Health Sector Financing Research Articles

Understanding Employee Wellness for Improved Performance and Achieving Sustainable Development Goal 3

The study examines the need, importance, and advantages of wellness that organisations should consider for their employees' general well-being. It is imperative to note that employee wellness is also linked to sustainable development goal 3 that deals with healthy living and wellness and expects organisations to abide to the goals and targets within their organisational context. The study is grounded in qualitative desktop research. The data is gathered through iterature and document reviews. The data was analysed through document and conceptual analysis. The findings explore the implementation gaps in employee wellness programmes, that also affect the effective realisation of SDG 3. In South Africa, societal issues such as health care, health sector financing, disease control and prevention pose a significant challenge to organisations and their ability to operate at peak performance. This is due to the main contributing factor, which is employee performance. The study suggests that this is imperative in every sector to sustain the physical, emotional, psychological, and health wellness of individual professionals, at every level, that has a positive impact on sustaining performance of the organisations. Effective wellness programmes may decrease stress levels and assist professionals to perform better.

What Do We Know about Performance-Based Financing?

As in other countries, health financing reform in Mongolia is based on the concept of universal coverage [1]. The Mongolia the Ministry of Finance of Mongolia with the technical assistance of the Asian Development Bank launched the “Health Sector Financing Improvement Project” in 2019-2022. This allows the need to achieve universal health coverage and to provide quality care and services that meet the health demands and needs of the people in an equally accessible way, without incurring financial risks [2,3]. Mongolia’s health care sector financing model has changed from an input-based financing model to an output-oriented model, and implemented the performance-based financing of health care and services as a reform [2]. Universal health coverage (UHC) is a growing policy priority in many countries, as well as a significant and increasing focus of attention at the international level, forming one of the targets of sustainable development goal 3 [4]. Performance‐based financing (PBF) or paying for performance (P4P) has received increased attention as a strategy for improving the performance of healthcare providers, organizations and governments since the early 2010s [5,6]. In PBF people are given money or other rewards if they carry out a particular task or meet a particular target [7]. This is a strategic purchasing mechanism which [8] becomes a common strategy to improve health sector quality [9].

Select Firm Specific Determinates and Debt Procurement Policy of Small and Medium Sized Indian Health Sectors Firms: A Generalised Methods of Moment Approach

The study of corporate capital structure is no longer limited to listed, large-scale businesses; rather, the global executive growth of small and medium-sized businesses is a pressing concern that necessitates thorough investigation of the "Capital structure" of such businesses. In the current environment, more research is needed to determine how to create a sophisticated model that will be successful in providing Debt capital towards the health sector businesses. In this regard, the authors attempted to determine the impact of a few firm-specific variables on the debt financing choices made by small and medium-sized health sector companies. To conduct the study, the researchers employed 246 observations for the period 2017-2022, used descriptive statistics, panel unit root test, Wald exogenity and system GMM analysis and concluded that due to the volatility of the debt market, the RBI's interest rate policy, and other variables, SME health sector companies frequently experience financial difficulties. As a result, they are occasionally unable to obtain formal financing. Hence, it is advised that the government, financial institutions, and policymakers adopt a strong SME-focused health sector financing policy in order to increase the sector's financing flexibility and borrower-centricity.

Health Sector Financing: Empirical Analysis of the Evolution of the Ratio between Public and Private Financing in Developed Economies

Health funding is essential to ensure access to health services. Over time, essentially in the last two decades, the mix of health funding in developed countries has changed. Thus, it is necessary to know this reality and evaluate how the type of funding is vital to ensure access to health services and to continue health coverage worldwide. Around the world, there are significant variations in the amount of financial resources countries spend on health. Therefore, the research aims to identify and quantify which macroeconomic factors have influenced the evolution of health financing in these economies over time. To identify and quantify which macroeconomic and demographic factors influence the evolution of the health funding ratio (specifically the ratio of public and private funding) in 36 countries from 2000 to 2019. The econometric methodology of panel data is applied. For estimating the models, annual statistical information is used for the 36 savings under study in the time scale. It is concluded that health funding through public spending has been decreasing while private spending has been increasing. It was also verified that sociodemographic factors do not influence health financing expenditure. Instead, socioeconomic factors make a significant contribution to health funding. The following variables: population used, unemployment rate, per capita income and inflation rate are statistically significant for the ratio under study.

