Health Financing System Research Articles

Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework.

The burden of hepatitis C infection is considerable among people who inject drugs (PWID), with an estimated prevalence of 39%, representing an estimated 6.1 million people who have recently injected drugs living with hepatitis C infection. As such, PWID are a priority population for enhancing prevention, testing, linkage to care, treatment and follow-up care in order to meet World Health Organization (WHO) hepatitis C elimination goals by 2030. There are many barriers to enhancing hepatitis C prevention and care among PWID including poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low hepatitis C testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. On 5 September 2017, the International Network of Hepatitis in Substance Users (INHSU) held a roundtable panel of international experts to discuss remaining challenges and future priorities for action from a health systems perspective. The WHO health systems framework comprises six core components: service delivery, health workforce, health information systems, medical procurement, health systems financing, and leadership and governance. Communication has been proposed as a seventh key element which promotes the central role of affected community engagement. This review paper presents recommended strategies for eliminating hepatitis C as a major public health threat among PWID and outlines future priorities for action within a health systems framework.

Critical Illness Insurance to alleviate catastrophic health expenditures: new evidence from China.

Currently, a high percentage of China's households face financial catastrophe as a direct result of excessive out-of-pocket (OOP) health expenditures. To alleviate this, China has set up the Critical Illness Insurance (CII) program since 2012. However, the current CII is still in an experimental phase and tested in 8 (out of 34) provinces, which has not been proved to be effective. This paper develops a health financing system for reducing catastrophic medical spending using a two-layer model for CII. This model partly compensates expenses exceeding the cap line of the Social Resident Basic Medical Insurance scheme to maintain the ratio of OOP expenses to total medical expenditure approximately at 20%. Adjustment coefficients based on individual net income across different regions are applied to increase fairness. The financial sustainability of the model is tested using a fund balance calculation. Finally, the two-layer model of the CII is empirically simulated with the latest provincial data from China Family Panel Studies. The results demonstrate that the model can effectively alleviate the incidence and severity of catastrophic health expenditures.

The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Background: There are substantial differences in long term health outcomes across countries, particularly in terms of both life expectancy at birth (LEAB) and healthy life expectancy (HALE). Socio-economic status, disease prevention approaches, life style and health financing systems all influence long-term health goals such as life expectancy. Within this context, universal health coverage (UHC) is expected to influence life expectancy as a comprehensive health policy. The aim of the study is to investigate this relationship between Universal Health Coverage (UHC) and life expectancy.Method: A multi-country cross-sectional study was performed drawing on different sources of data (World Health Organization, UNDP-Education and World Bank) from 193 UN member countries, applying administrative record linkage theory. Descriptive statistics, t-tests, Pearson correlations, hierarchical linear regressions were utilized as appropriate.Result: Global average healthy life years was shown to be 61.34 ± 8.40 and life expectancy at birth was 70.00 ± 9.3. Standardized coefficients from regression analysis found UHC (0.34), child vaccination (Diphtheria Pertussis Tetanus−3: 0.17) and sanitation coverage (0.31) were associated with significantly increased life expectancy at birth. In contrast, population growth was associated with a decrease (0.29). Likewise, unit increases in child vaccination (DPT 3), sanitation and UHC would increase healthy life expectancy considerably (0.18, 0.31, and 0.40 respectively), whereas the same for population growth reduces healthy life expectancy by 0.28.Conclusion: Universal Health Coverage (UHC) is a comprehensive health system approach that facilitates a wide range of health services and significantly improves the life expectancy at birth and healthy life expectancy. This study suggests that specific programs to achieve UHC should be considered for countries that have not seen sufficient gains in life expectancy as part of the wider push to achieve the Sustainable Development Goal (SDG).

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.

Are our \u2018UHC systems\u2019 learning systems? Piloting an assessment tool and process in six African countries

