysis of the contemporary capital financing practices of 25 of the nation's largest nonprofit hospitals and health systems. We find that these institutions relied on operating cash flows, public issues of insured variable rate debt, and accumulated investment to meet their capital financing needs. The combined use of these three financial instruments provided these organizations with $22.4 billion of long-term capital at favorable terms and the lowest interest rates. Our analysis further indicates that the extensive utilization of bond insurance, auction rate debt, and interest rate derivatives created significant risk exposures for these health systems. These risks were realized by the broader global financial crisis of 2008. Findings indicate these health systems incurred large losses from the early retirement of their variable rate debt. In addition, many organizations were forced to post nearly $1 billion of liquid collateral due to the falling values of their interest rate derivatives. Finally, the investment portfolios of these large nonprofit health systems suffered millions of dollars of unrealized capital losses, which may minimize their ability to finance future capital investment requirements.

  19. Decentralized Portfolio Management

    Directory of Open Access Journals (Sweden)

    Benjamin Miranda Tabak

    2003-12-01

    Full Text Available We use a mean-variance model to analyze the problem of decentralized portfolio management. We find the solution for the optimal portfolio allocation for a head trader operating in n different markets, which is called the optimal centralized portfolio. However, as there are many traders specialized in different markets, the solution to the problem of optimal decentralized allocation should be different from the centralized case. In this paper we derive conditions for the solutions to be equivalent. We use multivariate normal returns and a negative exponential function to solve the problem analytically. We generate the equivalence of solutions by assuming that different traders face different interest rates for borrowing and lending. This interest rate is dependent on the ratio of the degrees of risk aversion of the trader and the head trader, on the excess return, and on the correlation between asset returns.

  20. Decentralized Ground Staff Scheduling

    DEFF Research Database (Denmark)

    Sørensen, M. D.; Clausen, Jens

    2002-01-01

    scheduling is investigated. The airport terminal is divided into zones, where each zone consists of a set of stands geographically next to each other. Staff is assigned to work in only one zone and the staff scheduling is planned decentralized for each zone. The advantage of this approach is that the staff...... work in a smaller area of the terminal and thus spends less time walking between stands. When planning decentralized the allocation of stands to flights influences the staff scheduling since the workload in a zone depends on which flights are allocated to stands in the zone. Hence solving the problem...... depends on the actual stand allocation but also on the number of zones and the layout of these. A mathematical model of the problem is proposed, which integrates the stand allocation and the staff scheduling. A heuristic solution method is developed and applied on a real case from British Airways, London...

  1. [International financing for cooperation to develop health in Latin America and the Caribbean].

    Science.gov (United States)

    De Los Ríos, Rebecca; Arósquipa, Carlos; Vigil-Oliver, William

    2011-08-01

    gross domestic product. Given these realities and the fact that LAC is the world's most unequal region, but not its poorest, it is imperative to reconsider the concepts, management, and delivery of cooperation in the development of health, using innovative approaches and alternative financing mechanisms that respond more effectively to the realities of the region.

  2. The form and context of federalism: meanings for health care financing.

    Science.gov (United States)

    France, George

    2008-08-01

    This article examines the meaning of federalism for health care financing (HCF) and is based on two considerations. First, federal institutions are embedded in their national context and interact with them. The design and performance of HCF policy will be influenced by contexts, the workings of the federal institutions, and the interactions of these institutions with different elements of the context. This article unravels these influences. Second, there is no unique model of federalism, and so we have to specify the particular form to which we refer. The examination of the influence of federalism and its context on HCF policy is facilitated by using a transnational comparative approach, and this article examines four mature federations: the United States, Australia, Canada, and Germany. The relatively poor performance of the U.S. HCF system seems associated with the fact that it operates in a context markedly less benign than those of the other national HCF systems. Heterogeneity of context appears also to have contributed to important differences between the United States and the other countries in the design of HCF policies. An analysis of how federalism works in practice suggests that, while U.S. federalism may be overall less favorable to the development of well-functioning HCF policies, the inferior performance of these policies is to be principally attributed to context.

  3. Decentralization in Ethiopia

    OpenAIRE

    Gemechu, Mulugeta Debebbe

    2012-01-01

    Ethiopia officially launched the District Level Decentralization Program (DLDP) by the year 2002. The program flagged core objectives such as institutionalizing viable development centers at local levels, deepening devolution of power, enhancing the democratization process through broad-based participatory strategy, promoting good governance and improving service delivery. Since the inception of this program two strategic planning terms (one strategic term is five years) have already elapsed ...

  4. Centralized vs decentralized contests

    OpenAIRE

    Beviá, Carmen; Corchón, Luis C.

    2015-01-01

    We compare two contests, decentralized in which there are several independent contests with non overlapping contestants and centralized in which all contestants fight for a unique prize which is the sum of all prizes in the small contests. We study the relationship between payoffs and efforts between these two contests. The first author acknowledges financial support from ECO2008-04756 (Grupo Consolidado-C), SGR2014-515 and PROMETEO/2013/037. The second author acknowledges financial suppor...

  5. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  6. Policy Implementation Decentralization Government in Indonesia

    Directory of Open Access Journals (Sweden)

    Kardin M. Simanjuntak

    2015-06-01

    Full Text Available Decentralization in Indonesia is that reforms not completed and until the current implementation is not maximized or have not been successful. The essence of decentralization is internalising cost and benefit' for the people and how the government closer to the people. That's the most important essence of essence 'decentralization’. However, the implementation of decentralization in Indonesia is still far from the expectations. It is shown that only benefits of decentralization elite and local authorities, decentralization is a neo-liberal octopus, decentralization of public services are lacking in character, decentralization without institutional efficiency, decentralization fosters corruption in the area, and quasi-fiscal decentralization.

  7. Health-resort fee and a stay in a health-resort hospital – comments based on the general interpretation of the Minister of Finance

    Directory of Open Access Journals (Sweden)

    Jacek Wantoch-Rekowski

    2016-03-01

    Full Text Available The publication presents the argumentation of the Minister of Finance included in the general interpretation of 3 October 2014 concerning the interpretation of Article 17 paragraph 2 clause 2 of the Act on Local Taxes and Fees. It was explained what was understood by the term “hospital” before 3 October 2014 and what changed in this subject after the general interpretation of the Minister of Finance was issued. It was emphasized that now the health-resort fee should not be charged from legal persons staying in health resort hospitals.

  8. Decentral Smart Grid Control

    Science.gov (United States)

    Schäfer, Benjamin; Matthiae, Moritz; Timme, Marc; Witthaut, Dirk

    2015-01-01

    Stable operation of complex flow and transportation networks requires balanced supply and demand. For the operation of electric power grids—due to their increasing fraction of renewable energy sources—a pressing challenge is to fit the fluctuations in decentralized supply to the distributed and temporally varying demands. To achieve this goal, common smart grid concepts suggest to collect consumer demand data, centrally evaluate them given current supply and send price information back to customers for them to decide about usage. Besides restrictions regarding cyber security, privacy protection and large required investments, it remains unclear how such central smart grid options guarantee overall stability. Here we propose a Decentral Smart Grid Control, where the price is directly linked to the local grid frequency at each customer. The grid frequency provides all necessary information about the current power balance such that it is sufficient to match supply and demand without the need for a centralized IT infrastructure. We analyze the performance and the dynamical stability of the power grid with such a control system. Our results suggest that the proposed Decentral Smart Grid Control is feasible independent of effective measurement delays, if frequencies are averaged over sufficiently large time intervals.

  9. Decentral Smart Grid Control

    International Nuclear Information System (INIS)

    Schäfer, Benjamin; Matthiae, Moritz; Timme, Marc; Witthaut, Dirk

    2015-01-01

    Stable operation of complex flow and transportation networks requires balanced supply and demand. For the operation of electric power grids—due to their increasing fraction of renewable energy sources—a pressing challenge is to fit the fluctuations in decentralized supply to the distributed and temporally varying demands. To achieve this goal, common smart grid concepts suggest to collect consumer demand data, centrally evaluate them given current supply and send price information back to customers for them to decide about usage. Besides restrictions regarding cyber security, privacy protection and large required investments, it remains unclear how such central smart grid options guarantee overall stability. Here we propose a Decentral Smart Grid Control, where the price is directly linked to the local grid frequency at each customer. The grid frequency provides all necessary information about the current power balance such that it is sufficient to match supply and demand without the need for a centralized IT infrastructure. We analyze the performance and the dynamical stability of the power grid with such a control system. Our results suggest that the proposed Decentral Smart Grid Control is feasible independent of effective measurement delays, if frequencies are averaged over sufficiently large time intervals. (paper)

  10. Impact of performance-based financing on primary health care services in Haiti.

    Science.gov (United States)

    Zeng, Wu; Cros, Marion; Wright, Katherine D; Shepard, Donald S

    2013-09-01

    To strengthen Haiti's primary health care (PHC) system, the country first piloted performance-based financing (PBF) in 1999 and subsequently expanded the approach to most internationally funded non-government organizations. PBF complements support (training and technical assistance). This study evaluates (a) the separate impact of PBF and international support on PHC's service delivery; (b) the combined impact of PBF and technical assistance on PHC's service delivery; and (c) the costs of PBF implementation in Haiti. To minimize the risk of facilities neglecting potential non-incentivized services, the incentivized indicators were randomly chosen at the end of each year. We obtained quantities of key services from four departments for 217 health centres (15 with PBF and 202 without) from 2008 through 2010, computed quarterly growth rates and analysed the results using a difference-in-differences approach by comparing the growth of incentivized and non-incentivized services between PBF and non-PBF facilities. To interpret the statistical analyses, we also interviewed staff in four facilities. Whereas international support added 39% to base costs of PHC, incentive payments added only 6%. Support alone increased the quantities of PHC services over 3 years by 35% (2.7%/quarter). However, support plus incentives increased these amounts by 87% over 3 years (5.7%/quarter) compared with facilities with neither input. Incentives alone was associated with a net 39% increase over this period, and more than doubled the growth of services (P < 0.05). Interview findings found no adverse impacts and, in fact, indicated beneficial impacts on quality. Incentives proved to be a relatively inexpensive, well accepted and very effective complement to support, suggesting that a small amount of money, strategically used, can substantially improve PHC. Haiti's experience, after more than a decade of use, indicates that incentives are an effective tool to strengthen PHC.

  11. The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach

    Science.gov (United States)

    Zakeri, Mohammadreza; Olyaeemanesh, Alireza; Zanganeh, Marziee; Kazemian, Mahmoud; Rashidian, Arash; Abouhalaj, Masoud; Tofighi, Shahram

    2015-01-01

    Background: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? Methods: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. Results: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). Conclusion: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the

  12. Decentralized control of complex systems

    CERN Document Server

    Siljak, Dragoslav D

    2011-01-01

    Complex systems require fast control action in response to local input, and perturbations dictate the use of decentralized information and control structures. This much-cited reference book explores the approaches to synthesizing control laws under decentralized information structure constraints.Starting with a graph-theoretic framework for structural modeling of complex systems, the text presents results related to robust stabilization via decentralized state feedback. Subsequent chapters explore optimization, output feedback, the manipulative power of graphs, overlapping decompositions and t

  13. Descentralização, universalidade e eqüidade nas reformas da saúde Decentralization, universal access, and equity in health reforms

    Directory of Open Access Journals (Sweden)

    Hésio Cordeiro

    2001-01-01

    Full Text Available Este artigo contextualiza as políticas aplicadas ao campo da saúde na década de 1990 a partir de dois eixos contraditórios: o mandato da Constituição Federal de 1988 e da Lei Orgânica da Saúde (LOAS de 1990; e a onda neoliberal que influenciou as reformas de Estado em toda a América Latina. O texto detalha os percursos e os percalços do setor saúde na implantação de uma agenda de descentralização fundamentada nos princípios constitucionais de universalização, eqüidade e participação cidadã. E conclui que a reforma da saúde, tal como prevista na LOAS, está se realizando com oscilações, avanços e recuos que traduzem ambigüidades, conflitos e contradições em relação às mudanças no papel do Estado brasileiro a partir da década de 1990. Ele perdeu sua capacidade de formular e implementar políticas nacionais de desenvolvimento, centrou-se no ajuste fiscal e está permeado pelas pressões da globalização do capital.This article analyzes Brazilian policies applied to the field of health in the 1990s from two contradictory angles: the mandate of the 1988 Federal Constitution and the 1990 National Health Act (LOAS on the one hand and the neoliberal wave that influenced public sector reforms throughout Latin America on the other. The paper discusses pathways and obstacles in the health sector during the implementation of a decentralization agenda based on the constitutional principles of universal access, equity, and citizens' participation. It concludes that the health reform provided for under the National Health Act is being achieved with ups and downs that express contradictions related to changes in the role of the Brazilian public sector beginning in the 1990s. The state lost its capacity to formulate and implement national development policies, focused on fiscal adjustment, and is permeated by pressure from globalization of capital.

  14. Health financing at district level in Malawi: an analysis of the distribution of funds at two points in time.

    Science.gov (United States)

    Borghi, Josephine; Munthali, Spy; Million, Lameck B; Martinez-Alvarez, Melisa

    2018-01-01

    There is growing attention to tracking country level resource flows to health, but limited evidence on the sub-national allocation of funds. We examined district health financing in Malawi in 2006 and 2011, and equity in the allocation of funding, together with the association between financing and under five and neonatal mortality. We explored the process for receiving and allocating different funding sources at district level. We obtained domestic and external financing data from the Integrated Financial Management Information System (2006-11) and AidData (2000-12) databases. Out-of-pocket payment data came from two rounds of integrated household budget surveys (2005; 2010). Mortality data came from the Multiple Indicator Cluster Survey (2006) and Demographic and Health Survey (2010). We described district level health funding by source, ran correlations between funding and outcomes and generated concentration curves and indices. 41 semi-structured interviews were conducted at the national level and in 10 districts with finance and health managers. Per capita spending from all sources varied substantially across districts and doubled between 2006 and 2011 from 7181 Kwacha to 15 312 Kwacha. In 2011, external funding accounted for 74% of funds, with domestic funding accounting for 19% of expenditure, and out of pocket (OOP) funding accounting for 7%. All funding sources were concentrated among wealthier districts, with OOP being the most pro-rich, followed by domestic expenditure and external funding. Districts with higher levels of domestic and external funding had lower levels of post-neonatal mortality, and those with higher levels of out-of-pocket payments had higher levels of 1-59 month mortality in 2006. There was no association between changes in financing and outcomes. Districts reported delayed receipt of lower-than-budgeted funds, forcing them to scale-down activities and rely on external funding. Governments need to track how resources are allocated

  15. Financing medical office buildings.

    Science.gov (United States)

    Blake, J W

    1995-01-01

    This article discusses financing medical office buildings. In particular, financing and ownership options from a not-for-profit health care system perspective are reviewed, including use of tax-exempt debt, taxable debt, limited partnerships, sale, and real estate investment trusts (REITs).

  16. How You Pay Determines What You Get: Alternative Financing Options as a Determinant of Publicly Funded Health Care in Canada

    Directory of Open Access Journals (Sweden)

    Ronald D. Kneebone

    2012-06-01

    Full Text Available A Canadian returning home from a visit to a physician has no idea of the cost of providing the service just received. This is true for two reasons. One is because he or she does not receive a bill to pay. The other reason has to do the myriad of ways provincial governments fund the provision of health care. Health care is financed by a wide variety of types of taxation, by intergovernmental transfers determined by opaque and changing rules, by borrowing against future taxes and by drawing down savings. Confusion over how health care is funded creates a fiscal illusion that it is cheaper than it really is; a fiscal illusion that grows larger the less provincial governments rely on taxing individuals. In this paper it is shown that when provincial health spending is financed in ways other than taxation, it grows two to three times more quickly than it would have otherwise. From 2001-2008 alone, these distortions amounted to $6.75 billion at the national level, draining funds from other government services many of which have been shown to keep Canadians healthier and so reduce their demand for health care. Simply put, when Canadians are clear about the true cost of health care they more effectively play the traditional role of consumers by guarding against waste and inefficiency and so contribute to a more efficient and effective publicly-funded health care system.