Health Insurance Coverage and Its Associated Factors Among Reproductive-Age Women in East Africa: A Multilevel Mixed-Effects Generalized Linear Model.

BackgroundDespite improvement in access to modern healthcare services in East African countries, health-service delivery and health status of the population remained poor mainly due to the weak health-sector financing system. Therefore, the current study aimed to assess the health insurance coverage and its associated factors among reproductive-age group (RAG) women in East Africa.MethodsThe most recent (between 2010 and 2018) Demographic and Health Surveys (DHS) data of the ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe) were included. STATA version 16.0 statistical software was used for data processing and analysis. In the multilevel mixed-effects generalized linear model, variables with a p-value ≤0.05 were declared as significant associated factors of health insurance coverage.ResultsThe overall health insurance coverage in East Africa was 7.56% (95% CI: 7.42%, 7.77%). The odds of health insurance coverage were high among educated, currently working, and rich RAG women whereas it was low among rural residents. Besides, RAG women who have media exposure, visited by field workers, and visited health facilities have a higher chance of health insurance coverage.ConclusionHealth insurance coverage in East Africa among RAG women was below ten percent. Educational status, working status, place of residence, wealth index, media exposure, visiting health facility within 12 months and being visited by field worker were significantly associated with health insurance coverage among RAG women in East Africa. Improving women’s access to health facilities, promoting field workers’ visit, and media exposure targeting uneducated, unemployed, and rural resident women of RAG will be a gateway to promote health insurance coverage.

Supply-side factors influencing informal payment for healthcare services in Tanzania.

Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers’ perspectives. Consequently, we have explored the characteristics of health workers and facilities influencing informal payments in Tanzania, examining two hypotheses: health workers with power and position in the system are more likely to receive informal payments, and transparency and accountability measures can be bypassed by those who can game the system. We conducted a cross-sectional survey of 432 health workers from 42 public health facilities (hospitals and health centres) in 12 district councils from Pwani and Dar es Salam regions in Tanzania. Our dependent variable was whether the health worker has ever asked for or been given informal payments or bribes, while explanatory variables were measured at the individual and facility level. Given the hierarchical structure of the data, we used a multilevel mixed-effect logistic regression to explore the determinants. Twenty-seven percent of 432 health workers ever engaged in informal payment. This was more common amongst younger (<35 years) health workers and those higher in the hierarchy (specialists and heads of departments). Those receiving entitlements and benefits in a timely manner and who were subject to continued supervision were significantly less likely to receive informal payments. The likelihood of engaging in informal payments varied among health workers, consistent with our first hypothesis, but evidence on the second hypothesis remains mixed. Thus, policy responses should address both individual and system-level factors, including ensuring adequate and progressive health sector financing, better and timely remuneration of frontline public health providers, and enhanced governance and supervision.

Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden.

Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

Health workforce financing in Uganda: challenges and opportunities

Abstract Background For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope. Methods The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings. Results The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth. Conclusions The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce. Key messages The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.