BackgroundIf there is one universal recommendation to countries wanting to make progress towards Universal Health Coverage (UHC), it is to develop the learning capacities that will enable them to ‘find their own way’ – this is especially true for countries struggling with fragmented health financing systems. This paper explores results from a multi-country study whose main aim was to assess the extent to which UHC systems and processes at country level operate as ‘learning systems’.MethodThis study is part of a multi-year action-research project implemented by two communities of practice active in Africa. For this specific investigation, we adapted the concept of the learning organisation to so-called ‘UHC systems’. Our framework organises the assessment around 92 questions divided into blocks, sub-blocks and levels of learning, with a seven scale score in a standardised questionnaire developed during a protocol and methodology workshop attended by all the research teams. The study was implemented in six francophone African countries by national research teams involving researchers and cadres of the ministries involved in the UHC policy. Across the six countries, the questionnaire was administrated to 239 UHC actors. Data were analysed per country, per blocks and sub-blocks, by levels of learning and per question.ResultsThe study confirms the feasibility and relevance of adapting the learning organisation framework to UHC systems. All countries scored between 4 and 5 for all the sub-blocks of the learning system. The study and the validation workshops organised in the six countries indicate that the tool is particularly powerful to assess weaknesses within a specific country. However, some remarkable patterns also emerge from the cross-country analysis. Our respondents recognise the leadership developed at governmental level for UHC, but they also report some major weaknesses in the UHC system, especially the absence of a learning agenda and the limited use of data.ConclusionCountries will not progress towards UHC without strong learning systems. Our tool has allowed us to document the situation in six countries, create some awareness at country level and initiate a participatory action-oriented process.

Źródła finansowania ochrony zdrowia w Polsce i w Wielkiej Brytanii

The sources of the health system funding in Poland and Great BritainThe subject of this paper are sources of healthcare financing in Poland and Great Britain. Healthcare system in Great Britain is based on the local government units and it is financed by the budgets of these units. Health insurance contribution does not exist in Great Britain. The financing model currently in place is based primarily on the proceeds of the National Health Fund which are ensured through collection of health insurance contributions. Public sources of healthcare financing also include the state budget and the budgets of local government units. Author have identified differences and similarities in the examined healthcare financing systems and sources. This paper also includes conclusions with a view of the future law in Poland.

Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach.

Introduction Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?

BackgroundThe goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage.MethodsA population-based household survey was conducted in four provinces of the DRC in 2014. Data included type, level and utilization of health care services, accessibility to care, patient satisfaction and disaggregated health care expenditure. Multivariate logistic regressions of excessive expenditure for outpatient care using alternative thresholds were performed to explore the incidence and predictors of atypically high expenditure incurred by individuals.ResultsOver 17% (17.5%) of individuals living in sample households reported an illness or injury without being hospitalized. Of 3341 individuals reporting an event in the four-week period prior to the survey, 65.6% sought outpatient care with an average of one visit (SD = 0.0). The overall mean expenditure per visit was US$ 6.7 (SD = 10.4) with 29.4% incurring excessive expenditure. The main predictors of a financial risk burden included utilizing public services offering the complementary benefit package, dissatisfaction with care received, being a member of a large household, expenditure composition, severity of illness, residence and wealth (p < .05). The insured status influenced the expenditure level, with no association with catastrophe. Those who did not seek care when needed reported financial constraints as the major reason for postponing or foregoing care. Wealth-related inequities were found in service and population coverage and in out-of-pocket payment for outpatient care.ConclusionBurdensome expenditure for primary care and its key drivers are of utmost importance. Forthcoming health financing reform agendas must incorporate a strategy for getting data used in the design of financial risk protection. Realizing equitable and efficient access to outpatient care is a vital ingredient for sustainable health systems.

Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring

BackgroundMonitoring financial protection against catastrophic health expenditures is important to understand how health financing arrangements in a country protect its population against high costs associated with accessing health services. While catastrophic health expenditures are generally defined to be when household expenditures for health exceed a given threshold of household resources, there is no gold standard with several methods applied to define the threshold and household resources. These different approaches to constructing the indicator might give different pictures of a country’s progress towards financial protection. In order for monitoring to effectively provide policy insight, it is critical to understand the sensitivity of measurement to these choices.MethodsThis paper examines the impact of varying two methodological choices by analysing household expenditure data from a sample of 47 countries. We assess sensitivity of cross-country comparisons to a range of thresholds by testing for restricted dominance. We further assess sensitivity of comparisons to different methods for defining household resources (i.e. total expenditure, non-food expenditure and non-subsistence expenditure) by conducting correlation tests of country rankings.ResultsWe found country rankings are robust to the choice of threshold in a tenth to a quarter of comparisons within the 5–85% threshold range and this increases to half of comparisons if the threshold is restricted to 5–40%, following those commonly used in the literature. Furthermore, correlations of country rankings using different methods to define household resources were moderate to high; thus, this choice makes less difference from a measurement perspective than from an ethical perspective as different definitions of available household resources reflect varying concerns for equity.ConclusionsInterpreting comparisons from global monitoring based on a single threshold should be done with caution as these may not provide reliable insight into relative country progress. We therefore recommend financial protection against catastrophic health expenditures be measured across a range of thresholds using a catastrophic incidence curve as shown in this paper. We further recommend evaluating financial protection in relation to a country’s health financing system arrangements in order to better understand the extent of protection and better inform future policy changes.