  17. Decentralized central heating

    Energy Technology Data Exchange (ETDEWEB)

    Savic, S.; Hudjera, A.

    1994-08-04

    The decentralized central heating is essentially based on new technical solutions for an independent heating unit, which allows up to 20% collectible energy savings and up to 15% savings in built-in-material. These savings are already made possible by the fact that the elements described under point A are thus eliminated from the classical heating. The thus superfluous made elements are replaced by new technical solutions described under point B - technical problem - and point E - patent claim. The technical solutions described in detail under point B and point E form together a technical unit and are essential parts of the invention protected by the patent. (author)

  18. Decentring the Creative Self

    DEFF Research Database (Denmark)

    Glaveanu, Vlad Petre; Lubart, Todd

    2014-01-01

    to themes depicting the interaction between these different others and the creator. Findings reveal both similarities and differences across the five domains in terms of the specific contribution of others to the creative process. Social interactions play a key formative, regulatory, motivational...... and informational role in relation to creative work. From ‘internalized’ to ‘distant’, other people are an integral part of the equation of creativity calling for a de-centring of the creative self and its re-centring in a social space of actions and interactions....

  19. Corruption and government spending : The role of decentralization

    OpenAIRE

    Korneliussen, Kristine

    2009-01-01

    This thesis points to a possible weakness of the empirical literature on corruption and government spending. That corruption affects the composition of government spending, and in particular that it affects education and health spending adversely, seems to be empirically well established. However, there exist additional literature closely related to corruption and government spending, treating(i) a relationship between corruption and decentralization, and (ii) a relationship between decentral...

  20. Taking a Step Forward in Public Health Finance: Establishing Standards for a Uniform Chart of Accounts Crosswalk.

    Science.gov (United States)

    Honoré, Peggy A; Leider, Jonathon P; Singletary, Vivian; Ross, David A

    2015-01-01

    In its 2012 report on the current and future states of public health finance, the Institute of Medicine noted, with concern, the relative lack of capacity for practitioners and researchers alike to make comparisons between health department expenditures across the country. This is due in part to different accounting systems, service portfolios, and state- or agency-specific reporting requirements. The Institute of Medicine called for a uniform chart of accounts, perhaps building on existing efforts such as the Public Health Uniform National Data Systems (PHUND$). Shortly thereafter, a group was convened to work with public health practitioners and researchers to develop a uniform chart of accounts crosswalk. A year-long process was undertaken to create the crosswalk. This commentary discusses that process, challenges encountered along the way and provides a draft crosswalk in line with the Foundational Public Health Services model that, if used by health departments, could allow for meaningful comparisons between agencies.

  1. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2015-06-01

    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  2. On Decentralization and Life Satisfaction

    DEFF Research Database (Denmark)

    Bjørnskov, Christian; Dreher, Axel; Fischer, Justina A.V.

    2008-01-01

    We empirically analyze the impact of fiscal and political decentralization on subjective well-being in a cross-section of 60,000 individuals from 66 countries. More spending or revenue decentralization raises well-being while greater local autonomy is beneficial only via government consumption sp...

  3. A contingency approach to decentralization

    NARCIS (Netherlands)

    Fleurke, F.; Hulst, J.R.

    2006-01-01

    After decades of centralization, in 1980 the central government of the Netherlands embarked upon an ambitious project to decentralize the administrative system. It proclaimed a series of general decentralization measures that aimed to improve the performance of the administrative system and to boost

  4. Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries.

    Science.gov (United States)

    Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

    2012-01-01

    In many countries financing for health services has traditionally been disbursed directly from governmental and non-governmental funding agencies to providers of services: the 'supply-side' of healthcare markets. Demand-side financing offers a supplementary model in which some funds are instead channelled through, or to, prospective users. In this review we considered evidence on five forms of demand-side financing that have been used to promote maternal health in developing countries: OBJECTIVES: The overall review objective was to assess the effects of demand-side financing interventions on maternal health service utilisation and on maternal health outcomes in low- and middle-income countries. Broader effects on perinatal and infant health, the situation of underprivileged women and the health care system were also assessed. This review considered poor, rural or socially excluded women of all ages who were either pregnant or within 42 days of the conclusion of pregnancy, the limit for postnatal care as defined by the World Health Organization. The review also considered the providers of services.The intervention of interest was any programme that incorporated demand-side financing as a mechanism to increase the consumption of goods and services that could impact on maternal health outcomes. This included the direct consumption of maternal health care goods and services as well as related 'merit goods' such as improved nutrition. We included systems in which potential users of maternal health services are financially empowered to make restricted decisions on buying maternal health-related goods or services - sometimes known as consumer-led demand-side financing. We also included programmes that provided unconditional cash benefits to pregnant women (for example in the form of maternity allowances), or to families with children under five years of age where there was evidence concerning maternal health outcomes.We aimed to include quantitative studies (experimental

  5. The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care.

    Science.gov (United States)

    White, Joseph

    2013-07-01

    This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

  6. Human trafficking, labor brokering, and mining in southern Africa: responding to a decentralized and hidden public health disaster.

    Science.gov (United States)

    Steele, Sarah

    2013-01-01

    Many southern African economies are dependent on the extractive industries. These industries rely on low-cost labor, often supplied by migrants, typically acquired through labor brokers. Very little attention has so far been paid to trafficking of men into extractive industries or its connection with trafficked women in the region's mining hubs. Recent reports suggest that labor-brokering practices foster human trafficking, both by exposing migrant men to lack of pay and exploitative conditions and by creating male migratory patterns that generate demand for sex workers and associated trafficking of women and girls. While trafficking in persons violates human rights, and thus remains a priority issue globally, there is little or no evidence of an effective political response to mine-related trafficking in southern Africa. This article concludes with recommendations for legal and policy interventions, as well as an enhanced public health response, which if implemented would help reduce human trafficking toward mining sites.

  7. Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

    Directory of Open Access Journals (Sweden)

    Molvik Stian

    2009-05-01

    Full Text Available Abstract Background The VELO study is a comparative study of two Community Mental Health Centres (CMHC in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs. Methods 167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression. Results We found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression. Conclusion The implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

  8. Medical Student Financing and the Armed Forces Health Professions Scholarship Program

    Science.gov (United States)

    1982-01-01

    exclusive alternatives arises in a wide variety of contexts. The conditional logit technique, recently popularized by McFadden,, has become a widely...financing your medical school educacion this ear (76-77). Assume that you were eligible and that each of these alternatives had een available to you at

  9. Coalition or decentralization

    DEFF Research Database (Denmark)

    Mahdiraji, Hannan Amoozad; Govindan, Kannan; Zavadskas, Edmundas Kazimieras

    2014-01-01

    retailers. The Nash equilibrium and definition are used bearing in mind inventory and pricing and marketing cost as decision variables for this matter. This paper studies a three-echelon supply chain network and focuses on the value of integrating a pair of partners in the chain. In the decentralized case......, the supplier sets its own price, the manufacturer points out order quantity, wholesale price and backorder quantity, and the retailer charges the final retail price of the product and marketing product. Though there are multiple players at a single echelon level, each manufacturer supplies only a specific...... to enforce marketing effort any more. Supplier-manufacturer integration brings similar benefits. Under each scenario, all parties involved simultaneously set their strategies. Through a numerical experiment, 17 design cases (through designing experiments) have been developed and the total profit...

  10. Maternal and reproductive health financing in Burundi: public-sector contribution levels and trends from 2010 to 2012.

    Science.gov (United States)

    Chaumont, Claire; Muhorane, Carmen; Moreira-Burgos, Isabelle; Juma, Ndereye; Avila-Burgos, Leticia

    2015-10-01

    An understanding of public financial flows to reproductive health (RH) at the country level is key to assessing the extent to which they correspond to political commitments. This is especially relevant for low-income countries facing important challenges in the area of RH. To this end, the present study analyzes public expenditure levels and trends with regards to RH in Burundi between the years 2010 to 2012, looking specifically at financing agents, health providers, and health functions. The analysis was performed using standard RH sub-account methodology. Information regarding public expenditures was gathered from national budgets, the Burundi Ministry of Public Health information system, and from other relevant public institutions. Public RH expenditures in Burundi accounted for $41.163 million international dollars in 2012, which represents an increase of 16 % from 2010. In 2012, this sum represented 0.57 % of the national GDP. The share of total public health spending allocated to RH increased from 15 % in 2010 to 19 % in 2012. In terms of public agents involved in RH financing, the Ministry of Public Health proved to play the most important role. Half of all public RH spending went to primary health care clinics, while more than 70 % of this money was used for maternal health; average public RH spending per woman of childbearing age stagnated during the study period. The flow patterns and levels of public funds to RH in Burundi suggest that RH funding correctly reflects governmental priorities for the period between 2010 and 2012. In a context of general shrinking donor commitment, local governments have come to play a key role in ensuring the efficient use of available resources and the mobilizing of additional domestic funding. A strong and transparent financial tracking system is key to carrying out this role and making progress towards the MDG Goals and development beyond 2015.

  11. Financing Maternal Health and Family Planning: Are We on the Right Track? Evidence from the Reproductive Health Subaccounts in Mexico, 2003-2012.

    Directory of Open Access Journals (Sweden)

    Leticia Avila-Burgos

    Full Text Available To analyze whether the changes observed in the level and distribution of resources for maternal health and family planning (MHFP programs from 2003 to 2012 were consistent with the financial goals of the related policies.A longitudinal descriptive analysis of the Mexican Reproductive Health Subaccounts 2003-2012 was performed by financing scheme and health function. Financing schemes included social security, government schemes, household out-of-pocket (OOP payments, and private insurance plans. Functions were preventive care, including family planning, antenatal and puerperium health services, normal and cesarean deliveries, and treatment of complications. Changes in the financial imbalance indicators covered by MHFP policy were tracked: (a public and OOP expenditures as percentages of total MHFP spending; (b public expenditure per woman of reproductive age (WoRA, 15-49 years by financing scheme; (c public expenditure on treating complications as a percentage of preventive care; and (d public expenditure on WoRA at state level. Statistical analyses of trends and distributions were performed.Public expenditure on government schemes grew by approximately 300%, and the financial imbalance between populations covered by social security and government schemes decreased. The financial burden on households declined, particularly among households without social security. Expenditure on preventive care grew by 16%, narrowing the financing gap between treatment of complications and preventive care. Finally, public expenditure per WoRA for government schemes nearly doubled at the state level, although considerable disparities persist.Changes in the level and distribution of MHFP funding from 2003 to 2012 were consistent with the relevant policy goals. However, improving efficiency requires further analysis to ascertain the impact of investments on health outcomes. This, in turn, will require better financial data systems as a precondition for improving

  12. Financing Maternal Health and Family Planning: Are We on the Right Track? Evidence from the Reproductive Health Subaccounts in Mexico, 2003-2012.

    Science.gov (United States)

    Avila-Burgos, Leticia; Cahuana-Hurtado, Lucero; Montañez-Hernandez, Julio; Servan-Mori, Edson; Aracena-Genao, Belkis; Del Río-Zolezzi, Aurora

    2016-01-01

    To analyze whether the changes observed in the level and distribution of resources for maternal health and family planning (MHFP) programs from 2003 to 2012 were consistent with the financial goals of the related policies. A longitudinal descriptive analysis of the Mexican Reproductive Health Subaccounts 2003-2012 was performed by financing scheme and health function. Financing schemes included social security, government schemes, household out-of-pocket (OOP) payments, and private insurance plans. Functions were preventive care, including family planning, antenatal and puerperium health services, normal and cesarean deliveries, and treatment of complications. Changes in the financial imbalance indicators covered by MHFP policy were tracked: (a) public and OOP expenditures as percentages of total MHFP spending; (b) public expenditure per woman of reproductive age (WoRA, 15-49 years) by financing scheme; (c) public expenditure on treating complications as a percentage of preventive care; and (d) public expenditure on WoRA at state level. Statistical analyses of trends and distributions were performed. Public expenditure on government schemes grew by approximately 300%, and the financial imbalance between populations covered by social security and government schemes decreased. The financial burden on households declined, particularly among households without social security. Expenditure on preventive care grew by 16%, narrowing the financing gap between treatment of complications and preventive care. Finally, public expenditure per WoRA for government schemes nearly doubled at the state level, although considerable disparities persist. Changes in the level and distribution of MHFP funding from 2003 to 2012 were consistent with the relevant policy goals. However, improving efficiency requires further analysis to ascertain the impact of investments on health outcomes. This, in turn, will require better financial data systems as a precondition for improving the

  13. Trends in the distribution of health care financing across developed countries: the role of political economy of states.

    Science.gov (United States)

    Calikoglu, Sule

    2009-01-01

    Since the 1980s, major health care reforms in many countries have focused on redefining the boundaries of government through increasing emphasis on private sources of finance and delivery of health care. Apart from managerial and financial choices, the reliance on private sources reflects the political character of a country. This article explores whether the public-private mix of health care financing differs according to political traditions in a sample of 18 industrialized countries, analyzing a 30-year period. The results indicate that despite common trends in all four political traditions during the study period, the overall levels of expenditure and the rates of growth in public and private expenditures were different. Christian democratic countries had public expenditure levels as high as those in social democracies, but high levels of private expenditure differentiated them from the social democracies. Christian democratic countries also relied on both private insurance and out-of-pocket payments, while private insurance expenditures were very limited in social democratic countries. The level of public spending increased at much higher rates among ex-authoritarian countries over the 30 years, bringing these countries to the level of liberal countries by 2000.

  14. Project financing

    International Nuclear Information System (INIS)

    Cowan, A.

    1998-01-01

    Project financing was defined ('where a lender to a specific project has recourse only to the cash flow and assets of that project for repayment and security respectively') and its attributes were described. Project financing was said to be particularly well suited to power, pipeline, mining, telecommunications, petro-chemicals, road construction, and oil and gas projects, i.e. large infrastructure projects that are difficult to fund on-balance sheet, where the risk profile of a project does not fit the corporation's risk appetite, or where higher leverage is required. Sources of project financing were identified. The need to analyze and mitigate risks, and being aware that lenders always take a conservative view and gravitate towards the lowest common denominator, were considered the key to success in obtaining project financing funds. TransAlta Corporation's project financing experiences were used to illustrate the potential of this source of financing

  15. Corporate finance

    OpenAIRE

    P. Quiry; Y. Le Fur; A. Salvi; M. Dallocchio; P. Vernimmen

    2011-01-01

    Corporate Finance: Theory and Practice, 3rd Edition, the website www.vernimmen.com and the Vernimmen.com newsletter are all written and created by an author team who are both investment bankers/corporate financiers and academics. This book covers the theory and practice of Corporate Finance from a truly European perspective. It shows how to use financial theory to solve practical problems and is written for students of corporate finance and financial analysis and practising corporate financie...

  16. Consumer Finance

    OpenAIRE

    Peter Tufano

    2009-01-01

    Although consumer finance is a substantial element of the economy, it has had a smaller footprint within financial economics. In this review, I suggest a functional definition of the subfield of consumer finance, focusing on four key functions: payments, risk management, moving funds from today to tomorrow (saving/investing), and from tomorrow to today (borrowing). I provide data showing the economic importance of consumer finance in the American economy. I propose a historical explanation fo...

  17. Project financing

    International Nuclear Information System (INIS)

    Alvarez, M.U.

    1990-01-01

    This paper presents the basic concepts and components of the project financing of large industrial facilities. Diagrams of a simple partnership structure and a simple leveraged lease structure are included. Finally, a Hypothetical Project is described with basic issues identified for discussion purposes. The topics of the paper include non-recourse financing, principal advantages and objectives, disadvantages, project financing participants and agreements, feasibility studies, organization of the project company, principal agreements in a project financing, insurance, and an examination of a hypothetical project

  18. Assessing public and private sector contributions in reproductive health financing and utilization for six sub-Saharan African countries.