An Economic Approach to Health Insurance

Financing the healthcare sector, which directly affects the health of the population, has become a topic of major importance at a global level because even developed countries face difficulties in sustaining the financial sustainability of these services. In most countries, such as the Netherlands, Croatia, France, Slovakia, Romania, etc., the financing of health care through health insurance is the basis for its financing. This article proposes an analysis of the financing of the health sector through health insurance in order to emphasize the need to increase the percentage of GDP in this sector for comprehensive coverage of the population with health services and to improve access to health care. In this respect, Romania is being analyzed in the context of the EU, because a comparative criterion is needed to form an overview of the way and level of financing of health services in Romania. The objective of this article is to highlight the impact of health sector financing on the access of the population to health care and the financing of health insurance as a percentage of the total expenditures of this sector. The motivation for approaching the theme comes from the fact that the health care activity has an important influence on the development of the national economy because, at the macroeconomic level, the health condition contributes to the labor force and to the general well-being. Making a radiograph of the health insurance system in Romania is necessary and timely at the same time as it is a topical issue because the health condition has profound implications on social-economic life.

Disease in a Debt Crisis: Financing Global Health, Development and AIDS between WHO and World Bank, 1978–87

This article examines how international organisations with mandates in health and development interpret global economic crises and respond to disease. It contributes the perspective of World Bank to emerging scholarship on the various factors leading to the decline of the World Health Organization (WHO) and its Health for All (HFA) mission during structural adjustment. It does so by telling a story of collaboration and conflict between WHO and World Bank’s Population, Health and Nutrition (PHN) Department following the ambitious Alma Ata Declaration in 1978 until the initial global AIDS response. As debt crises emerged in Latin America in the early 1980s, WHO tried to find a way forward for HFA. However, the African crisis of 1985 fractured the international community’s support, causing WHO and PHN to dialogue more closely regarding health sector financing. As AIDS became a global crisis, this culminated in their 1987 joint research on the disease’s macroeconomic and demographic impact. However, observing WHO’s continued hesitance regarding financing and its decision to act as a donor gatekeeper, the Bank ultimately opted to work separately in AIDS. Thus, the themes of the Alma Ata versus Selective Primary Health Care debate of the late 1970s continued throughout the 1980s into the early years of the global AIDS response: a perennial conflict of financing within resource constraints and the appropriate role of donors in the grand project of health and development.

Public Financial Management Perspectives on Health Sector Financing and Resource Allocation in Ethiopia

In this paper, we discuss Ethiopia’s approach to health delivery, trends in health financing trends, focusing on the financing arrangements and expenditure management systems through which health funding is allocated from various internal and external sources. The paper reviews Ethiopia’s public financial management system to identify challenges and opportunities to improve domestic resource mobilization for health and resource allocation within the health sector. With the imminent transition away from external donor support that Ethiopia faces due to economic growth, the paper explores the sources of fiscal space for health in Ethiopia to sustain progress in the health sector through a deep dive of the sources of health financing through tax and non-tax revenues, additional borrowing, future aid prospects, and better fiscal discipline and expenditure efficiency.

Problems and directions of the development of a health financing system

The analysis of a state and development of health sector in Russia is presented in article. The developed trends in receipt and expenditure of means of financing of medical services of health care in the country are revealed. The authors have identified existing problems in the field of health related to its lack of funding. Comparative characteristic of the amounts of financing of medicine is manufactured in Russia and a number of the leading foreign countries. The typology, advantages and shortcomings of various ways of financing of health sector are revealed. Characteristic and an assessment of national peculiarities of financing of health care in world practice is given. The author's approach on modernization of the model of financing of health sector existing in the country with attraction for this purpose means of the state, business and the population allowing to pass to real, ordered, economically rational consumption of medical services and to increase the responsibility of citizens for strengthening of own health is offered. This approach is focused on a gradual transition from a budget-insurance type of financing of medical services with a private-insurance type and is based on expanding the ability of citizens to manage their financial resources on accumulative medical bills. In addition, the author's approach assumes that the functions of the state will include the implementation of programs to provide socially unprotected segments of the population with medical services on favorable terms. This approach forms model of financing of health sector with considerable participation of the population in joint financing of expenses on medical services, conditions for development of systems of voluntary health insurance and implementation of programs of medical insurance taking into account a possibility of the free choice by the citizen of volume of the consumed medical services.