PHS124 - How Values Inform the Health Policy Decision-Making Processes About Health-System Financing in Latin America? A Critical Interpretive Synthesis

To understand how and under what conditions societal values inform decisions about health system financing in Latin American (LA) countries. A critical interpretive synthesis approach was utilized for this work. We searched 17 databases in December 2016 to identify all empirical and non-empirical articles written in English, Spanish or Portuguese that focus on values that inform the policy process for health-system financing in LA countries at macro and meso levels. Two reviewers independently screened records and assessed for inclusion. One researcher conceptually mapped included articles, created structured summaries of key findings from each; and selected a purposive sample of articles to thematically synthetize the results across the domains: agenda setting/prioritization, policy development and implementation. We identified 5925 references, included 199 papers, and synthetized 68 papers. Articles were focused on health systems of countries in Central America (n=36), South America (n=81), Central and South America (n=13) or with a general scope in LA (n=69). We identified 116 values, and developed a framework to explain how values have been used to inform policy decisions about financing in LA. This framework has four categories: 1) goal-related values (i.e. guiding principles of the health system); 2) technical values (those incorporated into the instruments adopted by policymakers to ensure a sustainable and efficient health system); 3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision-making); 4) situational values (a broad category of values that represent competing strategies to make decisions in the health systems, their influence vary according to four factors). This review and the framework that emerged from the analysis, are an effort to consolidate and explain how different social values are taken into consideration and support the policy decision-making about health system financing in Latin America.

Analysis of Joint External Evaluations in the WHO Eastern Mediterranean Region

Joint External Evaluation (JEE) was developed as a new model of peer-to-peer expert external evaluations of IHR capacities using standardized approaches. This study aimed to consolidate findings of these assessments in the Eastern Mediterranean Region and assess their significance. Analysis of the data were conducted for 14 countries completing JEE in the Region. Mean JEE score for each of the 19 technical areas and for the overall technical areas were calculated. Bivariate and multivariate analyses were done to assess correlations with key health, socio-economic and health system indicators. Mean JEE scores varied substantially across technical areas. The cumulative mean JEE (mean of indicator scores related to that technical area) was 3 (range: 1-4). Antimicrobial resistance, Biosecurity and Biosafety indicators obtained the lowest scores. Medical countermeasures, personnel deployment and linking public health with security capacities had the highest cumulative mean score of 4 (range: 2-5). JEE scores correlated with most of the key indicators examined. Countries with better health financing system, health service coverage and health status generally had higher JEE scores. Adolescent fertility rate, neonatal mortality ratio and net primary school enrollment ratio were primary factors within a country's overall JEE score. An integrated multisectoral approach, including well-planned cross-cutting health financing system and coverage, are critical to address the key gaps identified by JEEs in order to ensure regional and global health security.

Proactive Strategies to Address Health Equity and Disparities: Recommendations from a Bi-National Symposium.

Health inequities persist in Canada and the United States. Both countries show differential health status and health care quality by social characteristics, making zip or postal code a greater predictor of health than genetics. Many social determinants of health overlap in the same individuals or communities, exacerbating their vulnerability. Many of the contributing factors and problems are structural and evade simple solutions. In March 2017 a binational Canada-US symposium was held in Washington DC involving 150 primary care thought leaders, including clinicians, researchers, patients, and policy makers to address transformation in integrated primary care. This commentary summarizes the session's principal insights and solutions of the session tackling health inequities at policy and delivery levels. The solution lies in intervening proactively to reduce disparities-developing risk-adjustment measures that integrate social factors; increasing the socioeconomic, racial, and ethnic diversity of health providers; teaching cultural humility; supporting community-oriented primary care; and integrating equity considerations into health system funding. We propose moving from retrospective analysis to proactive measures; from equality to equity; from needs-based to strength-based approaches; and from an individual to a population focus.

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

SummaryBackgroundAchieving 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.MethodsWe 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.FindingsIn 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 covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030.InterpretationWe chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC.FundingThe Bill & Melinda Gates Foundation.