    Science.gov (United States)

    Nguyen, Ha; Snider, Jeremy; Ravishankar, Nirmala; Magvanjav, Oyunbileg

    2011-05-01

    The present study provides evidence to support enhanced attention to reproductive health and comprehensive measures to increase access to quality reproductive health services. We compare and contrast the financing and utilization of reproductive health services in six sub-Saharan African countries using data from National Health Accounts and Demographic and Health Surveys. Spending on reproductive health in 2006 ranged from US$4 per woman of reproductive age in Ethiopia to US$17 in Uganda. These are below the necessary level for assuring adequate services given that an internationally recommended spending level for family planning alone was US$16 for 2006. Moreover, reproductive health spending shows signs of decline in tandem with insufficient improvement in service utilization. Public providers played a predominant role in antenatal and delivery care for institutional births, but home deliveries with unqualified attendants dominated. The private sector was a major supplier of condoms, oral pills and IUDs. Private clinics, pharmacies and drug vendors were important sources of STI treatment. The findings highlight the need to commit greatly increased funding for reproductive health services as well as more policy attention to the contribution of public, private and informal providers and the role of collaboration among them to expand access to services for under-served populations. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  19. Decentralized Quasi-Newton Methods

    Science.gov (United States)

    Eisen, Mark; Mokhtari, Aryan; Ribeiro, Alejandro

    2017-05-01

    We introduce the decentralized Broyden-Fletcher-Goldfarb-Shanno (D-BFGS) method as a variation of the BFGS quasi-Newton method for solving decentralized optimization problems. The D-BFGS method is of interest in problems that are not well conditioned, making first order decentralized methods ineffective, and in which second order information is not readily available, making second order decentralized methods impossible. D-BFGS is a fully distributed algorithm in which nodes approximate curvature information of themselves and their neighbors through the satisfaction of a secant condition. We additionally provide a formulation of the algorithm in asynchronous settings. Convergence of D-BFGS is established formally in both the synchronous and asynchronous settings and strong performance advantages relative to first order methods are shown numerically.

  20. Consumer-led demand side financing in health and education and its relevance for low and middle income countries.

    Science.gov (United States)

    Ensor, Tim

    2004-01-01

    There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.

  1. The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

    Directory of Open Access Journals (Sweden)

    Philip J. van der Wees

    2016-01-01

    Full Text Available Background Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered and depth of coverage (the proportion of costs of the covered benefits that is covered publicly are corresponding variables in determining the benefits package. We hypothesized that a more comprehensive health benefit package may increase user costsharing charges. Methods We conducted a desktop research study to assess the interrelationship between the scope of covered health benefits and the height of statutory spending in a sample of 8 European countries: Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted a targeted literature search to identify characteristics of the healthcare systems in our sample of countries. We analyzed similarities and differences based on the dimensions of publicly financed healthcare as published by the European Observatory on Health Care Systems. Results We found that the scope of services is comparable and comprehensive across our sample, with only marginal differences. Cost-sharing arrangements show the most variation. In general, we found no direct interrelationship in this sample between the ranges of services covered in the health benefits package and the height of public spending on healthcare. With regard to specific services (dental care, physical therapy, we found indications of an association between coverage of services and cost-sharing arrangements. Strong variations in the volume and price of healthcare services between the 8 countries were found for services with large practice variations. Conclusion Although reducing the scope of the benefit package as well as increasing user charges may contribute to the financial sustainability of healthcare, variations in the volume and price of care seem to have

  2. Decentralized Bribery and Market Participation

    OpenAIRE

    Popov, Sergey V.

    2012-01-01

    I propose a bribery model that examines decentralized bureaucratic decision-making. There are multiple stable equilibria. High levels of bribery reduce an economy's productivity because corruption suppresses small business, and reduces the total graft, even though the size of an individual bribe might increase. Decentralization prevents movement towards a Pareto-dominant equilibrium. Anticorruption efforts, even temporary ones, might be useful to improve participation, if they lower the bribe...

  3. Regional Development and Decentralization – two Options to Overcome Lack of Funding

    Directory of Open Access Journals (Sweden)

    Dubravka JURLINA ALIBEGOVIC

    2014-11-01

    Full Text Available Decentralization can be generally described as a process in which selected functions are assigned to sub-national units. The literature identifies a number of positive consequences of decentralization which all lead to a better satisfaction of citizens’ needs for public services. Although the decentralization process in Croatia started more than ten years ago, it has not yet been completed. While leading to a new allocation of authorities and responsibilities to local government units, the level of fiscal decentralization remained lower than in the EU countries.In this paper we analyze the fiscal capacity of local government units to provide an insight into the main problems of decentralization in Croatia. We show that most local government units have very low fiscal capacity, which is insufficient for financing basic public functions with their own resources. The paper presents the results of a survey relating to the decentralization process conducted among local councilors at the regional level in Croatia. We explore how local councilors at the regional level evaluate different goals of decentralization. With the lack of fiscal capacity in mind, we identify two possible solutions for an optimal provision of public functions. The first one is the level of political will for a joint provision of public functions by different local units, and the second one is a change in the territorial organization of the country. We measure the difference in the attitudes toward these questions across counties.

  4. How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology.

    Science.gov (United States)

    Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T

    2018-01-01

    Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Behavioral finance

    Directory of Open Access Journals (Sweden)

    Kapor Predrag

    2014-01-01

    Full Text Available This paper discuss some general principles of behavioral finance Behavioral finance is the dynamic and promising field of research that mergers concepts from financial economics and cognitive psychology in attempt to better understand systematic biases in decision-making process of financial agents. While the standard academic finance emphasizes theories such as modern portfolio theory and the efficient market hypothesis, the behavioral finance investigates the psychological and sociological issues that impact the decision-making process of individuals, groups and organizations. Most of the research behind behavioral finance has been empirical in nature, concentrating on what people do and why. The research has shown that people do not always act rationally, nor they fully utilise all information available to them.

  6. Methodological challenges in evaluating health care financing equity in data-poor contexts: lessons from Ghana, South Africa and Tanzania.

    Science.gov (United States)

    Borghi, Josephine; Ataguba, John; Mtei, Gemini; Akazili, James; Meheus, Filip; Rehnberg, Clas; Di, McIntyre

    2009-01-01

    Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings. FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socioeconomic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised. LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g., wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with 'public transport' use

  7. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review.

    Science.gov (United States)

    Whyle, Eleanor Beth; Olivier, Jill

    2016-12-01

    In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria.

    Science.gov (United States)

    Bhatnagar, Aarushi; George, Asha S

    2016-09-01

    In 2012, the Nigerian government launched performance-based financing (PBF) in three districts providing financial incentives to health workers based on the quantity and quality of service provision. They were given autonomy to use funds for operational costs and performance bonuses. This study aims to understand changes in perceived motivation among health workers with the introduction of PBF in Wamba district, Nigeria. The study used a qualitative research design to compare perceptions of health workers in facilities receiving PBF payments in the pilot district of Wamba to those that were not. In-depth semi-structured interviews (n = 39) were conducted with health workers from PBF and non-PBF facilities along with managers of the PBF project. Framework analysis was used to identify patterns and variations in responses. Facility records were collated and triangulated with qualitative data. Health workers receiving PBF payments reported to be 'awakened' by performance bonuses and improved working environments including routine supportive supervision and availability of essential drugs. They recounted being more punctual, hard working and proud of providing better services to their communities. In comparison, health workers in non-PBF facilities complained about the dearth of basic equipment and lack of motivating strategies. However, health workers from both sets of facilities considered there to be a severe shortage of manpower resulting in excessive workload, fatigue and general dissatisfaction. PBF strategies can succeed in motivating health workers by bringing about a change in incentives and working conditions. However, such programmes need to be aligned with human resource reforms including timely recruitment and appropriate distribution of health workers to prevent burn out and attrition. As people working on the frontline of constrained health systems, health workers are responsive to improved incentives and working conditions, but need more

  9. Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

    Science.gov (United States)

    Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

    2018-01-01

    To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  10. Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model.

    Science.gov (United States)

    Megiddo, Itamar; Colson, Abigail; Chisholm, Dan; Dua, Tarun; Nandi, Arindam; Laxminarayan, Ramanan

    2016-03-01

    An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery. We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance. All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure. Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth

  11. Financing Investment

    DEFF Research Database (Denmark)

    Hirth, Stefan; Flor, Christian Riis

    Intuition suggests that corporate investment should be decreasing in financing constraints. We show that even when financing is obtained using a standard debt contract and there is symmetric information between the firm and outside investors, the relation is actually U-shaped. We thus provide a new...... theoretical explanation for the recent empirical findings of Cleary et al. (2007). We split up the endogenously implied financing costs and propose a trade-off between expected liquidation costs and second-best investment costs. For rather unconstrained firms, the risk of costly liquidation dominates the cost...

  12. A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

    Science.gov (United States)

    Iwami, Michiyo; Petchey, Roland

    2002-12-01

    In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

  13. Teaching and assessing systems-based practice: a pilot course in health care policy, finance, and law for radiation oncology residents.

    Science.gov (United States)

    Mitchell, James D; Parhar, Preeti; Narayana, Ashwatha

    2010-09-01

    Under the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, residency programs are required to provide data on educational outcomes and evidence for how this information is used to improve resident education. To teach and assess systems-based practice through a course in health care policy, finance, and law for radiation oncology residents, and to determine its efficacy. We designed a pilot course in health care policy, finance, and law related to radiation oncology. Invited experts gave lectures on policy issues important to radiation oncology and half of the participants attended the American Society for Therapeutic Radiation and Oncology (ASTRO) Advocacy Day. Participants completed pre- and postcourse tests to assess their knowledge of health policy. Six radiation oncology residents participated, with 5 (84%) completing all components. For the 5 residents completing all assessments, the mean precourse score was 64% and the mean postcourse score was 84% (P  =  .05). Improvement was noted in all 3 sections of health policy, finance, and medical law. At the end of the course, 5 of 6 residents were motivated to learn about health policy, and 4 of 6 agreed it was important for physicians to be involved in policy matters. Teaching radiation oncology residents systems-based practice through a course on health policy, finance, and law is feasible and was well received. Such a course can help teaching programs comply with the ACGME Outcome Project and would also be applicable to trainees in other specialties.

  14. Financing Innovation

    OpenAIRE

    William R. Kerr; Ramana Nanda

    2014-01-01

    We review the recent literature on the financing of innovation, inclusive of large companies and new startups. This research strand has been very active over the past five years, generating important new findings, questioning some long-held beliefs, and creating its own puzzles. Our review outlines the growing body of work that documents a role for debt financing related to innovation. We highlight the new literature on learning and experimentation across multi-stage innovation projects and h...

  15. Robust Decentralized Formation Flight Control

    Directory of Open Access Journals (Sweden)

    Zhao Weihua

    2011-01-01

    Full Text Available Motivated by the idea of multiplexed model predictive control (MMPC, this paper introduces a new framework for unmanned aerial vehicles (UAVs formation flight and coordination. Formulated using MMPC approach, the whole centralized formation flight system is considered as a linear periodic system with control inputs of each UAV subsystem as its periodic inputs. Divided into decentralized subsystems, the whole formation flight system is guaranteed stable if proper terminal cost and terminal constraints are added to each decentralized MPC formulation of the UAV subsystem. The decentralized robust MPC formulation for each UAV subsystem with bounded input disturbances and model uncertainties is also presented. Furthermore, an obstacle avoidance control scheme for any shape and size of obstacles, including the nonapriorily known ones, is integrated under the unified MPC framework. The results from simulations demonstrate that the proposed framework can successfully achieve robust collision-free formation flights.

  16. Trends in research on forestry decentralization policies

    DEFF Research Database (Denmark)

    Lund, Jens Friis; Rutt, Rebecca Leigh; Ribot, Jesse

    2018-01-01

    institutions; studies focusing on power and the role of elites in forestry decentralization, and; studies that historicize and contextualize forestry decentralization as reflective of broader societal phenomena. We argue that these strands reflect disciplinary differences in values, epistemologies, and methods...

  17. Query Optimizations over Decentralized RDF Graphs

    KAUST Repository

    Abdelaziz, Ibrahim; Mansour, Essam; Ouzzani, Mourad; Aboulnaga, Ashraf; Kalnis, Panos

    2017-01-01

    Applications in life sciences, decentralized social networks, Internet of Things, and statistical linked dataspaces integrate data from multiple decentralized RDF graphs via SPARQL queries. Several approaches have been proposed to optimize query

  18. Health insurance in practice: international variations in financing, benefits, and problems

    National Research Council Canada - National Science Library

    Glaser, William G

    1991-01-01

    In "Health Insurance in practice", the author pinpoints the strengths and weaknesses of health insurance programs in developing countries and uses a lessons-from-abroad approach to offer suggestions...

  19. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    Directory of Open Access Journals (Sweden)

    Emil OLTEANU

    2014-11-01

    Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.

  20. Comprehensive Revenue and Expense Data Collection Methodology for Teaching Health Centers: A Model for Accountable Graduate Medical Education Financing.

    Science.gov (United States)

    Regenstein, Marsha; Snyder, John E; Jewers, Mariellen Malloy; Nocella, Kiki; Mullan, Fitzhugh

    2018-04-01

    Despite considerable federal investment, graduate medical education financing is neither transparent for estimating residency training costs nor accountable for effectively producing a physician workforce that matches the nation's health care needs. The Teaching Health Center Graduate Medical Education (THCGME) program's authorization in 2010 provided an opportunity to establish a more transparent financing mechanism. We developed a standardized methodology for quantifying the necessary investment to train primary care physicians in high-need communities. The THCGME Costing Instrument was designed utilizing guidance from site visits, financial documentation, and expert review. It collects educational outlays, patient service expenses and revenues from residents' ambulatory and inpatient care, and payer mix. The instrument was fielded from April to November 2015 in 43 THCGME-funded residency programs of varying specialties and organizational structures. Of the 43 programs, 36 programs (84%) submitted THCGME Costing Instruments. The THCGME Costing Instrument collected standardized, detailed cost data on residency labor (n = 36), administration and educational outlays (n = 33), ambulatory care visits and payer mix (n = 30), patient service expenses (n =  26), and revenues generated by residents (n = 26), in contrast to Medicare cost reports, which include only costs incurred by residency programs. The THCGME Costing Instrument provides a model for calculating evidence-based costs and revenues of community-based residency programs, and it enhances accountability by offering an approach that estimates residency costs and revenues in a range of settings. The instrument may have feasibility and utility for application in other residency training settings.

  1. Organisation and financing of the health care systems of Bulgaria and Greece – what are the parallels?

    Directory of Open Access Journals (Sweden)

    Exadaktylos Nikolaos M

    2005-05-01

    Full Text Available Abstract Background The Bulgarian and Greek Medical Care systems have been reformated the last fifteen years. The aim of this study was an examination and comparison of the Bulgarian and Greek Medical Care Systems. Methods This study was prepared by using all the published data related to both Bulgarian and Greek Medical Care systems. Besides, personal communications with related offices such as administration offices of hospitals and Ministries of Health were made. Results In both countries, besides the compulsory insurance there is also additional voluntary insurance which is provided by private companies. The most important difference is the family doctor (specialist in general medicine existing in Bulgaria. Every insured person needs a 'referral form' completed by the family doctor before visiting a hospital for medical attention (except emergencies. In contrast, in Greece an insured person can directly visit any hospital without needing any forms and independent of the severity of their health problem. An important disadvantage of the Greek health system is the low number of hospitals (139, in relation to population. In contrast, there are 211 hospitals in Bulgaria, although its population is lower than in Greece. Conclusion In both Greek and Bulgarian health systems changes must be done to solve the problems related to informal payments, limited financing, large debts, lack of appropriate investment policy, lack of an objective method for the costing of medical activities and inefficient management.