Evaluating the health system financing of the Eastern Mediterranean Region (EMR) countries using Grey Relation Analysis and Shannon Entropy

BackgroundSufficient and sustainable financing of the health system is essential for improving the health of the community. The health systems financing of the EMR countries is facing the challenge. Assessment and ranking of healthcare financing can help identify and resolve some challenges of health systems. So, the aim of this study is to evaluate and rank the condition of the health sector financing in the EMR countries.MethodsThis study was a cross-sectional study. The data was of secondary type, extracted from the official WHO and World Bank data. The six healthcare financing indicators in a 10-year interval (2005–2014) in 19 EMR countries analyzed using Grey Relation Analysis and Shannon Entropy.ResultsOn average, the countries in the EMR region spent 4.87% of their GDP on the health sector. Jordan and Qatar allocated the highest (8.313) and the lowest (2.293) percentages of their GDP to the health sector, respectively. The results showed That Qatar was in a better condition than other EMR countries during 2005–2014 in terms of the health system financing and earned the first rank. After that, the UAE and Kuwait were ranked second and third.ConclusionsThere is a lot of inequality among the EMR countries in terms of health financing. However, our findings confirmed that only increasing the total health expenditure in a country would not improve its financing status compared to other countries, but it also depends on financing methods.

Needs for Restructuring the Health Sector Financing in Nigeria: An Exploratory Comparative Study

Evidence reveals that health outcomes of all nations have improved dramatically globally during the 21st century; however, enormous disparities still exist between Nigeria and other developing countries. For instance, Nigeria has the third highest infant mortality rate in the world after India and Pakistan; while in every single day, Nigeria loses an estimated of 2,300 under-five year olds children which also makes her the second largest contributor to under-five mortality rates worldwide after Republic of Chad. Therefore, this study present exploratory comparative analysis on health sector financing across countries in Africa with emphasize on Nigeria. The trend analysis of the study reveals that the direction of governments’ priorities and commitments in terms of health spending and resources devoted to health sectors have led to the glaring disparities in health indicators (life expectancy, infant and under-five mortality rates) with Nigeria lagging behind. The findings of the study further suggest that Nigeria needs to strengthen efforts towards improving health status of her citizens through restructuring her health sector.

The Policy Strategy for the Acceleration of Population Data Integration and Its Utilization in Indonesia: A Study on the Health Sector Financing

The Policy Strategy for the Acceleration of Population Data Integration and Its Utilization in Indonesia: A Study on the Health Sector Financing

Strategic Investment and Resource Allocation Model (SIRAM): Preventing and Managing Preventable Chronic Diseases in NT Australia

This paper presents a Strategic Investment and Resource Allocation Model (SIRAM) designed to facilitate health sector financing. This model is used to inform public policy on strategic investment and resource allocation to prevent and manage preventable chronic diseases (PCDs) viz. Diabetes Type II (NIDDM), Chronic Obstructive Airways Disease (COAD), Ischaemic Heart Disease (IHD), Hypertension and Renal Failure. The SIRAM enables forecast of future status of health and assessment of the gap between the projected and desired health status, future demand for health services and evaluate options for health intervention based on costs and a return (financial and health gains). The present phase of the study makes forecast of the future demands for public hospital services and costs of providing services by public hospitals in the Northern Territory (NT) of Australia to manage PCDs. The main findings are summarised here: •The base (2000) year hospital in-patient cost for management of PCDs is around $19 million and this accounts for 20 percent of the total hospital in-patient service cost of public hospitals in the NT. Without any strategic improvements to reduce the burden of PCDs, this cost will increase to $ 58 million by year 2025. •Out of the total hospital service cost for PCDs, about 75% ($ 15 million) was spent on treatment of PCDs among Indigenous Australians and the rest (25%) spent on providing hospital services to other Australians. Over the years there would be slight decrease (2%) in the percentage share of hospital service cost for PCDs for Indigenous population (73%) where as the percentage share of this cost would increase by 2% (27%) for other Australians. This is due to the higher proportion of expected ageing population of non-Indigenous population. •During the financial year 2000, hospital services cost for renal failure accounted for 55% of the total public hospital expenditure for PCDs followed by COAD (29%), NIDDM (9%), IHD (7%) and HT (0.5%). The projected cost for the next 25 years remains almost in the same proportion. During the financial year 2000, the number of public hospital separations and weighted inliers equivalence separations (WIES) were 20767 and 6099 respectively. By year 2025, these separations and WIES will increase to 39137 and 11275 respectively. •In the base year (2000), Indigenous Australians accounted for 85% PCDs related public hospital separations and this percentage might decline by 2% by 2025. This again must be due to higher proportion of ageing population of non-indigenous Australians who might be hospitalised due to PCD related illness. During the same period, the number of WIES for PCDs related hospital services provided to indigenous Australians accounted for 79% of the total PCDs related WIES and this proportion would remain the same until 2025. The next phase of the study will focus on simulation of the expected health when there is a change in the rate of incidence or prevalence of PCDs because of the changed health interventions viz. prevention, promotion and best practice clinical management. Note: A conference paper presented in the plenary session of the International Health Outcome Conference Held in Canberra, July 2002.