Cepten Sağlık Harcamalarının Finansmanında Eşitsizlik ve Hakkaniyet: Uygulamalı Bir Ekonometrik Yaklaşım - Inequality and Inequity in Financing Out-of-Pocket Health Expenditures: An Applied Econometric Approach

In this study, it is aimed to examine the effect of regulations about unification of health financing system to control out-of-pocket health expenditures, in terms of inequality and inequity of distribution of out-of-pocket health expenditures in Turkey. Data came from Turkish Statistical Institute Household Budget Survey for the years 2003, 2009 and 2015. Index and curve approaches are used together; to determine inequality and inequity and Gini and Concentration indices and departure of Concentration curve from Lorenz curve analysed. Study findings show that, out-ofpocket health expenditures increased from 2003 to 2015, inequality is decreased in terms of the distribution of out-of-pocket health expenditures (Gini index: 2003 [0.75], 2009 [0.71] ve 2015 [0.69]). However, out-of-pocket health expenditures is a kind of a progressive health financing source, considering departure of Concentration curve from Lorenz curve and the level of progressivity is decreasing. Study results shows that, health financing system regulations have contributions, in terms of equal distribution of the financial burden, with an increasing number of people integrated into the health financing system. However, it is remarkable that, there exist a deterioration in progressivity pattern of health financing and there is a heavy burden on poor populations. Thus, it is advisable to increase insurance coverage and determine propoor policies to ensure sustainability of health financing system.

Health insurance coverage and healthcare expenditure pattern in rural Mandya, Karnataka

Background: Poverty and ill-health go hand in hand.In developing countries, high out of pocket payment, absence of risk pooling mechanism in health financing systems, and high level of poverty are said to result in catastrophic health expenditure.Health insurance (HI) is the need of the hour in the absence of Universal Health Coverage. Hence this study was undertaken to assess the health insurance coverage among people of rural field practice area of Mandya Institute of Medical Sciences, Mandya and to describe the health care expenditure pattern in the study population.Methods: Study design was based on community based cross sectional study. Study area was at rural field practice area of Mandya Institute of Medical Sciences, which comprises of 11 villages. Study population: Permanent residents of villages in the study area. Study period was on 4 months (August 2016–November 2016). Sample size: 264 households. Sampling method: Multistage sampling. Method of data collection: Personal interview of patients/head of the family of patients admitted to a hopital during study period using semi structured questionnaire.Results: 58.0% of the households in study area had some form of health insurance coverage. Among the covered households only 40.50% were having whole family coverage. Individual level HI coverage was 48.8%. Out of pocket (OOP) expenditure for inpatient care contributed to 83.81% of the health care expenditure.Conclusions: HI coverage is higher than national average. But health care expenditure is largely borne out of pocket.

Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010.

Background: There is high reliance on out-of-pocket (OOP) health payments as a means of financing health system in Nigeria. OOP health payments can make households face catastrophe and become impoverished. The study aims to examine the financial burden of OOP health payments among households in Nigeria. Methods: Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/2010 was utilized to assess the catastrophic and impoverishing effects of OOP health payments on households in Nigeria. Data analysis was carried out using ADePT 6.0 and STATA 12. Results: We found that a total of 16.4% of households incurred catastrophic health payments at 10% threshold of total consumption expenditure while 13.7% of households incurred catastrophic health payments at 40% threshold of nonfood expenditure. Using the $1.25 a day poverty line, poverty headcount was 97.9% gross of health payments. OOP health payments led to a 0.8% rise in poverty headcount and this means that about 1.3 million Nigerians are being pushed below the poverty line. Better-off households were more likely to incur catastrophic health payments than poor households. Conclusion: Our study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plan against informal OOP health payments in order to provide financial risk protection which is currently absent among high percentage of households in Nigeria

Health system assessment for safe surgical care in rural Nicaragua: a retrospective survey