  2. Procedures and Criteria for the regulation of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2007-01-01

    Full Text Available Because great interest in an efficient range of effective medicinal innovations and achievements has arisen, many countries have introduced procedures to regulate the adoption of innovative non-medicinal technologies into the benefit catalogue of solidly financed health care insurances. With this as a background, this report will describe procedures for the adoption of innovative non-medicinal technologies by solidly financed health care insurances in Germany, England, Australia and Switzerland. This report was commissioned by the German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information.In order to find the relevant literature and information, systematic literature research, a hand search and a written survey were carried out. All the selected documents (chosen according to defined criteria for inclusion and exclusion were qualitatively evaluated, summarized and presented on a chart using a framework developed for this purpose. All the countries in this report require that some innovative non-medicinal technologies undergo evaluation by a central governing body. This evaluation is a prerequisite for adoption into the benefit catalogue. The process of evaluation can differ (e. g. the people and institutions concerned, the division of the synthesis of evidence and overall evaluation, processing the evidence. Similarities do exist, such as the size and composition of the governing bodies or the overreaching criteria according to which institutions must make their recommendations. This is how all the countries examined in this report determine how the benefits and effectiveness of the innovations, as well as their cost-effectiveness, can be chosen as criteria for the evaluation. Furthermore, there are many criteria which differ from country to country (social and ethical aspects, possible effects on the health system, etc. and which are also relevant to an evaluation. The preferred types of

  3. Decentralized Control of Autonomous Vehicles

    Science.gov (United States)

    2003-01-01

    Autonomous Vehicles by John S. Baras, Xiaobo Tan, Pedram Hovareshti CSHCN TR 2003-8 (ISR TR 2003-14) Report Documentation Page Form ApprovedOMB No. 0704...AND SUBTITLE Decentralized Control of Autonomous Vehicles 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Decentralized Control of Autonomous Vehicles ∗ John S. Baras, Xiaobo Tan, and Pedram

  4. Ubiquitous consultation tool for decentral knowledge workers

    OpenAIRE

    Nazari Shirehjini, A.A.; Rühl, C.; Noll, S.

    2003-01-01

    The special issue of this initial study is to examine the current work situation of consulting companies, and to elaborate a concept for supporting decentralized working consultants. The concept addresses significant challenges of decentralized work processes by deploying the Peer-to-Peer methodology to decentralized expert and Knowledge Management, cooperation, and enterprise resource planning.

  5. Public financing systems for radiology: experience in 12 European countries

    International Nuclear Information System (INIS)

    Kesteloot, K.

    1999-01-01

    This paper illustrates the evolution in public health care financing systems in 12 European countries, in terms of the financing of radiology services. The financing systems for radiology used by public health care financing agencies are described in detail. The implications of these new financing conditions for health care delivery are briefly sketched. The paper concludes with some strategies to help radiologists cope with the tightening financing conditions for medical imaging. (orig.) (orig.)

  6. Federal Economic Policy and the Finance of Elementary and Secondary Education in the Eighties.

    Science.gov (United States)

    Nelson, F. Howard

    1983-01-01

    Reviews the United States' fiscal situation and the outlook for local, state, and federal government support of education. Focuses on the impact of decentralization of education financing under a conservative government and on the influence of federal budget deficits on school finance. Includes suggestions for educators in seeking financial…

  7. Provincial Health Accounts in Kerman, Iran: An Evidence of a “Mixed” Healthcare Financing System

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Mehrolhassani

    2014-02-01

    Full Text Available Background Provincial Health Accounts (PHA as a subset of National Health Accounts (NHA present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC. This study aimed to examine Health Accounts in Kerman Province. Methods The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA method was used, in which data set was adjusted for the province. Results During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41 was related to private household funds, of which the Out-of-Pocket (OOP payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs (65.19% was related to curative services. Conclusion The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By performing the Family Physician Program (FPP and emphasizing Social Determinant of Health (SDH approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor

  8. Analisis Kebijakan Pembiayaan Kesehatan di Kabupaten Kepulauan Aru (Policy Analysis: Health Financing in Aru Island

    Directory of Open Access Journals (Sweden)

    Turniani Laksmiarti

    2014-04-01

    Full Text Available Background: The calculation of Community Health Development Index (IPKM of Aru Islands is in rank 352, of alldistricts/cities in Indonesia. This low in IPKM rank was suspected to be the result of the ineffectivity and ineffi ciency on health budgeting. Various problems can be detected and identifi ed through the implementation of the District Health Accounts (DHA in the district/city level. The objectives of this research is mapping district health account, which consist of resources, organizer, activity and program. Method: This method applied was cross sectional design, and was conducted in 2012. The analysis unit was health district offi ce and a cross- sector health agencies ho had health funding allocation (Hospital, Department of Population and Family Planning, Regional Development Planning Board, Social Services. Results: The results showed that the largest source of funding comes from the Aru Islands government is 91.95% (81.60% APBD and APBN 9.31%. Most budget management is dominated by the government (94.42%. Most of the archipelagic Aru District budgets are used for activities that 54.67% indirect and direct activities amounted to 45.33%. Besides, fi nancing mapping results also indicate that public health programs Aru district absorb 11.25% of the total budget, 18.36% for individual health program efforts and the remaining 70.39% for program support. Conclusions: Health budget in District Aru largely sourced from the government (central, provincial and district levels. Indirect activities absorb more budget than Important government programs such as HIV / AIDS, tuberculosis, malaria, etc. Recomendations: The government should provide more funds to implement important programs of the government. Health District Offi ce should also be able to allocate substantial funds for essential government programs.

  9. Provincial health accounts in Kerman, Iran: an evidence of a "mixed" healthcare financing system.

    Science.gov (United States)

    Mehrolhassani, Mohammad Hossein; Jafari, Mohammad; Zeinali, Javad; Ansari, Mina

    2014-02-01

    Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province. The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General's office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province. During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services. The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector.

  10. Health Reform for Communities: Financing Substance Abuse Services. Recommendations from a Join Together Policy Panel.

    Science.gov (United States)

    Join Together, Boston, MA.

    Substance abuse treatment has been demonstrated to be effective in reducing not only substance use, but also the economic, health, and social costs associated with substance abuse. This document examines how health care reform can preserve and enhance community substance abuse services. The cost effectiveness of funding substance abuse prevention…

  11. Performance-based financing with GAVI health system strengthening funding in rural Cambodia: a brief assessment of the impact.

    Science.gov (United States)

    Matsuoka, Sadatoshi; Obara, Hiromi; Nagai, Mari; Murakami, Hitoshi; Chan Lon, Rasmey

    2014-07-01

    Though Cambodia made impressive gains in immunization coverage between the years 2000 and 2005, it recognized several health system challenges to greater coverage of immunization and sustainability. The Global Alliance for Vaccines and Immunization (GAVI) opened a Health System Strengthening (HSS) funding window in 2006. To address the health system challenges, Cambodia has been receiving the GAVI HSS fund since October 2007. The major component of the support is performance-based financing (PBF) for maternal, neonatal and child health (MNCH) services. To examine the impact of the PBF scheme on MNCH services and administrative management in rural Cambodia. Quantitative and qualitative studies were conducted in Kroch Chhmar Operational District (OD), Cambodia. Quantitative analyses were conducted on the trends of the numbers of MNCH services. A brief analysis was conducted using qualitative data. After the commencement of the PBF support, the volume of MNCH services was significantly boosted. In addition, strengthened financial and operational management was observed in the study area. However, the quality of the MNCH services was not ensured. Technical assistance, rather than the PBF scheme, was perceived by stakeholders to play a vital role in increasing the quality of the services. To improve the quality of the health services provided, it is better to include indicators on the quality of care in the PBF scheme. Mutual co-operation between PBF models and technical assistance may ensure better service quality while boosting the quantity. A robust but feasible data validation mechanism should be in place, as a PBF could incentivize inaccurate reporting. The capacity for financial management should be strengthened in PBF recipient ODs. To address the broader aspects of MNCH, a balanced input of resources and strengthening of all six building blocks of a health system are necessary. Published by Oxford University Press in association with The London School of Hygiene

  12. Decentralized control: Status and outlook

    Czech Academy of Sciences Publication Activity Database

    Bakule, Lubomír

    2014-01-01

    Roč. 38, č. 1 (2014), s. 71-80 ISSN 1367-5788 R&D Projects: GA ČR GA13-02149S Institutional support: RVO:67985556 Keywords : decentralized control * networked control systems * event-triggered approach Subject RIV: BC - Control Systems Theory Impact factor: 2.518, year: 2014

  13. Peer Matcher : Decentralized Partnership Formation

    NARCIS (Netherlands)

    Bozdog, Nicolae Vladimir; Voulgaris, Spyros; Bal, Henri; van Halteren, Aart

    2015-01-01

    This paper presents Peer Matcher, a fully decentralized algorithm solving the k-clique matching problem. The aim of k-clique matching is to cluster a set of nodes having pair wise weights into k-size groups of maximal total weight. Since solving the problem requires exponential time, Peer Matcher

  14. Music Libraries: Centralization versus Decentralization.

    Science.gov (United States)

    Kuyper-Rushing, Lois

    2002-01-01

    Considers the decision that branch libraries, music libraries in particular, have struggled with concerning a centralized location in the main library versus a decentralized collection. Reports on a study of the Association of Research Libraries that investigated the location of music libraries, motivation for the location, degrees offered,…

  15. Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

    Science.gov (United States)

    Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

    2014-10-12

    The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

  16. Donor Financing of Global Mental Health, 1995—2015: An Assessment of Trends, Channels, and Alignment with the Disease Burden

    Science.gov (United States)

    Dieleman, J.; Singh, L.; Whiteford, H. A.

    2017-01-01

    Background A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Studies. Methods In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas—development assistance for health (in US Dollars) per DALY. Findings DAMH increased from USD 18 million in 1995 to USD 132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (USD 435 million, 30% of DAMH), while the United States government provided USD 270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%). DAMH available per DALY in 2013 ranged from USD 0.27 in East Asia and the Pacific to USD 1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden—approximately USD150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than USD1 of DAH per DALY. Interpretation Combining estimates of disease burden

  17. Donor Financing of Global Mental Health, 1995-2015: An Assessment of Trends, Channels, and Alignment with the Disease Burden.

    Directory of Open Access Journals (Sweden)

    F J Charlson

    Full Text Available A recent report by the Institute for Health Metrics and Evaluation (IHME highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year as estimated by the Global Burden of Disease Studies.In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas-development assistance for health (in US Dollars per DALY.DAMH increased from USD 18 million in 1995 to USD 132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (USD 435 million, 30% of DAMH, while the United States government provided USD 270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%. DAMH available per DALY in 2013 ranged from USD 0.27 in East Asia and the Pacific to USD 1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden-approximately USD150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than USD1 of DAH per DALY.Combining estimates of disease burden and development assistance for health

  18. Donor Financing of Global Mental Health, 1995-2015: An Assessment of Trends, Channels, and Alignment with the Disease Burden.

    Science.gov (United States)

    Charlson, F J; Dieleman, J; Singh, L; Whiteford, H A

    2017-01-01

    A recent report by the Institute for Health Metrics and Evaluation (IHME) highlights that mental health receives little attention despite being a major cause of disease burden. This paper extends previous assessments of development assistance for mental health (DAMH) in two significant ways; first by contrasting DAMH against that for other disease categories, and second by benchmarking allocated development assistance against the core disease burden metric (disability-adjusted life year) as estimated by the Global Burden of Disease Studies. In order to track DAH, IHME collates information from audited financial records, project level data, and budget information from the primary global health channels. The diverse set of data were standardised and put into a single inflation adjusted currency (2015 US dollars) and each dollar disbursed was assigned up to one health focus areas from 1990 through 2015. We tied these health financing estimates to disease burden estimates (DALYs) produced by the Global Burden of Disease 2015 Study to calculated a standardised measure across health focus areas-development assistance for health (in US Dollars) per DALY. DAMH increased from USD 18 million in 1995 to USD 132 million in 2015, which equates to 0.4% of total DAH in 2015. Over 1990 to 2015, private philanthropy was the most significant source (USD 435 million, 30% of DAMH), while the United States government provided USD 270 million of total DAMH. South and Southeast Asia received the largest proportion of funding for mental health in 2013 (34%). DAMH available per DALY in 2013 ranged from USD 0.27 in East Asia and the Pacific to USD 1.18 in the Middle East and North Africa. HIV/AIDS received the largest ratio of funds to burden-approximately USD150 per DALY in 2013. Mental and substance use disorders and its broader category of non-communicable disease received less than USD1 of DAH per DALY. Combining estimates of disease burden and development assistance for health provides

  19. Quantitative Finance

    Science.gov (United States)

    James, Jessica

    2017-01-01

    Quantitative finance is a field that has risen to prominence over the last few decades. It encompasses the complex models and calculations that value financial contracts, particularly those which reference events in the future, and apply probabilities to these events. While adding greatly to the flexibility of the market available to corporations and investors, it has also been blamed for worsening the impact of financial crises. But what exactly does quantitative finance encompass, and where did these ideas and models originate? We show that the mathematics behind finance and behind games of chance have tracked each other closely over the centuries and that many well-known physicists and mathematicians have contributed to the field.

  20. Leveraging finances for public health system improvement: results from the Turning Point initiative.

    Science.gov (United States)

    Bekemeier, Betty; Riley, Catharine M; Berkowitz, Bobbie

    2007-01-01

    Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

  1. La reforma del sector salud, descentralización, prevención y control de enfermedades transmitidas por vectores Health system, decentralization, and the control of vector-borne diseases

    Directory of Open Access Journals (Sweden)

    Gabriel A. Schmunis

    2000-01-01

    Full Text Available Con las nuevas macropolíticas mundiales, la salud en América Latina ha sufrido importante transición en direción a la decentralización, sin compatibilizar la salud pública con la lógica de las economías de mercado. Con esto, el control decentralizado de las enfermedades endémicas presenta dificultades políticas y operativas. Aunque la decentralización se justifica por los presupuestos teóricos, no hay tradición de este control en los niveles municipales, lo que dificulta la simple o burocrática transferencia de encargos para estos niveles. La falta de expertise, el turn-over político y la corrupción son dificultades adicionales, conllevando a una extinción de varias instituiciones y programas. La falta de efectividad en el enfrentamiento del dengue, de la malaria y de la enfermedad de Chagas son algunos ejemplos. Requierese una modernización con responsabilidad, con una transición compartida entre los niveles y garantizada por acciones continuadas. Sugierese mantener estructuras regionales para referencia, consolidación epidemiológica, normatización, capacitación y supervisión, incluso con reserva técnica para acciones finalísticas supletivas.Economic policies are changing Latin American health programs, particularly promoting decentralization. Numerous difficulties thus arise for the control of endemic diseases, since such activities traditionally depend on vertical, and centralized structures. Theoretical arguments in favor of decentralization notwithstanding, no such tradition exists at the county level. The lack of program expertise at peripheral levels, intensive staff turnover, and even corruption are additional difficulties. Hence, the simple bureaucratic transfer of activities from the Federal to county level is often irresponsible. The loss of priority for control of endemic diseases in Latin America may mean the inexorable extinction of traditional control services. Malaria, dengue fever, and Chagas disease

  2. Intra Sector Policy Interventions for Improvement of Iranian Health Financing System

    Directory of Open Access Journals (Sweden)

    Peivand Bastani

    2013-09-01

    Full Text Available Background and purpose: To determine an appropriate financial model for the health system of Iran, several studies have been conducted. But it seems that these studies were not comprehensive and further investigation is required. So to design a valid and enforceable mechanism, the study of policy interventions will be considered through consensus of all stakeholders. This investigation was done to determine the necessary policies and internal interventions for health care system financial improvement in Iran. Materials and methods: The present work was carried out through investigating all key stakeholders in the medical system and the related sectors in Iran, along with the analysis of internal and external communication by using SWOT and STEEP.V methods. Results: Strategic management of health-care costs, the development of a new financial system, clarity of costs, benefiting from health national accounts, the regulation of budget based on operations, preparing the credit of per capita from prepayment and risk accumulation, the development of referral systems and mechanisms, the establishment of public fund for services purchase, preventing the involvement of insurances in non-insurance cases, competing services with the private sector and increasing resources for the promotion of equality level have been determined as the key proposed interventions. Conclusion: It seems that the interventions based to the development of improving health financial system including the deployment of full accrual basis instead of cash basis, preparing and using services cost and operational budgeting and finally, cost management and productivity are the prerequisites of reforming health financial system.