Financing of Health Sector in India

Financing of Health Sector in India

Humanitarian morals and money: health sector financing and the prelude to the Liberian Ebola epidemic

The 2014 West African Ebola epidemic prompted reconsideration of West African health systems’ resilience to external shocks. To understand the post-conflict histories of West Africa’s health systems reconstruction, it is necessary to understand the health systems in place when the epidemic emerged. This paper recounts the debates that shaped Liberia’s post-conflict health sector from 2003 to 2014, with particular attention to 2006–2008, when two Médecins Sans Frontières (MSF) units withdrew, and World Vision closed clinics across Liberia, prompting a national healthcare crisis. These debates highlighted medical non-governmental organizations' (NGOs') obligations to provide health care to vulnerable post-conflict populations; the restricted support available for health care in low-income post-conflict countries; and the demand for Liberian sovereignty over the national healthcare sector. They juxtaposed financial, bureaucratic, and logistical demands against public health, political, and post-conflict security risks. Through interviews with insiders in the Liberian government, medical NGOs, and Liberian healthcare providers, this paper presents a narrative of post-conflict health sector transition that reveals how post-conflict transitions create moral, bureaucratic, and procedural dilemmas requiring ad hoc responses from humanitarian and national government actors. Although funding for the Liberian health sector was ultimately obtained, the surveillance, coordination, testing, and social mobilization vulnerabilities then in place set the stage for the 2014 Ebola epidemic.

The path dependence of district manager decision-space in Ghana.

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors.

Developments in Financing and Reforming the Health Care System in Albania, the Road Ahead

The Albanian Health sector is in the continuing transformation in the function of the realization of the proper standards. To realize the reform in this sector and to help the decision makers in their decision is necessary to have the right information on the source of the financing of health sector, on the destination of the expenditure in this sector and their control. “The establishment of the National Health Service is an integral part of the new Albanian Government program and it is also the fairest intervention intended to upgrade the system of service financing at the levels required by providers and recipients of health services. In this paper research we are try to present the current situation concerning our insurance scheme, developments in financing the primary health care and hospital sectors, our future projects to improve the way of financing hospital services, etc. were displayed in this presentation. We are in focus of Albanian reforms, improvement of the services and we are studying the health costs for health services.Our learning and evaluation team reviewed every incoming evaluation to ensure that it met the quality standards in our policy. When evaluations failed to meet the standard, the three most common concerns, wich are analyze in this paper: (1) evaluation teams received too many questions—especially questions that are too general and ill-defined—relative to the resources available for the evaluation, (2) the data collection and analysis methods were not appropriate to answer the evaluation questions, or (3) evaluation reports.