Abstract Background To improve access to surgical care in rural Nicaragua, a collaboration was established between the Global Initiative for Children's Surgery (GICS), Operation Smile Nicaragua, and the Nicaragua Ministry of Health. Prior to implementation of the surgical programme Surgery for the People Nicaragua, our aim was to perform a baseline assessment of the Nicaraguan health system's capacity to provide safe surgical care in its rural zones. Methods In June and July 2017, a retrospective baseline evaluation of safe surgical care provision was performed at two rural district hospitals in Las Minas using the GICS Optimal Resources tool, the WHO/Program in Global Surgery & Social Change (PGSSC) Surgical Assessment tool, the World Federation of Societies of Anesthesiologists Assessment tool, and the PGSSC Qualitative Assessment tool. Main outcome measures were: surgical workforce density, surgical volume, perioperative mortality rates, level of infrastructure, access to essential medicines, and health system financing. Findings The surgical workforce density was six per 100 000 population, including one paediatric surgeon (the WHO target surgical workforce density is 20 per 100 000 population). The surgical volume was 1050 procedures per 100 000 population per year; less than 10% of the surgical volume was paediatric. Perioperative mortality rates were low but not routinely collected: range 0·12%–0·50%. There were major needs in infrastructure including: additional operating theatres; running water at one site; post-anaesthetic recovery room areas; and paediatric-specific surgical wards. There was adequate access to essential medications including oxygen, anaesthetics, and antibiotics. Care at the two district hospitals was free, and there were no recorded out-of-pocket expenses for surgical patients. Interpretation A major success of the Nicaraguan health system is free surgical care, protecting patients from catastrophic expenditure. However, to improve access to surgical care in rural Nicaragua, there is a need for investments in human resources, particularly in anaesthesia and paediatric providers. Furthermore, there is a need for monitoring and evaluation of key indicators including perioperative mortality and complication rates. Funding UBS Optimus Foundation.

Measuring Geographic Inequalities: Dealing with Multiple Health Resources by Data Envelopment Analysis.

The existence of geographic differences in health resources, health expenditures, the utilization of health services, and health outcomes have been documented by a lot of studies from various countries of the world. In a publicly financed health system, equal access is one of the main objectives of the national health policy. That is why inequalities in the geographic allocation of health resources are an important health policy issue. Measures of inequality express the complexity of variation in the observed variable by a single number, and there is a variety of inequality measures available. The objective of this study is to develop a measure of the geographic inequality in the case of multiple health resources. The measure uses data envelopment analysis (DEA), which is a non-parametric method of production function estimation, to transform multiple resources into a single virtual health resource. The study shows that the DEA originally developed for measuring efficiency can be used successfully to measure inequality. For the illustrative purpose, the inequality measure is calculated for the Czech Republic. The values of separate Robin Hood Indexes (RHIs) are 6.64% for physicians and 3.96% for nurses. In the next step, we use combined RHI for both health resources. Its value 5.06% takes into account that the combinations of two health resources serve regional populations.

Mental health quality improvement goes global.

Mental health quality improvement goes global.

Achieving Universal Health Coverage through Health Financing Reform: Ethiopian Showcase

Objective: This article aim to analyze the Ethiopian health care financing reform, by aggregating the system into its constituent part, and examine isolated relationships, in which, the policy interventions and results can be more readily measured and evaluated, and propose any further recommendation. Besides, the study examines how members of health insurance scheme access, utilize, and meeting their benefits package without financial hardship, which later might guide the decision-makers in managing the trade-off that will inevitably arises as the financing system evolves. Methods: Desk reviews of government policy documents, proclamations, and health system financing strategy were scrutinized. Moreover, scholarly, peer-reviewed journals, and scientific literatures search were conducted through various approaches focusing mainly on the health system financing and the path to universal health coverage direction that has currently encountered around the world today. The articles reviewed for this study includes from electronic databases on the Internet, specific article searches, and published articles. The following databases namely the World Bank, the World Health Organization, the EconBase (Elsevier), Walden University Library, and Abt Associates Inc. were thoroughly navigated. Results: Membership to a health insurance scheme is crucial to improve the health status as well as foster productivity by the provision of health care services and reducing out-of-pocket payment at the time of illness. The Ethiopian showcase embraces two risk pooling arrangements, namely Social Health Insurance (SHI) and Community Based Health Insurance (CBHI) schemes, which gives financial protection and access to health care services at the time of demand. Accordingly, the CBHI scheme’s members are able to access health care benefits without financial hardship when they actually seek care. Conclusion: The existing health insurance schemes are a profound health care financing program, attributable for inclusiveness, diversity, and further researching, which in turn lends to positive social change through multitude comings paving a way to universal health coverage achievement, sustained economic and social development, and improvement in health outcomes. Furthermore, it may contribute to strengthen home-grown approaches, bestowing recommendations to the implementers, organizations or any other researchers by disclosing the successes, failures, as well as setbacks.