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Journal ArticleDOI

Revisiting the debate on health financing in Low and Middle-income countries: An integrative review of selected models.

TL;DR: It is argued that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms, which is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.
Abstract: Universal Health Coverage (UHC) as a health policy goal is gaining added currency in the policy agendas of many Low and Middle-Income Countries (LMIC) following the onslaught of the coronavirus (COVID-19) pandemic. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without suffering financial hardship. Whereas most industrialised countries have achieved UHC through the implementation of various traditional health financing mechanisms, most LMIC have not made significant progress in providing financial protection against the costs of illness for majority of the population due to limited fiscal space and or lack of political commitment to raise government revenues and increase fiscal space for health. While the onslaught of COVID-19 refreshes the call for reform of countries' health financing policies to reflect the healthcare needs of the population, the debate about the type or combination of health financing models to employ in LMIC has yet to reach a consensus. This review critically analyses five health financing models to ascertain their appropriateness in providing financial risk protection against the cost of illness, especially in this era of COVID-19. Given the limited fiscal space for health in LMICs, we argue that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms. Moreover, because the creation of fiscal space is context-specific, and UHC is a political issue rather than technical, securing strong political support is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.
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Journal ArticleDOI
TL;DR: In this article , health financing has increasingly become a much-debated concept when it comes to ensuring a healthy nation in recent years, and this calls for extending our understanding of health financing in the context of African countries, especially in the unique context of Zimbabwe.
Abstract: Health financing has increasingly become a much-debated concept when it comes to ensuring a healthy nation in recent years. Surprisingly, health financing towards attaining sustainable development has been given scant attention in the development discourse. As such, this calls for extending our understanding of health financing in the context of African countries, especially in the unique context of Zimbabwe. Given this information, this chapter focuses on the health financing challenges. Six health financing challenges were ascertained, that is, fragile economy; corruption; unanticipated health shocks; budget constraints; poor political commitment towards public health; and high-out-of-pocket payments. In order to deal with these serious health financing challenges, a plethora of recommendations were offered herein. The research outcomes of this study could help policymakers and practitioners.
References
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Journal ArticleDOI
TL;DR: Methods for conducting an integrative review are discussed and it is indicated that the majority of integrative reviews in nursing fell short of primary research standards.
Abstract: Integrative reviews of research are a valuable part of the process of creating and organizing a body of literature. It has been argued that integrative reviews should be held to the same standards of clarity, rigor, and replication as primary research. In this paper methods for conducting an integrative review are discussed. Seventeen reviews from nursing journals were examined and compared with a proposed set of criteria for reviews. The results indicated that the majority of integrative reviews in nursing fell short of primary research standards. Guidelines for conducting more rigorous reviews are presented.

902 citations

Journal ArticleDOI
Björn Ekman1
TL;DR: The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing.
Abstract: Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.

486 citations

Journal ArticleDOI
TL;DR: How successful a country's delivery and/or financing system is in achieving its stated equity goals is investigated to compare the current situation with some ideal or 'target* situation.
Abstract: textEquity is widely acknowledged to be an important goal in the field of health care. Indeed, McLachlan and Maynard (1982) have gone so far as to suggest that' the vast majority of the population would elect for equity to be the prime consideration' (p. 556)—a view endorsed by Mooney (1986, p. 145). Several researchers have investigated how successful their own country's delivery and/or financing system is in achieving its stated equity goals. In general the strategy of these studies is to compare the current situation with some ideal or 'target* situation. Le Grand (1978), for example, in what has become a classic study in the field, compares the distributions across socio-economic groups of illness and public expenditure on health care in Britain in 1972, and concludes that the National Health Service (NHS) has failed to achieve equity in the delivery of health care.

386 citations

Journal ArticleDOI
TL;DR: This work estimates the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population and finds that in most low-/middle-income countries, the better-off not only pay more, they also get more health care.

304 citations

Journal ArticleDOI
TL;DR: It is found that on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick.
Abstract: Objectives : The study investigates the effect of Ghana’s National Health Insurance Scheme (NHIS) on health care utilisation. Methods : We provide a short history of health insurance in Ghana, and briefly discuss general patterns of enrolment in Ghana as well as in Accra in a first step. In a second step, we use data from the Women’s Health Study of Accra wave II to evaluate the effect of insurance on health seeking behaviour using propensity score matching. Results : We find that on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick. Conclusion : These results suggest that the government’s objective to increase access to the formal health care sector through health insurance has at least partially been achieved.

298 citations

Trending Questions (1)
How do financing reforms influence hospital financial health in Low and middle incomes countries?

The paper does not specifically address the influence of financing reforms on hospital financial health in LMICs.