Global perspective on health service financing

Abstract

Are there new sources of finance which Third World countries can tap to pay for Health for All? Is there anything valuable to be learnt in this respect from the experience of countries which are now developed? Countries have drifted into different ways of paying for health services, often without foreseeing the long run consequences. In many Third World countries the financing of services has been strongly influenced by their colonial past. This explains why many of them attempt to provide wholly free services and provide privileged services not only to the armed forces but to public servants as well. Introducing charges is one way of securing more revenue. It is noticeable that in some countries which were never colonized, there is a greater willingness to use charging and that this stimulates the growth of informal systems of voluntary health insurance. While many developed countries have made a transition from health insurance to universal services while retaining a considerable element of contributions from employers and employees, it is more difficult in political terms to introduce contributions unless those who contribute get something specific for them. The problem for developing countries contemplating the introduction of compulsory health insurance is to design systems which avoid all the problems which have manifested themselves in Europe, North America and on a wider scale in Latin America. These problems include the escalation of costs, failure to collect contributions due, the provision of ‘paper’ rights, bureaucratic obstacles to receiving care, different funds with varying rights, wholly separated services for insured persons, the bias to urban curative services and the separation of curative from preventive services. World experience suggests that services provided under compulsory health insurance need to be closely coordinated with governmental services and the policy governing them should be kept under the close supervision of Ministers of Health.