Showing papers by "Guy Carrin published in 2005"

Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems.

Abstract: We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.

Social Health Insurance: Key Factors Affecting the Transition Towards Universal Coverage

Abstract: Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand the factors that affect the transition from incomplete to universal coverage. This paper analyses the experience of eight countries in the implementation of social health insurance. It highlights the importance of the socioeconomic and political context, particularly in relation to the level of income, structure of the economy, distribution of the population, ability to administer and level of solidarity within the country, but also stresses the important stewardship role government can play in facilitating the transition to universal coverage via social health insurance.

Social Health Insurance: Key Factors Affecting the Transition Towards Universal Coverage

Abstract: Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand the factors that affect the transition from incomplete to universal coverage. This paper analyses the experience of eight countries in the implementation of social health insurance. It highlights the importance of the socioeconomic and political context, particularly in relation to the level of income, structure of the economy, distribution of the population, ability to administer and level of solidarity within the country, but also stresses the important stewardship role government can play in facilitating the transition to universal coverage via social health insurance.

Clarifying efficiency-equity tradeoffs through explicit criteria, with a focus on developing countries

Abstract: Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.

Key performance indicators for the implementation of social health insurance

Abstract: Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand what characterises a well performing social health insurance scheme. This article provides a simple framework to analyse key performance issues related to the functions of health financing within the context of social health insurance. The framework first illustrates how performance in the health financing functions of revenue collection, pooling and purchasing affects the realisation of health financing targets of resource generation, optimal resource use and financial accessibility of health services for all. Then, within each health financing function, key performance issues and associated measurable indicators are developed. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. In doing so, policy makers can come closer to achieving universal coverage -- access to appropriate healthcare for all at an affordable cost -- the ultimate goal of social health insurance.

The challenge of private insurance for public good.

Abstract: A fundamental principle of WHO’s work in health financing is the concept of universal coverage. This requires access for all people to appropriate promotive, preventive, curative and rehabilitative health care at an affordable cost. This is one requirement of health for all and is consistent with the principle of equity in access. The objective of universal coverage is also associated with equity in financing, whereby households con-tribute to financing the health system on the basis of their ability to pay.The goal of universal coverage is accepted in most countries, though its realization is dependent on organiza-tional mechanisms that allow financial contributions to the health system to be collected efficiently from different sources, that pool these contributions so that the risk of having to pay for health care is shared by all and not borne by each contributor individu-ally, and that use these contributions to purchase or provide effective health interventions.A variety of different arrangements can be observed in how funds are raised, pooled and used for health care, and it is this mix that determines the efficiency and equity of health systems. Unfor-tunately, in the majority of the poorest countries, a major — and sometimes the primary — financing mechanism is out-of-pocket payments at the point of service, which is the most inequitable system of financing health care (1).The paper by Sekhri & Savedoff (pp. 127–134) provides some valuable information on the significant degree to which private health insurance exists in many countries. Although the label “private” is quite comprehensive and merits further scrutiny (2), the authors posit that it can be one stepping stone or critical component on the way to uni-versal coverage. The potential of a such a trajectory is contingent on two key

El seguro social de salud: factores clave que inciden en la transición hacia la cobertura universal

Abstract: Varios paises de ingresos bajos y medianos estan interesados en que su actual seguro de salud, destinado especificamente a ciertos grupos, sea extendido con el fin de cubrir eventualmente a toda su poblacion. Es importante que esos paises entiendan cuales son los factores que inciden en la transicion de una cobertura incompleta a otra de caracter universal. Analizamos en el presente articulo la experiencia de ocho paises en lo concerniente a la instrumentacion del seguro social de salud, destacando la importancia del contexto socioeconomico y politico, particularmente en relacion con el nivel de ingresos, la estructura de la economia, la distribucion de la poblacion, la capacidad para administrar y el grado de solidaridad existente en el pais. Pero tambien subrayamos la gravitacion del papel de conductor que puede desempenar el gobierno para facilitar la transicion hacia la cobertura universal por la via del seguro social de salud.