Source Of Health Care Financing Research Articles

SOURCES OF HEALTH CARE FINANCING AMONG SURGICAL PATIENTS SEEN AT THE DALHATU ARAF SPECIALIST HOSPITAL LAFIA NASARAWA STATE NIGERIA

Sources of healthcare financing especially among surgical patients in Nasarawa state is presently unknown. Sub-Saharan African countries have introduced a number of methods to funding healthcare system. The Nigerian government commenced implementation of a social health insurance scheme (National Health Insurance Scheme; NHIS) so as to improve on healthcare funding for its citizens. This study determined the sources of financing surgical cases, type of surgeries and compared the cost of treatment among patients attending the Dalhatu Araf Specialist Hospital and other Health Centers in Nasarawa State. It was a hospital based cross-sectional descriptive study among 420 adults aged 18 years to 75 years in a study that lasted for two years. The data collected was analyzed using Statistical package for the Social Science (SPSS) version 20.0. Significant p was < 0.05. The average age of patient was 28.6 ± 11.9 years. There were more females (75.5%) with most (73.8) of our participants living in rural areas. Majority (60.0%) had Caesarean Section and one-sixth had exploratory laparotomy respectively. Most spending for healthcare needs was Out-Of-Pocket (OOP) with only a handful (6.7%) enjoying insurance coverage. The average cost of surgery was 41,337.73 Naira and 28,426.47 Naira among the low and high socio-economic class respectively. Most of the participants in this study were on Out-Of[1]Pocket healthcare financing with only one out of fifteen having health insurance coverage of the NHIS. Most of the surgical patients are from the rural areas, are females, do not attend tertiary level of education and are of low socio-economic status. Caesarean section and exploratory laparatomy were the predominant indications for surgeries. Those from the lower socio-economic status pay more for surgeries even though they earn less. We recommended that the state consider State health insurance agency and this should cater for people in both the formal ana the non-formal sectors. In addition, rural dwellers and surgeries such as caesarean section and emergency laparatomies should not be left out.

Порядок и источники финансирования здравоохранения в субъектах Российской Федерации

Introduction. Currently, human rights to medical care and health protection in our country are regulated by the Constitution of the Russian Federation, federal laws and by-laws. And, accordingly, to realize these rights, the state needs to form, allocate and effectively spend a sufficient amount of financial resources. The purpose of the study is to analyze the procedure and sources of healthcare financing in the constituent entities of the Russian Federation. Methods. The analysis of modern scientific literature, as well as the regulatory framework on the procedure and sources of healthcare financing in the Russian Federation is carried out. For this purpose, the methods of bibliographic, informational and semantic search of sources in various databases are used. Results. The sources of financing the healthcare system in the Russian Federation are employers’ insurance premiums for Compulsory Health Insurance (CHI) of the working population, insurance premiums from the budgets of the constituent entities of the Russian Federation for CHI of the non-working population, as well as expenditures of regional budgets and inter-budgetary transfers. The CHI system is currently the main source of funding for the state healthcare system in the Russian Federation. Single-channel financing made it possible to increase the efficiency of the healthcare system and played a positive role during the pandemic, which allowed the system to compensate for epidemiological risks quite quickly, but currently there are problems that require the reform of the healthcare system. The disadvantages of the CHI system are the complexity of the medical care financing chain, as well as the problems of distributing the capacity of medical care between medical organizations within the framework of the territorial CHI program. From the standpoint of the objective situation of insufficient financing of healthcare in the Russian Federation, it is advisable not so much to increase financial resources as to increase the efficiency of the use of allocated funds, which requires the legislative consolidation of responsibility for their irrational use, as well as strengthening the state control of resources allocated to healthcare. Conclusions. The activities of the Compulsory Health Insurance system require strengthening public control measures.