  3. Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

    Science.gov (United States)

    Mann, Carlyn; Ng, Courtney; Akseer, Nadia; Bhutta, Zulfiqar A; Borghi, Josephine; Colbourn, Tim; Hernández-Peña, Patricia; Huicho, Luis; Malik, Muhammad Ashar; Martinez-Alvarez, Melisa; Munthali, Spy; Salehi, Ahmad Shah; Tadesse, Mekonnen; Yassin, Mohammed; Berman, Peter

    2016-09-12

    Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data. Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20-64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005-2010) for RMNH expenditures (2005-2010) and 165 % for CH expenditures (2005-2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements. Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures

  4. Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

    Directory of Open Access Journals (Sweden)

    Carlyn Mann

    2016-09-01

    Full Text Available Abstract Background Countdown to 2015 (Countdown supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. Methods This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania, supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data. Results Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20–64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005–2010 for RMNH expenditures (2005–2010 and 165 % for CH expenditures (2005–2011. Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements. Conclusions Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in

  5. The Two Edge Knife of Decentralization

    Directory of Open Access Journals (Sweden)

    Ahmad Khoirul Umam

    2011-07-01

    Full Text Available A centralistic government model has become a trend in a number of developing countries, in which the ideosycretic aspect becomes pivotal key in the policy making. The situation constitutes authoritarianism, cronyism, and corruption. To break the impasse, the decentralized system is proposed to make people closer to the public policy making. Decentralization is also convinced to be the solution to create a good governance. But a number of facts in the developing countries demonstrates that decentralization indeed has ignite emerges backfires such as decentralized corruption, parochialism, horizontal conflict, local political instability and others. This article elaborates the theoretical framework on decentralization's ouput as the a double-edge knife. In a simple words, the concept of decentralization does not have a permanent relationship with the creation of good governance and development. Without substantive democracy, decentralization is indeed potential to be a destructive political instrument threating the state's future.

  6. Decentralized neural control application to robotics

    CERN Document Server

    Garcia-Hernandez, Ramon; Sanchez, Edgar N; Alanis, Alma y; Ruz-Hernandez, Jose A

    2017-01-01

    This book provides a decentralized approach for the identification and control of robotics systems. It also presents recent research in decentralized neural control and includes applications to robotics. Decentralized control is free from difficulties due to complexity in design, debugging, data gathering and storage requirements, making it preferable for interconnected systems. Furthermore, as opposed to the centralized approach, it can be implemented with parallel processors. This approach deals with four decentralized control schemes, which are able to identify the robot dynamics. The training of each neural network is performed on-line using an extended Kalman filter (EKF). The first indirect decentralized control scheme applies the discrete-time block control approach, to formulate a nonlinear sliding manifold. The second direct decentralized neural control scheme is based on the backstepping technique, approximated by a high order neural network. The third control scheme applies a decentralized neural i...

  7. The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study.

    Science.gov (United States)

    Achoki, Tom; Lesego, Abaleng

    2017-03-21

    Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance coverage offers promise in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualized to many African health systems. We interviewed 37 key informants drawn from public, private and civil society organizations involved in health service delivery in Botswana. The objective was to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. We thematically synthesized their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage. Participants suggested that expansion of health insurance would be characterized by increased financial resources for health and catalyze an upsurge in utilization of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realizing the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage. Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance

  8. Decentralization in Zambia: resource allocation and district performance.

    Science.gov (United States)

    Bossert, Thomas; Chitah, Mukosha Bona; Bowser, Diana

    2003-12-01

    Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or

  9. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation

    Science.gov (United States)

    2013-01-01

    Background Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. Methods This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. Results The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. Conclusions The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars

  10. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

    Science.gov (United States)

    Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

    2013-09-29

    Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within

  11. Capitation-Based Financing Hampers the Provision of Preventive Services in Primary Health Care.

    Science.gov (United States)

    Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza

    2016-01-01

    Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive

  12. Sustainable finance

    NARCIS (Netherlands)

    Boersma-de Jong, Margreet F.

    2012-01-01

    Presentation for Springschool of Strategy, University of Groningen, 10 October 2012. The role of CSR is to stimulate ethical behaviour, and as a result, mutual trust in society. Advantage of CSR for the company and the evolution of CSR. From CSR to Sustainable Finance: how does CSR influence

  13. Financing Vidalia

    International Nuclear Information System (INIS)

    Lagassa, G.

    1991-01-01

    This article examines the innovative techniques the participants in the Vidalia, Mississippi hydropower project used to overcome the numerous obstacles to the financing of the project. The topics of the article are early obstacles, funding and permitting, hydrology questions, matching income to debt, unorthodox provisions and a tough closing

  14. Computational Finance

    DEFF Research Database (Denmark)

    Rasmussen, Lykke

    One of the major challenges in todays post-crisis finance environment is calculating the sensitivities of complex products for hedging and risk management. Historically, these derivatives have been determined using bump-and-revalue, but due to the increasing magnitude of these computations does...

  15. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol

    Directory of Open Access Journals (Sweden)

    Sidney Kristi

    2012-08-01

    Full Text Available Abstract Background High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSYand Chiranjeevi Yojana (CY, were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. Methods/designs The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. Discussion The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making

  16. Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available BACKGROUND: Emergency referral services (ERS are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. METHODS: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. RESULTS: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7 per patient transported or INR 21 (USD 0.35 per km travelled. CONCLUSION: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

  17. An evaluation of two large scale demand side financing programs for maternal health in India: the MATIND study protocol.

    Science.gov (United States)

    Sidney, Kristi; de Costa, Ayesha; Diwan, Vishal; Mavalankar, Dileep V; Smith, Helen

    2012-08-27

    High maternal mortality in India is a serious public health challenge. Demand side financing interventions have emerged as a strategy to promote access to emergency obstetric care. Two such state run programs, Janani Suraksha Yojana (JSY)and Chiranjeevi Yojana (CY), were designed and implemented to reduce financial access barriers that preclude women from obtaining emergency obstetric care. JSY, a conditional cash transfer, awards money directly to a woman who delivers in a public health facility. This will be studied in Madhya Pradesh province. CY, a voucher based program, empanels private obstetricians in Gujarat province, who are reimbursed by the government to perform deliveries of socioeconomically disadvantaged women. The programs have been in operation for the last seven years. The study outlined in this protocol will assess and compare the influence of the two programs on various aspects of maternal health care including trends in program uptake, institutional delivery rates, maternal and neonatal outcomes, quality of care, experiences of service providers and users, and cost effectiveness. The study will collect primary data using a combination of qualitative and quantitative methods, including facility level questionnaires, observations, a population based survey, in-depth interviews, and focus group discussions. Primary data will be collected in three districts of each province. The research will take place at three levels: the state health departments, obstetric facilities in the districts and among recently delivered mothers in the community. The protocol is a comprehensive assessment of the performance and impact of the programs and an economic analysis. It will fill existing evidence gaps in the scientific literature including access and quality to services, utilization, coverage and impact. The implementation of the protocol will also generate evidence to facilitate decision making among policy makers and program managers who currently work with or

  18. The organization and financing of cervical cancer prevention carried out by midwives in primary health care.

    Science.gov (United States)

    Sobczyk, Karolina; Woźniak-Holecka, Joanna; Holecki, Tomasz; Szałabska, Dorota

    2016-01-01

    The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.

  19. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand

    DEFF Research Database (Denmark)

    Seeberg, Jens; Pannarunothai, Supasit; Padmawati, Retna S

    2014-01-01

    This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar...

  20. Protecting the Health and Finances of the Elderly With Early Cognitive Impairment.

    Science.gov (United States)

    Edersheim, Judith; Murray, Evan D; Padmanabhan, Jaya L; Price, Bruce H

    2017-03-01

    The projected expansion of the nation's elderly population necessitates the revision of health care and policy strategies for safeguarding the health and assets of this community. The elderly are at greatly increased risk for developing mild cognitive impairment and Alzheimer's disease. These conditions are associated with diminished complex decision-making abilities that adversely affect patients, their families, and society, even during early stages of Alzheimer's disease. We present three composite patient histories that demonstrate problems routinely encountered by families, health care providers, and legal professionals during the course of early AD and MCI. We review the prevalence of cognitive and behavioral symptoms associated with MCI and early AD. Obstacles to early detection of cognitive decline, limitations of current testing modalities and benefits of earlier detection are discussed. Central themes common to medical and judicial approaches toward capacity assessment are discussed. We argue that an emphasis on earlier detection will result in benefits for patient health and result in financial savings to patients and the country as a whole. Finally, we recommend national guidelines for the evaluation of task-specific decision-making capacities to reduce the variability of outcome and improve quality of evaluations found among medical professionals, forensic evaluators, and legal actors. © 2017 American Academy of Psychiatry and the Law.

  1. Public-private partnerships in practice: collaborating to improve health finance policy in Ghana and Kenya.

    Science.gov (United States)

    Suchman, Lauren; Hart, Elizabeth; Montagu, Dominic

    2018-06-13

    Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public-private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. Drawing on semi-structured interviews conducted with National Health Insurance (NHI) officials in Kenya and Ghana, as well as with staff from several international NGOs (INGOs) representing social franchise networks that are partnering to increase private provider accreditation into the NHIs, this article examines one example of public-private collaboration in practice. We found that interviewees initially had incomplete knowledge about the potential for cross-sector synergy, but both sides were motivated to work together around shared goals and the potential for mutual benefit. The public-private relationship then evolved over time through regular face-to-face interactions, reciprocal feedback, and iterative workplan development. This process led to a collegial relationship that also has given small private providers more voice in the health system. In order to sustain this relationship, we recommend that both public and private sector representatives develop formalized protocols for working together, as well as less formal open channels for communication. Models for aggregating small private providers and delivering them to government programmes as a package have potential to facilitate public-private partnerships as well, but there is little evidence on how these models work in LMICs thus far.

  2. Petroleum products fiscality in the first 2006 finance law and in the amended 2005 finance law

    International Nuclear Information System (INIS)

    2006-01-01

    The measures relative to petroleum products fiscality adopted in the amended 2005 finance law aim at adjusting the allocation of the domestic tax on petroleum products (DTPP) to the 'departements' in order to compensate for the competence transfers which took place in the framework of decentralization. They concern the agriculture and LPG sectors and prepare to the DTPP regionalization. The measures adopted in the first 2006 finance law deal with the fiscality of biofuels and with the DTPP transfers to regions. (J.S.)

  3. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

  4. Promoting the dissemination of decision aids: an odyssey in a dysfunctional health care financing system.

    Science.gov (United States)

    Billings, John

    2004-01-01

    The usefulness of patient decision aids (PtDAs) is well documented, yet they are not in widespread use. Barriers include assuring balance and fairness (auspices matter), the cost of producing and maintaining them, and getting them into the hands of patients at the right time. The Foundation for Informed Medical Decision Making and its for-profit partner, Health Dialog, have developed a creative business model that helps overcome these barriers and has greatly expanded the reach of decision aids.

  5. Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes.

    Science.gov (United States)

    Weiser, Sheri D; Bukusi, Elizabeth A; Steinfeld, Rachel L; Frongillo, Edward A; Weke, Elly; Dworkin, Shari L; Pusateri, Kyle; Shiboski, Stephen; Scow, Kate; Butler, Lisa M; Cohen, Craig R

    2015-09-10

    Food insecurity and HIV/AIDS outcomes are inextricably linked in sub-Saharan Africa. We report on health and nutritional outcomes of a multisectoral agricultural intervention trial among HIV-infected adults in rural Kenya. This is a pilot cluster randomized controlled trial. The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and education in sustainable farming practices and financial management. Two health facilities in Nyanza Region, Kenya were randomly assigned as intervention or control. HIV-infected adults 18 to 49 years' old who were on antiretroviral therapy and had access to surface water and land were enrolled beginning in April 2012 and followed quarterly for 1 year. Data were collected on nutritional parameters, CD4 T-lymphocyte counts, and HIV RNA. Differences in fixed-effects regression models were used to test whether patterns in health outcomes differed over time from baseline between the intervention and control arms. We enrolled 72 and 68 participants in the intervention and control groups, respectively. At 12 months follow-up, we found a statistically significant increase in CD4 cell counts (165 cells/μl, P security (3.6 scale points higher, P < 0.001) and frequency of food consumption (9.4 times per week greater frequency, P = 0.013) compared to controls. Livelihood interventions may be a promising approach to tackle the intersecting problems of food insecurity, poverty and HIV/AIDS morbidity.

  6. The impact of orthopaedic research evidence on health financing in Australia.

    Science.gov (United States)

    Hua, Martin; Myers, Daniel; Host, Lachlan

    2018-05-02

    In Australia, approval by the Medical Services Advisory Committee (MSAC) is an important step in the implementation of new health technologies. The MSAC considers health technology assessments (HTA) when submitting a recommendation to the Minister of Health on a new technology's suitability for public funding. Despite being such a critical tool in formulating policy, there has been little scrutiny on the impact of limited evidence on the performance of a national HTA agency's mandate. We aim to determine the proportion of HTAs of orthopaedic technologies prepared for the MSAC that were supported by higher levels of evidence for effectiveness, and whether this affected the MSAC's ability to conclude on efficacy. We also investigated whether the availability of higher level evidence affected the performance of cost-effectiveness analyses. We performed a cohort study of all HTAs prepared for the MSAC from 1998 to 2017 with regards to new technologies in orthopaedic surgery. We identified seven HTAs encompassing nine orthopaedic technologies for inclusion. Higher levels of evidence were available for assessing the technology's effectiveness in six out of the nine technologies. The results did not show a statistically significant relationship between the availability of higher level evidence and MSAC's ability to make a clear conclusion on the assessment of effectiveness (P = 0.5). The proportion of HTAs where a cost-effectiveness analysis was performed was significantly higher (P decision-making.

  7. Ethics, health care and spinal cord injury: research, practice and finance.

    Science.gov (United States)

    Donovan, W H

    2011-02-01

    Dating back to ancient times, mankind has been absorbed with 'doing the right thing', that is, behaving in ways approved by the society and the culture during the era in which they lived. This has been and still is especially true for the medical and related health-care professions. Laws and professional codes have evolved over the years that provide guidelines as to how physicians should treat patients, beginning with the one authored by Hippocrates. Only more recently, however, have laws and codes been created to cover health-care research and the advances in health-care practice that have been brought to light by that research. Although these discoveries have clearly impacted the quality of life and duration of life for people with spinal cord injury and other maladies, they have also raised questions that go beyond the science. Questions such as when, why, how and for how long should such treatments be applied often relate more to what a society and its culture will condone and the answers can differ and have differed among societies depending on the prevailing ethics and morals. Modern codes and laws have been created so that the trust people have traditionally placed in their healers will not be violated or misused as happened during wars past, especially in Nazi Germany. This paper will trace the evolution of the rules that medical researchers, practitioners and payers for treatment must now follow and explain why guiding all their efforts that honesty must prevail.

  8. Vouchers as demand side financing instruments for health care: a review of the Bangladesh maternal voucher scheme.

    Science.gov (United States)

    Schmidt, Jean-Olivier; Ensor, Tim; Hossain, Atia; Khan, Salam

    2010-07-01

    Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup. Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts. The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services. The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health

  9. Local Stakeholders’ Perceptions about the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts

    Directory of Open Access Journals (Sweden)

    Elisabeth Paul

    2014-09-01

    Full Text Available Background Performance-Based Financing (PBF has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. Methods The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis. Results The Ministry of Health (MoH strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak—and ‘blurred’—to have a lasting inciting effect. It rather seems that PBF motivates health

  10. A descentralização da Vigilância em Saúde em Minas Gerais: caracterização dos serviços municipais, 2014 | The decentralization of health surveillance in Minas Gerais: characterization of counties’ services, 2014

    Directory of Open Access Journals (Sweden)

    Lucília Nunes Assis

    2017-08-01

    Full Text Available Introdução: O Projeto de Fortalecimento da Vigilância em Saúde implantado em 2012, em Minas Gerais, visava a descentralização da Vigilância Sanitária, subsidiada no diagnóstico local. Objetivos: Caracterizar os serviços municipais de Vigilância em Saúde no estado de Minas Gerais em 2014. Método: Estudo transversal que analisou diagnósticos de 527/853 (62% municípios do total do estado de MG. As variáveis comuns às áreas da Vigilância em Saúde foram instrumentos de gestão, financiamento, categoria profissional, qualificação e sistema de informação. Aquelas específicas às áreas da Vigilância em Saúde caracterizaram infraestrutura, serviços de referência e ações. Analisaram-se frequências, medianas, diferenças interquartílicas e coeficiente de Spearman (p< 0,05. Resultados: Observou-se associação entre instrumentos de gestão, disponibilidade de categorias profissionais, sistema de informação e porte populacional (p<0,001. Identificou-se infraestrutura insuficiente nas Vigilâncias Sanitária e Ambiental e predomínio das ações programáticas frente àquelas de monitoramento. Conclusões: O desafio da Vigilância em Saúde demanda enfrentamentos no campo da gestão, das práticas e do financiamento. ==================================================Introduction: The Health Surveillance Strengthening Project implemented in 2012 in Minas Gerais -subsidized by a local diagnosis- aimed at decentralizing Health Surveillance. Objectives: To characterizes the local Health Surveillance services in the state of Minas Gerais in 2014. Method: Descriptive study that analyzed 527 (62% out of a total of 853 counties. The common variables to the Health Surveillance areas were instruments of management, financing, professional category, qualification and information system. Specific variables to the Health Surveillance areas were characterized infrastructure, reference services and actions. Frequencies, medians

  11. Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

    Directory of Open Access Journals (Sweden)

    Alvaro Hidalgo-Vega

    2017-01-01

    Full Text Available Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in SpainThe editorial addresses the current use of economic evaluation in the assessment and potential funding and reimbursement of health technologies. Cost-effectiveness ratio and the acceptability thresholds are analyzed, pointing out the limitations that the current approach has for capturing the value of new technologies. A potential shift from National Health Systems to value-based prices is discussed, with a focus on health economics outcomes where multi-criteria analyses can be a complementary tool to traditional cost-effectiveness approaches.