OUT OF POCKET AND HEALTH FACILITY CHARGES AMONG PATIENTS UNDERGOING DIALYSIS AT SERVICES HOSPITAL, LAHORE

ABSTRAC
 Background:- Dialysis is the process of removing waste products and excess fluid from the body. Dialysis allows the patient with kidney failure a chance to live a productive life. Government Hospitals in Punjab providing free treatment to all Hemodialysis patients, Government introduced Sehat Sahoolat card for citizen of Pakistan for their family by providing 1 million rupees per year for every family. Most of the patients spending out of pocket expenditures to meet their medical demand and due to this burden some time they can’t continue their routine visit for Hemodialysis to sustain their daily life, the impact of this out pocket expenditure disturb the home budget as well as their treatment continuity. The purpose of this study to find out different categories of expenses and its impact on their treatment, 
 Of patients being treated with dialysis about 10% receive peritoneal dialysis and the remainders receive Hemodialysis. Pakistan is among the lower middle income countries. It is reported that the cost of dialysis per patient is approximately international $4,003.03 per year. Dialysis is exhausting for patients and fraught with morbidity and eventual mortality. While out-of-pocket expenditure remains the major source of health care financing in Pakistan (two-thirds of the total health spending), the financial burden varies enormously across diseases and by the economic wellbeing of the households.1
 Objectives: To assess out of pocket expenditures and health facility charges among patients undergoing dialysis at Services Hospital, Lahore.
 Study design: It was a descriptive Cross section study.
 Study setting: Dialysis unit of Services Hospital, Lahore.
 Sample size: The sample size was estimated by using WHO SS (Sample Size) software by using formula of estimating a population proportion with specific relative precision at confidence level of 75%, anticipated population proportion of 75% and relative precision of 10%. The maximum sample size is 130.
 Result: We audited records Mean out of pocket incurred both medical and non medical 4950/week while mean out of pocket charges on lab investigation were 10300/ during one year of dialysis, Study shows that those with co-morbidity but they lost the regularity treatment were 69.2% and having only renal dialysis 8.4% and lost the regular treatment due to out of pocket expenditures either expending from their own pocket or support from family. Highly significant with df=1 Chi squire=14.0793 P value=0.0001. 
 Reason to lost continuity of treatment from 33 cases 90.9% due to out of pocket expenditures while 9.09% says due to other reason ,their source of income was personal and from family support respectively. df=1 Chi squire= 0.0143478 P value=0.90
 Conclusion: Our research concluded that health facilities provided by the dialysis unit of Services hospital to the patients were considered to be average. Majority of patients who spent money on medicines and transport, were financially supported by their families. Government hospitals were preferred because medical facilities were affordable.
 Key words: Out of Pocket. Hemodialysis,Financial burden ,Co-Morbidity

Health care financing and services utilization in cross river state, nigeria

The average annual budgetary allocation for health in Nigeria is about the lowest in Africa at 5.7% as the total health expenditure is only 0.7% of GDP against the WHO recommended 4%-5%. The out-of-pocket spending by Nigerians is more than 60% of total health expenditure instead of WHO recommended 30-40%, while the national coverage of the National Health Insurance is below 5% which poses a serious problem to health care service utilization. In Nigeria, the ever rising socioeconomic costs of healthcare and the limited or complete lack of supportive public financing is a major challenge to the attainment of the sustainable development goals (SDGs) recently adopted to reduce poverty and improve the wellbeing of all citizens of the world. This paper examined health care financing in Cross River State and determined the extent to which it poses problems to services utilization. The paper reviewed literature relevant to the study while the Marxist conflict theory of healthcare utilization was employed. The design for the paper was Expost facto which relied on secondary data from Cross River State Ministry of Health. The study reviewed various sources of health care financing in Cross River State and the impact of these sources on health care system strengthening or quality health care provision. From the study or discourse and review of health expenditure and its related challenges, it was found out that, out-of -pocket expenditure or user-fee charges, community-based financing, private donor agencies financing and tax-based public health financing sources in the state have not significantly impacted on good services provision to individuals. From these findings, it was recommended among others that government should encourage the establishment of village/ward development committees whose responsibilities should include taking initiative to assist government in building health post (in communities where such do not exist), Government should maintain existing health facilities and provide proper logistics during health campaigns and monitoring of health workers activities at the health facilities.