  12. The Canadian health system and its financing El sistema de salud del Canadá y su financiamiento

    Directory of Open Access Journals (Sweden)

    Francisco Xavier Solórzano

    1997-07-01

    Full Text Available This work stems from a brief visit in 1993 to the Canadian health services as part of the PAHO International Health Training Program and the subsequent research, discussion, and analysis relating to that experience. By no means is this paper an exhaustive account of the system, but rather a close look at one of its aspects: financing. The main objective is to identify some of the virtues and limitations of a health system that is considered one of the most efficient, effective, and equitable in the world. Although the Canadian health system is financed by the federal government and the provincial governments, cost containment is a constant concern, since factors such as the growing use of highly complex technologies, hospital care, and long-term treatment of chronic and degenerative illnesses tend to increase costs. The progressive reduction in the federal budget has led to more efficient use of resources and the rationalization of installed capacity. At the same time, the relative simplicity of the system’s operation has permitted administrative costs to be kept low. In addition, alternative forms of care, such as local centers for community-based care, care at home and in special institutions to promote the maximum level of self-sufficiency, and the use of volunteers, have been devised in order to partially control cost increases. The people’s participation in planning and decision-making permit them to guide the development of the health services. Nevertheless, given the current situation, it is essential that the system be modified to prepare it for the challenges the twenty-first century will bring.El presente trabajo es el fruto de una breve visita realizada en 1993 a los servicios de salud de Canadá como parte del Programa de Formación en Salud Internacional de la OPS, y de un subsiguiente ejercicio de investigación, discusión y análisis. No pretende en modo alguno ser exhaustivo, sino más bien aproximarse a uno de los aspectos

  13. El sistema de salud del Canadá y su financiamiento The Canadian health system and its financing

    Directory of Open Access Journals (Sweden)

    Francisco Xavier Solórzano

    1997-03-01

    that experience. By no means is this paper an exhaustive account of the system, but rather a close look at one of its aspects: financing. The main objective is to identify some of the virtues and limitations of a health system that is considered one of the most efficient, effective, and equitable in the world. Although the Canadian health system is financed by the federal government and the provincial governments, cost containment is a constant concern, since factors such as the growing use of highly complex technologies, hospital care, and long-term treatment of chronic and degenerative illnesses tend to increase costs. The progressive reduction in the federal budget has lead to more efficient use of resources and the rationalization of installed capacity. At the same time, the relative simplicity of the system's operation has permitted administrative costs to be kept low. In addition, alternative forms of care, such as local centers for community-based care, care at home and in special institutions to promote the maximum level of self-ufficiency, and the use of volunteers, have been devised in order to partially control cost increases. The people's participation in planning and decision-making permit them to guide the development of the health services. Nevertheless, given the current situation, it is essential that the system be modified to prepare it for the challenges the twenty-first century will bring.

  14. Centralized or decentralized electricity production

    International Nuclear Information System (INIS)

    Boer, H.A. de.

    1975-01-01

    Because of low overall efficiency in electric power generation, it is argued that energy provision based on gas, combined with locally decentralized electricity production, saves for the Netherlands slightly more fossile fuel than nuclear technologies and makes the country independent of uranium resources. The reason the Netherlands persues this approach is that a big part of the energy is finally used for heating in the normal or moderate temperatures

  15. Problems in decentralized data acquisition

    International Nuclear Information System (INIS)

    Eder, R.

    1985-04-01

    This paper describes INIS (International Nuclear Information System) which is operated by the International Atomic Energy Agency (IAEA) in collaboration with 73 Member States and 14 international organizations. INIS is a computerized system for collecting, processing and disseminating nuclear information. The collection and scanning of literature, input preparation and the dissemination of output are completely decentralized, the checking and merging of the information data are centralized. This paper shows the structure, management, processing and problem areas of this system. (Author)

  16. [The new strategy of the British health system: reflections on the changes in British health care system in the light of the WHO report on the financing of health systems worldwide].

    Science.gov (United States)

    Vaccari, Vittorio; Passerino, Costantino; Giagnorio, Maria Laura

    2011-01-01

    The search for a strategy that can optimise resources far the financing of health systems is currently the subject of numerous worldwide experiments. This interest stems from the fact that in most countries, although having each one different specific characteristics, governments try to improve the efficiency and equity of health care. This worle analyses how innovative financing options at national level can be combined with decision-making processes typical of quality management to devise strategies far funding health services that are oriented towards their continuous improvement. The paper discusses, in particular, the strategy adopted in England, where the new law Equity and Excellence, liberating the NHS radically changes the management of the NHS, giving patients the choice of using different types of structures and therefore the possibility to find the most convenient combination in order to obtain the required service.

  17. Innovation, development, and financing of institutions of Higher Education in health

    Directory of Open Access Journals (Sweden)

    Mario Roberto Dal Poz

    Full Text Available Abstract: The article analyzes the configuration and trends in institutions of Higher Education and their relationship as components of the Health Economic-Industrial Complex (HEIC. The expansion of higher education is part of the transition from elite to mass systems, with tensions between quantitative and qualitative aspects. Such changes reflect different cultures and are related to international phenomena such as globalization, economic transformations, the development of new information and communication technologies, and the emergence of an international knowledge network. The scale and content of these changes vary according to the expansion and institutional reconfiguration of educational systems, as well as the link between state and society. Market expansion for private higher education stirs competition, shapes business clusters, modifies training processes, and raises new public policy challenges.

  18. From consumer to energy producer. Financing of decentral energy production with the participation of citizens as consumer by means of the Consumer Stock Ownership Plans (CSOP); Vom Verbraucher zum Energieproduzenten. Finanzierung dezentraler Energieproduktion unter Beteiligung von Buergern als Konsumenten mittels sog. Consumer Stock Ownership Plans (CSOPs)

    Energy Technology Data Exchange (ETDEWEB)

    Lowitzsch, Jens; Goebel, Katarzyna [Europa-Universitaet Viadrina, Frankfurt an der Oder (Germany). Osteuropaeisches Wirtschaftsrecht und Europaeische Rechtspolitik

    2013-06-15

    Sustainable growth? A paradoxical term in order to sell sustainability as a logical consequence of a continuous policy of controlled growth. In the context of sustainable energy today there is a lot of talk about growth. However, sustainability is not continuous growth, but at worst shrinkage and at best intelligent growth. The decentralization of the production of renewable energy with consumers as producers is as a way to sustainability.

  19. Household Finance

    OpenAIRE

    Campbell, John

    2006-01-01

    The welfare benefits of financial markets depend in large part on how effectively households use these markets. The study of household finance is challenging because household behavior is difficult to measure accurately, and because households face constraints that are not captured by textbook models, including fixed costs, uninsurable income risk, borrowing constraints, and contracts that are non-neutral with respect to inflation. Evidence on participation, diversification, and the exercise ...

  20. Willingness to pay for publicly financed health care services in Central and Eastern Europe: evidence from six countries based on a contingent valuation method.

    Science.gov (United States)

    Tambor, Marzena; Pavlova, Milena; Rechel, Bernd; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

    2014-09-01

    The increased interest in patient cost-sharing as a measure for sustainable health care financing calls for evidence to support the development of effective patient payment policies. In this paper, we present an application of a stated willingness-to-pay technique, i.e. contingent valuation method, to investigate the consumer's willingness and ability to pay for publicly financed health care services, specifically hospitalisations and consultations with specialists. Contingent valuation data were collected in nationally representative population-based surveys conducted in 2010 in six Central and Eastern European (CEE) countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine) using an identical survey methodology. The results indicate that the majority of health care consumers in the six CEE countries are willing to pay an official fee for publicly financed health care services that are of good quality and quick access. The consumers' willingness to pay is limited by the lack of financial ability to pay for services, and to a lesser extent by objection to pay. Significant differences across the six countries are observed, though. The results illustrate that the contingent valuation method can provide decision-makers with a broad range of information to facilitate cost-sharing policies. Nevertheless, the intrinsic limitations of the method (i.e. its hypothetical nature) and the context of CEE countries call for caution when applying its results. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. A enfermeira no processo de descentralização do sistema de saúde La enfermera en el proceso de descentralización del sistema de salud The nurse in the decentralization process of the health system

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Santa Fé Borges

    2004-12-01

    Full Text Available Estudo sobre o processo de descentralização do sistema de saúde nas décadas de 80 e 90 no município de Itabuna-BA; com o objetivo de descrever o processo de descentralização da saúde no município, identificando a inserção/participação da enfermeira nesse processo. Estudo descritivo, qualitativo de caráter exploratório, que utilizou para coleta de dados a entrevista semi-estruturada, e a análise documental. Os resultados apontam que a inserção da enfermeira no processo da descentralização seguiu-se de acordo com as mudanças transcorridas a cada gestão municipal, onde ela atuou mais efetivamente conforme foi o cenário estabelecido e sofreu influência das diversas conjunturas conformadas pelas políticas implantadas ou implementadas em cada contexto da gestão do Sistema de saúde municipal.Estudio sobre el proceso de descentralización del sistema de salud en las décadas de 80 y 90 en el municipio de Itabuna-BA; con el objetivo de describir el proceso de descentralización de la salud en el municipio, identificando la inserción/participación de la enfermera en este proceso. Estudio descriptivo cualitativo de carácter exploratorio, que utilizó para la coleta de datos la entrevista semiestructurada, y el análisis documental. Los resultados apuntan que la inserción de la enfermera en el proceso de descentralización se siguió de acuerdo con los cambios transcurridos en cada gestión municipal, donde actuó más efectivamente, conforme fue el escenario establecido y sufrió influencia de las diversas coyunturas conformadas por las políticas implantadas o implementadas en cada contexto de gestión del Sistema de salud municipal.Study about the decentralization process of the health system in the '80s and '90s in the city of Itabuna-BA. It is aimed at describing the city's health decentralization process, identifying the nurse's insertion/participation in this process. Descriptive/qualitative study of exploratory nature

  2. Medicaid’s Role in Financing Health Care for Children With Behavioral Health Care Needs in the Special Education System: Implications of the Deficit Reduction Act

    Science.gov (United States)

    Mandell, David S.; Machefsky, Aliza; Rubin, David; Feudtner, Chris; Pita, Susmita; Rosenbaum, Sara

    2010-01-01

    BACKGROUND Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid-reimbursed behavioral health care expenditures for school-aged children in general and children in special education in particular. METHODS Medicaid claims and special education records of youth ages 6 to 18 years in Philadelphia, PA, were merged for calendar year 2002. Behavioral health care volume, type, and expenditures were compared between Medicaid-enrolled children receiving and not receiving special education. RESULTS Significant overlap existed among the 126,533 children who were either Medicaid enrolled (114,257) or received special education (27,620). Medicaid-reimbursed behavioral health care was used by 21% of children receiving special education (37% of those Medicaid enrolled) and 15% of other Medicaid-enrolled children. Total expenditures were $197.8 million, 40% of which was spent on the 5728 children in special education and 60% of which was spent on 15,092 other children. CONCLUSIONS Medicaid-reimbursed behavioral health services disproportionately support special education students, with expenditures equivalent to 4% of Philadelphia’s $2 billion education budget. The results suggest that special education programs depend on Medicaid-reimbursed services, the financing of which the DRA may jeopardize. PMID:18808472

  3. Introduction to U.S. health policy: the organization, financing, and delivery of health care in America

    National Research Council Canada - National Science Library

    Barr, Donald A

    2011-01-01

    ... A. Barr reviews the current structure of the American health care system, describing the historical and political contexts in which it developed and the core policy issues that continue to confront us today...

  4. Introduction to U.S. health policy: the organization, financing, and delivery of health care in America

    National Research Council Canada - National Science Library

    Barr, Donald A

    2011-01-01

    Health care reform has dominated public discourse over the past several years, and the recent passage of the Affordable Care Act, rather than quell the rhetoric, has sparked even more debate. Donald...

  5. Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia.

    Science.gov (United States)

    Sukeri, Surianti; Mirzaei, Masoud; Jan, Stephen

    2017-01-01

    Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system. A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey. The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses. Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Innovation, development, and financing of institutions of Higher Education in health.

    Science.gov (United States)

    Poz, Mario Roberto Dal; Couto, Maria Helena Costa; Franco, Thais de Andrade Vidaurre

    2016-11-03

    The article analyzes the configuration and trends in institutions of Higher Education and their relationship as components of the Health Economic-Industrial Complex (HEIC). The expansion of higher education is part of the transition from elite to mass systems, with tensions between quantitative and qualitative aspects. Such changes reflect different cultures and are related to international phenomena such as globalization, economic transformations, the development of new information and communication technologies, and the emergence of an international knowledge network. The scale and content of these changes vary according to the expansion and institutional reconfiguration of educational systems, as well as the link between state and society. Market expansion for private higher education stirs competition, shapes business clusters, modifies training processes, and raises new public policy challenges. Resumo: Este artigo analisa a configuração e as tendências das instituições de Ensino Superior de saúde no seu relacionamento enquanto componentes do Complexo Econômico Industrial da Saúde (CEIS). A expansão do Ensino Superior é parte da transição de sistemas de elite para sistemas de massa, com tensionamentos entre aspectos quantitativos e qualitativos. Essas mudanças refletem diferentes culturas e se relacionam com fenômenos de escopo mundial como globalização, transformações econômicas, desenvolvimento de novas tecnologias de comunicação e informação, e emergência de uma rede internacional de conhecimento. A escala e o conteúdo dessas mudanças variam com a ampliação dos sistemas de ensino e na reconfiguração institucional, bem como na articulação entre Estado e sociedade. A ampliação do mercado privado no ensino acirra a competitividade, conformando conglomerados empresariais, alterando processos de formação e forjando novos desafios para as políticas públicas.

  7. Wage Dispersion and Decentralization of Wage Bargaining

    DEFF Research Database (Denmark)

    Dahl, Christian M.; Le Maire, Christian Daniel; Munch, Jakob Roland

    in the individual worker's wage-setting system that facilitates identification of the effects of decentralization. Consistent with predictions we find that wages are more dispersed under firm-level bargaining compared to more centralized wage-setting systems. However, the differences across wage-setting systems......This paper studies how decentralization of wage bargaining from sector to firm level influences wage levels and wage dispersion. We use a detailed panel data set covering a period of decentralization in the Danish labor market. The decentralization process provides exogenous variation...

  8. Dilemas do processo de gestão descentralizada da vigilância sanitária no Estado do Rio de Janeiro Dilemmas of the process of decentralized management of health surveillance in Rio de Janeiro State

    Directory of Open Access Journals (Sweden)

    Mirian Miranda Cohen

    2009-01-01

    Full Text Available Com a criação do Sistema Único de Saúde, em 1990, o Ministério da Saúde tomou as primeiras medidas para descentralizar as ações de vigilância sanitária, o que significou decisiva inovação na tradicional institucionalidade dessa área e grande desafio para os gestores nos três níveis da Federação. Os efeitos dessa determinação somente foram sentidos após criação da Agência Nacional de Vigilância Sanitária, em fins de 1999, quando foi possível estruturar o atual Sistema Nacional de Vigilância Sanitária numa concepção que incentiva o papel diretor, coordenador e executor das ações de maior complexidade das Secretarias Estaduais de Saúde. Este estudo analisa a descentralização da gestão da VISA empreendida pela Secretaria de Estado de Saúde do Rio de Janeiro no período 2002-2006 e as condições das Secretarias Municipais no exercício das respectivas funções, através de pesquisa baseada em análise dos relatórios de avaliação da descentralização elaborados pelo Centro de Vigilância Sanitária. Entre as conclusões, destaca a fragilidade da própria Secretaria de Saúde do estado para assumir os encargos a ela atribuídos e questões subjacentes ao exercício municipal. Tais constatações refletem as muitas dificuldades enfrentadas nas relações intergovernamentais diante do imperativo de as partes agirem solidariamente numa área fundamental para a saúde individual e coletiva e para o bem-estar da população. O estudo informa requisitos básicos do processo de estruturação de um órgão de VISA e constitui importante contribuição para melhor compreender os entraves políticos, institucionais, técnicos, materiais e humanos que desafiam os gestores, para implementar as inovações ensejadas com a descentralização neste complexo campo.With the creation of the Unified Health System in 1990, the Ministry of Health has taken the first steps to decentralize health surveillance actions, which meant a

  9. Descentralización del sector de salud y conflictos con el gremio médico en México Health sector decentralization and divergences with the medical society in Mexico

    Directory of Open Access Journals (Sweden)

    Raquel Abrantes Pêgo

    2002-06-01

    Full Text Available OBJETIVO: Investigar la percepción y acción del gremio médico en el marco de la descentralización del Sector de Salud en dos estados de México, Guanajuato y Sonora. MÉTODOS: Se han utilizado técnicas cualitativas de investigación. Fueron realizadas 35 entrevistas, semiestructuradas, en total entre los dos estados, a médicos colegiados, Guanajuato y Sonora, tanto de instituciones públicas como privadas y representantes de las asociaciones gremiales y sindicales. RESULTADOS: Para el gremio médico de los dos estados investigados, la descentralización ha implicado en inseguridad, como resultado de la falta de claridad en la regulación del Sector de Salud. La acción de los Colegios de Médicos de ambos estados, se tradujo en una mayor politización de los Colegios de Médicos estatales, en la elaboración de propuestas con el objetivo de incidir en el control del mercado laboral médico de dichos estados y participación en la estructura de poder regional. CONCLUSIONES: La investigación comprueba una readaptación del gremio médico en el ámbito regional, indicando su permanencia como grupo de poder. Contrariamente a lo que informa la literatura estadounidense en México, los médicos han logrado influenciar en la regulación, con la finalidad de no perder su status privilegiado dentro de la competencia existente.OBJECTIVE: To evaluate the medical society's perception and actions in the context of health sector decentralization in the states of Guanajuato and Sonora, Mexico. METHODS: Qualitative research techniques were applied. Thirty-five semi-structured interviews were conducted with medical college members of both public and private institutions, and collegiate and union representatives of both states studied. RESULTS: Members of medical society in both states acknowledged that decentralization implied in insecurity due to the lack of clarity of health sector regulations. As a result of actions of the medical college in both

  10. Decentralizing constrained-efficient allocations in the Lagos–Wright pure currency economy

    OpenAIRE

    Bajaj, Ayushi; Hu, Tai Wei; Rocheteau, Guillaume; Silva, Mario Rafael

    2017-01-01

    This paper offers two ways to decentralize the constrained-efficient allocation of the Lagos–Wright (2005) pure currency economy. The first way has divisible money, take-it-or-leave-it offers by buyers, and a transfer scheme financed by money creation. If agents are sufficiently patient, the first best is achieved for finite money growth rates. If agents are impatient, the equilibrium allocation approaches the constrained-efficient allocation asymptotically as the money growth rate tends to i...

  11. Decentralized or Centralized Systems for Colleges and Universities?

    Science.gov (United States)

    Heydinger, Richard B.; Norris, Donald M.

    1979-01-01

    Arguments for and against decentralization of data management, analysis, and planning systems are presented. It is suggested that technological advances have encouraged decentralization. Caution in this direction is urged and the development of an articulated decentralization program is proposed. (SF)

  12. Patient Experiences of Decentralized HIV Treatment and Care in Plateau State, North Central Nigeria: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Grace O. Kolawole

    2017-01-01

    Full Text Available Background. Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities. Decentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient experiences are not well understood. Methods. We conducted a qualitative study of patient experiences in decentralized HIV care in Plateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully selected. Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection activities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories representing patient experiences of decentralized care. Results. Patient participants in this study experienced the transition to decentralized care as a series of “trade-offs.” Advantages cited included saving time and money on travel to clinic visits, avoiding dangers on the road, and the “family-like atmosphere” found in some decentralized clinics. Disadvantages were loss of access to ancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred decentralized services overall. Conclusion. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside urban centers, suggesting increased availability of community-based services will be enthusiastically received.

  13. Education Finance in Egypt: Problems and a Possible Solution. Occasional Paper. RTI Press Publication OP-0017-1401

    Science.gov (United States)

    Healey, F. Henry; Crouch, Luis; Hanna, Rafik

    2014-01-01

    Egypt, currently in the throes of major political change, will likely undergo reforms of various sorts in the next few years. Some of these reforms are likely to give local entities, including schools, greater control over education finances. In 2007, the Government of Egypt began to decentralize some non-personnel recurrent finances from the…

  14. Integrating centralized and decentralized organization structures: an education and development model.

    Science.gov (United States)

    Sheriff, R; Banks, A

    2001-01-01

    Organization change efforts have led to critically examining the structure of education and development departments within hospitals. This qualitative study evaluated an education and development model in an academic health sciences center. The model combines centralization and decentralization. The study results can be used by staff development educators and administrators when organization structure is questioned. This particular model maximizes the benefits and minimizes the limitations of centralized and decentralized structures.

  15. The stimulative effect of an unconditional block grant on the decentralized provision of care

    OpenAIRE

    Mark Kattenberg; Wouter Vermeulen

    2015-01-01

    Understanding the impact of central government grants on decentralized health care provision is of crucial importance for the design of grant systems, yet empirical evidence on the prevalence of flypaper effects in this domain is rare. We study the decentralization of home care in the Netherlands and exploit the gradual introduction of formula-based equalization to identify the effect of exogenous changes in an unconditional block grant on local expenditure and utilization. A one euro increas...

  16. Construindo o "pacto de gestão" no SUS: da descentralização tutelada à gestão em rede Constructing the "management pact" for Brazil's National Health System (SUS: from supervised decentralization to network management

    Directory of Open Access Journals (Sweden)

    Leonardo Nelmi Trevisan

    2007-08-01

    Full Text Available Observada na distância do tempo, a implantação do SUS enfrenta descompassos gerenciais. Primeiro, as pressões, sempre maiores, por reforma do Estado que minimalize custos afetam a proposta de atendimento universal do sistema. Depois, a difícil convivência entre o princípio da descentralização com o conceito de rede, aqui entendida não só como ligação entre esferas diferenciadas de gestão, mas o modo pelo qual o acesso a um direito é exercido em rede, desde o planejamento. Por outro lado, decisões operacionais sobre a saúde foram descentralizadas, mas o repasse das verbas para efetivar tais decisões não foi. No aspecto administrativo, a descentralização da gestão de saúde sofreu solução de continuidade com a edição da Norma Operacional de Assistência à Saúde 01/2001. No aspecto gerencial, a implantação do conceito de rede, a arma mais eficiente para enfrentar a verticalização de estruturas decisórias, enfrenta "gargalos" operacionais e financeiros que impedem os diferentes atores das diferentes organizações de falarem a mesma "linguagem", o meio mais eficaz para gerar "vínculos" interorganizacionais. Porém, a efetiva interação de linguagens só será obtida no processo de construção de pactos de gestão.Over time, the implementation of Brazil's National Health System (SUS has encountered management problems. Initially, steadily rising pressures calling for State reform and trimmer costs affect the universal healthcare that is the purpose of this system. Conflicts then flare up between the decentralization principle and the network concept, viewed here as not merely links among different spheres of management, but rather the model through which access to a right is exercised through a network. Operating decisions on healthcare have been decentralized, while the budget transfers underwriting these decisions remain unchanged. From the civil service standpoint, the decentralization of healthcare management

  17. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-01-01

    Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Interpretation Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax

  18. Financing universal health coverage--effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries.

    Science.gov (United States)

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-07-18

    How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995-2011. Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9.86 (95% CI 3.92-15.8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16.7, 9.16 to 24.3), but not for consumption taxes on goods and services (-$4.37, -12.9 to 4.11). In countries with low tax revenues (tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6.74 percentage points (95% CI 0.87-12.6) and the extent of financial coverage by 11.4 percentage points (5.51-17.2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major

  19. Decentralization in Botswana: the reluctant process | Dipholo ...

    African Journals Online (AJOL)

    Botswana\\'s decentralization process has always been justified in terms of democracy and development. Consequently, the government has always argued that it is fully committed to decentralization in order to promote popular participation as well as facilitating sustainable rural development. Yet the government does not ...

  20. Decentralized control using compositional analysis techniques

    NARCIS (Netherlands)

    Kerber, F.; van der Schaft, A. J.

    2011-01-01

    Decentralized control strategies aim at achieving a global control target by means of distributed local controllers acting on individual subsystems of the overall plant. In this sense, decentralized control is a dual problem to compositional analysis where a global verification task is decomposed

  1. Policy Recommendations on Decentralization, Local Power and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-12-22

    Policy Recommendations on Decentralization, Local Power and Women's Rights. December 22, 2010. Image. The present document comprises a set of policy recommendations that define a global agenda on gender and decentralization. It emerged from the analysis and experiences shared during the Conference and the ...

  2. Decentralized Decision Making Toward Educational Goals.

    Science.gov (United States)

    Monahan, William W.; Johnson, Homer M.

    This monograph provides guidelines to help those school districts considering a more decentralized form of management. The authors discuss the levels at which different types of decisions should be made, describe the changing nature of the educational environment, identify different centralization-decentralization models, and suggest a flexible…

  3. What supervisors want to know about decentralization.

    Science.gov (United States)

    Boissoneau, R; Belton, P

    1991-06-01

    Many organizations in various industries have tended to move away from strict centralization, yet some centralization is still vital to top management. With 19 of the 22 executives interviewed favoring or implementing some form of decentralization, it is probable that traditionally centralized organizations will follow the trend and begin to decentralize their organizational structures. The incentives and advantages of decentralization are too attractive to ignore. Decentralization provides responsibility, clear objectives, accountability for results, and more efficient and effective decision making. However, one must remember that decentralization can be overextended and that centralization is still viable in certain functions. Finding the correct balance between control and autonomy is a key to decentralization. Too much control and too much autonomy are the primary reasons for decentralization failures. In today's changing, competitive environment, structures must be continuously redefined, with the goal of finding an optimal balance between centralization and decentralization. Organizations are cautioned not to seek out and install a single philosopher-king to impose unified direction, but to unify leadership goals, participation, style, and control to develop improved methods of making all responsible leaders of one mind about the organization's needs and goals.

  4. Decentralization or centralization: striking a balance.

    Science.gov (United States)

    Dirschel, K M

    1994-09-01

    An Executive Vice President for Nursing can provide the necessary link to meet diverse clinical demands when encountering centralization--decentralization decisions. Centralized communication links hospital departments giving nurses a unified voice. Decentralization acknowledges the need for diversity and achieves the right balance of uniformity through a responsive communications network.

  5. Project Financing

    OpenAIRE

    S. GATTI

    2005-01-01

    Στην εισαγωγή της παρούσας εργασίας δίνεται ο ορισμός του project financing, τα ιστορικά στοιχεία και οι τάσεις αγοράς του. Στο πρώτο κεφάλαιο αναφέρεται γιατί οι εταιρείες προτιμούν την χρηματοδότηση με project financing. Γίνεται λόγος για τα πλεονεκτήματά του έναντι της άμεσης χρηματοδότησης, καθώς και για τα μειονεκτήματα του project financing. Στο δεύτερο κεφάλαιο παρουσιάζονται τα χρηματοοικονομικά στοιχεία και ο ρόλος του χρηματοοικονομικού συμβούλου. Στην τρίτη ενότητα γίνεται η αναγνώ...

  6. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.

    Science.gov (United States)

    Stenberg, Karin; Hanssen, Odd; Edejer, Tessa Tan-Torres; Bertram, Melanie; Brindley, Callum; Meshreky, Andreia; Rosen, James E; Stover, John; Verboom, Paul; Sanders, Rachel; Soucat, Agnès

    2017-09-01

    domestic product spent on health would increase to a mean of 7·5% (2·1-20·5). Around 75% of costs are for health systems, with health workforce and infrastructure (including medical equipment) as the main cost drivers. Despite projected increases in health spending, a financing gap of $20-54 billion per year is projected. Should funds be made available and used as planned, the ambitious scenario would save 97 million lives and significantly increase life expectancy by 3·1-8·4 years, depending on the country profile. All countries will need to strengthen investments in health systems to expand service provision in order to reach SDG 3 health targets, but even the poorest can reach some level of universality. In view of anticipated resource constraints, each country will need to prioritise equitably, plan strategically, and cost realistically its own path towards SDG 3 and universal health coverage. WHO. Copyright © 2017 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

  7. Wage Dispersion and Decentralization of Wage Bargaining

    DEFF Research Database (Denmark)

    Dahl, Christian Møller; le Maire, Christian Daniel; Munch, Jakob R.

    2013-01-01

    This article studies how decentralization of wage bargaining from sector to firm level influences wage levels and wage dispersion. We use detailed panel data covering a period of decentralization in the Danish labor market. The decentralization process provides variation in the individual worker......'s wage-setting system that facilitates identification of the effects of decentralization. We find a wage premium associated with firm-level bargaining relative to sector-level bargaining and that the return to skills is higher under the more decentralized wage-setting systems. Using quantile regression......, we also find that wages are more dispersed under firm-level bargaining compared to more centralized wage-setting systems....

  8. Wind Farm Decentralized Dynamic Modeling With Parameters

    DEFF Research Database (Denmark)

    Soltani, Mohsen; Shakeri, Sayyed Mojtaba; Grunnet, Jacob Deleuran

    2010-01-01

    Development of dynamic wind flow models for wind farms is part of the research in European research FP7 project AEOLUS. The objective of this report is to provide decentralized dynamic wind flow models with parameters. The report presents a structure for decentralized flow models with inputs from...... local models. The results of this report are especially useful, but not limited, to design a decentralized wind farm controller, since in centralized controller design one can also use the model and update it in a central computing node.......Development of dynamic wind flow models for wind farms is part of the research in European research FP7 project AEOLUS. The objective of this report is to provide decentralized dynamic wind flow models with parameters. The report presents a structure for decentralized flow models with inputs from...

  9. Decentralized Procurement in Light of Strategic Inventories

    DEFF Research Database (Denmark)

    Frimor, Hans; Arya, Anil; Mittendorf, Brian

    2015-01-01

    The centralization versus decentralization choice is perhaps the quintessential organizational structure decision. In the operations realm, this choice is particularly critical when it comes to the procurement function. Why firms may opt to decentralize procurement has been often studied and conf......The centralization versus decentralization choice is perhaps the quintessential organizational structure decision. In the operations realm, this choice is particularly critical when it comes to the procurement function. Why firms may opt to decentralize procurement has been often studied...... and confirmed to be a multifaceted choice. This paper complements existing studies by detailing the trade-offs in the centralization versus decentralization decision in light of firm's decision to cede procurement choices to its individual devisions can help moderate inventory levels and provide a natural salve...

  10. Six hospitals describe decentralization, cost containment, and downsizing.

    Science.gov (United States)

    Lineweaver, L A; Battle, C E; Schilling, R M; Nall, C M

    1999-01-01

    Decentralization, cost containment, and downsizing continue in full force as healthcare organizations continue to adapt to constant economic change. Hospitals are forced to take a second and third look at how health care is managed in order to survive. Six Northwest Florida hospitals were surveyed in an effort to explore current changes within the healthcare delivery system. This article provides both managers and staff with an overview of recent healthcare changes in an area of the country with implications for staff development.

  11. Decentralized Energy from Waste Systems

    Directory of Open Access Journals (Sweden)

    Blanca Antizar-Ladislao

    2010-01-01

    Full Text Available In the last five years or so, biofuels have been given notable consideration worldwide as an alternative to fossil fuels, due to their potential to reduce greenhouse gas emissions by partial replacement of oil as a transport fuel. The production of biofuels using a sustainable approach, should consider local production of biofuels, obtained from local feedstocks and adapted to the socio-economical and environmental characteristics of the particular region where they are developed. Thus, decentralized energy from waste systems will exploit local biomass to optimize their production and consumption. Waste streams such as agricultural and wood residues, municipal solid waste, vegetable oils, and algae residues can all be integrated in energy from waste systems. An integral optimization of decentralized energy from waste systems should not be based on the optimization of each single process, but the overall optimization of the whole process. This is by obtaining optimal energy and environmental benefits, as well as collateral beneficial co-products such as soil fertilizers which will result in a higher food crop production and carbon dioxide fixation which will abate climate change.

  12. Decentralized energy from waste systems

    International Nuclear Information System (INIS)

    Antizar-Ladislao, B.; Turrion-Gomez, J. L.

    2010-01-01

    In the last five years or so, biofuels have been given notable consideration worldwide as an alternative to fossil fuels, due to their potential to reduce greenhouse gas emissions by partial replacement of oil as a transport fuel. The production of biofuels using a sustainable approach, should consider local production of biofuels, obtained from local feedstocks and adapted to the socio-economical and environmental characteristics of the particular region where they are developed. Thus, decentralized energy from waste systems will exploit local biomass to optimize their production and consumption. Waste streams such as agricultural and wood residues, municipal solid waste, vegetable oils, and algae residues can all be integrated in energy from waste systems. An integral optimization of decentralized energy from waste systems should not be based on the optimization of each single process, but the overall optimization of the whole process. This is by obtaining optimal energy and environmental benefits, as well as collateral beneficial co-products such as soil fertilizers which will result in a higher food crop production and carbon dioxide fixation which will abate climate change. (author)

  13. Division of Finance Homepage

    Science.gov (United States)

    Top Department of Administration logo Alaska Department of Administration Division of Finance Search Search the Division of Finance site DOF State of Alaska Finance Home Content Area Accounting Charge Cards You are here Administration / Finance Division of Finance Updates IRIS Expenditure Object Codes

  14. Creative Bus Financing.

    Science.gov (United States)

    Malone, Wade

    1982-01-01

    Alternative ways of financing school bus purchases include financing privately through contractors or commercial banks, financing through sources such as insurance companies and pension funds, leasing the buses, or contracting for transportation services. (Author/MLF)

  15. El impacto de la financiación de la asistencia sanitaria en las desigualdades The impact of healthcare financing on health inequalities

    Directory of Open Access Journals (Sweden)

    Rosa M. Urbanos

    2004-05-01

    Full Text Available El presente trabajo examina el impacto de la financiación de la asistencia sanitaria sobre las desigualdades en la oferta, el acceso y la utilización de los servicios de salud. El nuevo modelo de financiación autonómica y sanitaria, pese a las iniciales ganancias de equidad y suficiencia en el momento de su puesta en funcionamiento, introduce incertidumbre con respecto al volumen de recursos que en el futuro podrán dedicar las comunidades autónomas a la financiación de la sanidad, lo que puede originar desigualdades en la oferta de servicios y en el acceso a la asistencia sanitaria. El Fondo de Cohesión Sanitaria, diseñado para financiar la atención a los desplazados, no parece el instrumento adecuado para garantizar la igualdad de acceso a las prestaciones en el conjunto del Sistema Nacional de Salud. Por otra parte, el cambio en la composición de las fuentes de financiación de la sanidad, en la medida en que otorgue más peso a los impuestos indirectos, puede acarrear pérdidas de equidad o progresividad. Finalmente, este trabajo discute el posible impacto de la actual asignación funcional del presupuesto sanitario, excesivamente sesgada hacia el ámbito de la atención especializada, en las desigualdades en su utilización.This article summarizes the impact of health care financing instruments on inequalities of supply, access and use of health care services. Firstly, the new scheme of regional and health care financing, apart from the initial gains in terms of equity and sufficiency, introduces uncertainty about the volume of resources that will be devoted to health care facilities by the regions. This fact may cause some inter-territorial inequalities in the health care supply and the access to public services. The Health Care Cohesion Fund, which was designed to guarantee equality of access to the National Health Service, is not the optimal instrument to achieve such an ambitious goal. Secondly, the change in composition of

  16. Bitcoin as a decentralized currency

    Directory of Open Access Journals (Sweden)

    Dinić Vladimir

    2014-01-01

    Full Text Available Bitcoin is the first decentralized peer-to-peer crypto-currency founded in 2009. Its main specificity is the fact that there is no issuer of this currency. On the other hand, the supply of this currency is software-programmed and limited. Among other things, its main features are relatively secure payments, low transaction costs, anonymity, inability of counterfeiting, irreversibility of transactions, but also extremely unstable exchange rate. Despite many advantages, the use of this currency is subject of numerous discussions, as this currency offers the possibility of performing various abuses and criminal activities. The future of this and other currencies in this regard depends on both security and privacy of these currencies, and legal regulation of such payments.

  17. A utilização de serviços de saúde por sistema de financiamento An analysis of health services utilisation, by financing system

    Directory of Open Access Journals (Sweden)

    Silvia Marta Porto

    2006-12-01

    Full Text Available Este artigo analisa, a partir de microdados de 1998 e 2003 da PNAD/IBGE, a utilização de serviços de saúde sob a perspectiva de seu financiamento ou, em outras palavras, sob o prisma do sistema de proteção à saúde pelo qual o serviço foi utilizado: se pelo Sistema Único de Saúde (SUS, ou seja, pelo sistema público financiado por meio de tributos; se por planos e seguros de saúde privados e financiados por prêmios pagos por beneficiários e/ou seus empregadores; ou, finalmente, se mediante a compra direta de serviços (pagamento direto no ato da utilização de serviços. Entre os principais resultados da análise, destacam-se os seguintes: 1 o SUS financia a maioria dos atendimentos e das internações realizados no País, participação que aumentou significativamente entre 1998 e 2003; 2 embora o número absoluto de atendimentos realizados pelos três sistemas de financiamento tenha aumentado, a expansão do SUS foi muito mais significativa e a ela correspondeu uma desaceleração do crescimento do gasto privado direto; 3 o SUS é o principal financiador dos dois níveis extremos de complexidade da atenção à saúde: o de atenção básica e o da alta complexidade.This article analyses, from micro-data of the National Sample Household Survey (PNAD/IBGE from 1998 and 2003, the utilisation of health services according to different financing systems. In other words, it analyses if this utilisation has been done through the National Health System SUS (public and universal health insurance, financed by taxes, through private health insurance (premiums paid by the insured population and/or their employers or through out-of-pocket payments. The main results are: 1 SUS finances most of inpatient and outpatient utilisation and its participation has strongly increased from 1998 to 2003; 2 although the absolute number of outpatient utilisation made through the three systems has increased, SUS expansion has been much stronger (it increased

  18. The National Heart Failure Project: a health care financing administration initiative to improve the care of Medicare beneficiaries with heart failure.

    Science.gov (United States)

    Masoudi, F A; Ordin, D L; Delaney, R J; Krumholz, H M; Havranek, E P

    2000-01-01

    This is the second in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first article outlined the history of HCFA quality-improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. This article details the objectives and design of the Medicare National Heart Failure Quality Improvement Project (NHF), which has as its goal the improvement of inpatient heart failure care. (c)2000 by CHF, Inc.

  19. Federalism and Decentralization of Education in Argentina. Unintended Consequences of Decentralization of Expenditures in a Federal Country.

    Science.gov (United States)

    Falleti, Tulia G.

    By analyzing the process of decentralization of education in Argentina, this paper complements the existing literature on decentralization and federalism in two ways: (1) it studies the impact of federal institutions on the origins and evolution of decentralization; and (2) it analyzes a case of decentralization of education that, in a way not…

  20. Decentralization and financial autonomy: a challenge for local public authorities in the Republic of Moldova

    Directory of Open Access Journals (Sweden)

    Tatiana MANOLE

    2017-09-01

    Full Text Available This article reflects the decentralization process currently taking place in the Republic of Moldova. The purpose of the research is to acquaint readers with the fundamental concept of decentralization, with the areas of administrative decentralization, with the forms of manifestation of financial decentralization: fiscal decentralization and budget decentralization. The priorities of the decentralization process are identified.

  1. Behavioral finance: Finance with normal people

    Directory of Open Access Journals (Sweden)

    Meir Statman

    2014-06-01

    Behavioral finance substitutes normal people for the rational people in standard finance. It substitutes behavioral portfolio theory for mean-variance portfolio theory, and behavioral asset pricing model for the CAPM and other models where expected returns are determined only by risk. Behavioral finance also distinguishes rational markets from hard-to-beat markets in the discussion of efficient markets, a distinction that is often blurred in standard finance, and it examines why so many investors believe that it is easy to beat the market. Moreover, behavioral finance expands the domain of finance beyond portfolios, asset pricing, and market efficiency and is set to continue that expansion while adhering to the scientific rigor introduced by standard finance.

  2. Equity in health personnel financing after Universal Coverage: evidence from Thai Ministry of Public Health?s hospitals from 2008?2012

    OpenAIRE

    Ruangratanatrai, Wilailuk; Lertmaharit, Somrat; Hanvoravongchai, Piya

    2015-01-01

    Background Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from hea...

  3. Computing for Decentralized Systems (lecture 2)

    CERN Multimedia

    CERN. Geneva

    2018-01-01

    With the rise of Bitcoin, Ethereum, and other cryptocurrencies it is becoming apparent the paradigm shift towards decentralized computing. Computer engineers will need to understand this shift when developing systems in the coming years. Transferring value over the Internet is just one of the first working use cases of decentralized systems, but it is expected they will be used for a number of different services such as general purpose computing, data storage, or even new forms of governance. Decentralized systems, however, pose a series of challenges that cannot be addressed with traditional approaches in computing. Not having a central authority implies truth must be agreed upon rather than simply trusted and, so, consensus protocols, cryptographic data structures like the blockchain, and incentive models like mining rewards become critical for the correct behavior of decentralized system. This series of lectures will be a fast track to introduce these fundamental concepts through working examples and pra...

  4. Decentralized Utilitarian Mechanisms for Scheduling Games

    NARCIS (Netherlands)

    Cole, R.; Correa, J.; Gkatzelis, V.; Mirrokni, V.; Olver, N.K.

    2015-01-01

    Game Theory and Mechanism Design are by now standard tools for studying and designing massive decentralized systems. Unfortunately, designing mechanisms that induce socially efficient outcomes often requires full information and prohibitively large computational resources. In this work we study

  5. Computing for Decentralized Systems (lecture 1)

    CERN Multimedia

    CERN. Geneva

    2018-01-01

    With the rise of Bitcoin, Ethereum, and other cryptocurrencies it is becoming apparent the paradigm shift towards decentralized computing. Computer engineers will need to understand this shift when developing systems in the coming years. Transferring value over the Internet is just one of the first working use cases of decentralized systems, but it is expected they will be used for a number of different services such as general purpose computing, data storage, or even new forms of governance. Decentralized systems, however, pose a series of challenges that cannot be addressed with traditional approaches in computing. Not having a central authority implies truth must be agreed upon rather than simply trusted and, so, consensus protocols, cryptographic data structures like the blockchain, and incentive models like mining rewards become critical for the correct behavior of decentralized system. This series of lectures will be a fast track to introduce these fundamental concepts through working examples and pra...

  6. The effects of fiscal decentralization in Albania

    Directory of Open Access Journals (Sweden)

    Dr.Sc. Blerta Dragusha

    2012-06-01

    Full Text Available “Basically decentralization is a democratic reform which seeks to transfer the political, administrative, financial and planning authority from central to local government. It seeks to develop civic participation, empowerment of local people in decision making process and to promote accountability and reliability: To achieve efficiency and effectiveness in the collection and management of resources and service delivery”1 The interest and curiosity of knowing how our country is doing in this process, still unfinished, served as a motivation forme to treat this topic: fiscal decentralization as a process of giving 'power' to local governments, not only in terms of rights deriving from this process but also on the responsibilities that come with it. Which are the stages before and after decentralization, and how has it affected the process in several key indicators? Is decentralization a good process only, or can any of its effects be seen as an disadvantage?

  7. Decentralization and the local development state

    DEFF Research Database (Denmark)

    Emmenegger, Rony Hugo

    2016-01-01

    This article explores the politics of decentralization and state-peasant encounters in rural Oromiya, Ethiopia. Breaking with a centralized past, the incumbent government of the Ethiopian People's Revolutionary Democratic Front (EPRDF) committed itself to a decentralization policy in the early 1990......s and has since then created a number of new sites for state-citizen interactions. In the context of electoral authoritarianism, however, decentralization has been interpreted as a means for the expansion of the party-state at the grass-roots level. Against this backdrop, this article attempts...... between the 2005 and 2010 elections. Based on ethnographic field research, the empirical case presented discloses that decentralization and state-led development serve the expansion of state power into rural areas, but that state authority is simultaneously constituted and undermined in the course...

  8. Local Public Finance Management in the People’s Republic of China: Challenges and Opportunities

    OpenAIRE

    Asian Development Bank (ADB)

    2014-01-01

    The People’s Republic of China is a highly decentralized unitary state with local governments having a dominant share of public service delivery responsibility. Local governance is critically linked to a local public finance system that creates incentives and accountability mechanisms. To ensure the policy response, this project focused on the three interrelated areas in local public finance management, i.e., local budgeting, local debt management and local taxation, and produced policy optio...

  9. Financing off-grid sustainable energy access for the poor

    International Nuclear Information System (INIS)

    Glemarec, Yannick

    2012-01-01

    This paper examines the role of public instruments in promoting private finance to achieve off-grid sustainable energy access. Renewable energy technologies are increasingly becoming the cheapest solutions for off-grid energy access. The dramatic uptake of mobile phones in developing countries shows how quickly decentralized services can develop on a commercial basis under the right conditions, and raises the prospect that private finance could also drive decentralized energy access for the poor. Indeed, there are already a number of instances of clean energy solutions – such as solar portable lights, household biogas units or solar home systems – that have managed to scale-up through leveraging private finance. However, the experience gained from first-generation market development projects show that, in almost all cases, significant public resources have been necessary to increase the affordability of clean energy technologies, provide access to financing for the poor, and remove non-economic barriers. Such public interventions may be funded by international public finance, domestic budgets and carbon finance. Despite mounting fiscal constraints facing governments worldwide, the emergence of new sources of climate finance and the political momentum in support of energy subsidy reforms, as well as new programming modalities, offer opportunities to leverage additional resources to achieve universal energy access by 2030. - Highlights: ► Renewable energy is increasingly the cheapest solution for off-grid energy access. ► Universal access to energy now depends less on technology and more business models. ► Substantial public finance will still be required to support universal energy access.

  10. Financing Universal Coverage in Malaysia: a case study

    OpenAIRE

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this...

  11. The Two Edge Knife of Decentralization

    OpenAIRE

    Umam, Ahmad Khoirul

    2011-01-01

    A centralistic government model has become a trend in a number of developing countries, in which the ideosycretic aspect becomes pivotal key in the policy making. The situation constitutes authoritarianism, cronyism, and corruption. To break the impasse, the decentralized system is proposed to make people closer to the public policy making. Decentralization is also convinced to be the solution to create a good governance. But a number of facts in the developing countries demonstrates that dec...

  12. Making decentralization work for women in Uganda

    OpenAIRE

    Lakwo, A.<