OECD AND UKRAINE: TRENDS IN HEALTH CARE FINANCING

The article examines current trends in healthcare financing in OECD countries and Ukraine. The focus is on assessing the dynamics of total healthcare spending and it is found that in 2020, the COVID-19 pandemic caused a significant increase in funding in all countries. In particular, only in 2019-2020, the share of healthcare costs in the GDP of OECD countries increased by 1% on average. Thus, advanced countries, realizing the impact of the healthcare industry on the economy and well-being of the country as a whole, tried to maximally strengthen its financial stability in general and to epidemic challenges in particular. The priority sources of health care financing were analyzed and it was found that the governments of the OECD countries diversify the sources of financing in the sector to protect their citizens from excessive financial burden and to ensure affordable and high-quality medical care. It was found that the direct costs of patients from OECR countries account for an average of 20% of all health care costs, while in Ukraine the population finances more than 46% of medical costs. It was noted that this indicator is threatening for the country, since the poor do not have access to medical care due to lack of funds and, as a result, the number of diseases, the level of disability, and mortality of citizens is increasing. It was established that the priority sources of financing for one group of OECD countries (Denmark, Sweden, Norway, Great Britain, Canada, etc.) are budget funds, and for another (Germany, Japan, France, etc.) - funds from the mandatory health insurance system. In recent years, there has been a tendency to increase the share of mandatory health insurance in the structure of financing sources of OECD countries, which increased by 2% on average and amounted to 39%. It was concluded that the Ukrainian health care system, in which the reform began in 2015, annually increases the amount of funding and has positive feedback from WHO and World Bank experts about the results of the reform. However, due to political changes in 2014 and economic constraints due to the COVID-19 pandemic, total health spending in dollar terms in 2020 did not reach the 2013 funding level. In addition, the war made adjustments to the activity of the industry, introducing a regime of maximum preservation of infrastructure, simplification of financing, and ensuring the availability of medical services. Despite this, the government developed a post-war healthcare recovery plan to revive destroyed facilities and radically transform the industry in peacetime.

The causal effect of catastrophic health expenditure on poverty in Poland.

Out-of-pocket medical expenses are a crucial source of health care financing in a number of countries. With the ongoing population aging, health care costs are likely to increase. Therefore, disentangling the relationship between health care spending and monetary poverty is becoming increasingly important. Although there is extensive literature on the impoverishment effect of out-of-pocket medical payments, it lacks empirical studies on a causal relationship between catastrophic health expenditure and poverty. In our paper, we try to fill this gap. We estimate recursive bivariate probit models using Polish Household Budget Survey data covering years from 2010 to 2013 and from 2016 to 2018. The model controls for a wide range of factors and endogeneity between poverty and catastrophic health expenditure. We show that the causal relationship between catastrophic health expenditure and relative poverty is significant and positive across different methodological approaches. We find no empirical evidence that a one-time incidence of catastrophic health expenditure creates a poverty trap. We also show that using a poverty measure which treats out-of-pocket medical payments and luxury consumption as perfect substitutes can lead to an underestimation of poverty among the elderly. Out-of-pocket medical payments should probably receive more attention from policymakers than the official statistics suggest. A current challenge is to correctly identify and appropriately support those who are most affected by catastrophic health expenditure. More prospectively, a complex modernization of the Polish public health system is needed.

Analysis of financial security of health care in Ukraine

The paper examines the theoretical principles of managing the financial support of health care institutions, in particular, the economic essence and sources of their formation. The content of the concept of "financial resources of health care institutions" was studied and the legal framework was considered, which is mainly formed in accordance with the principles and priorities of the state health care policy defined by the Constitution of Ukraine, the Basics of legislation on health care and others adopted in accordance with them by acts of legislation regulating public relations in the field of health care. The financing system of health care institutions of Ukraine was analyzed. It was concluded that in the modern conditions of the development of the medical industry of Ukraine, the search for additional sources of health care financing is especially relevant. The necessity to improve the process of financing domestic healthcare system is substantiated. Condition of funding of healthcare facilities in Ukraine in recent years of medical reform was analyzed. It is determined that financing of healthcare system is one of the main priorities of the budget today, and the budgetary expenditures for “Health Care” in 2021 grew compared to 2020 due to changes in the mechanism of medical services provision. Important areas are ensuring the provision of highquality medical services for all citizens, increase in the salaries of doctors. Condition of implementation of the budgetary program of state guarantees of health care in 2021 was analyzed. Ways to improve the financing of the health care sector are proposed. Conclusions and proposals are of practical importance and can be implemented in the activities of state administration bodies in order to improve the formation and use of financial resources of health care institutions. It is determined that the process of financing of healthcare institution provided for the itemized distribution of budget funds for the maintenance of medical infrastructure, not the expenditures related to maintaining of health of every citizen and improving quality of life, the funds were used inefficiently and not for their intended purpose.

A pilot study to explore societal, patient, and public authority perception on 'Value-Added Tax' system for healthcare financing in Zimbabwe: A case for cancer treatment.

Many of the cancer cases in Zimbabwe are HIV related, making it a significant health concern in the country. This concern requires innovative ways, such as implementing Value-Added Tax (VAT) to finance cancer management through health insurance. The study explores the general public, cancer patients, and public authorities' perception regarding using the VAT system for financing cancer treatment. A qualitative cross-sectional study was conducted to explore the perception of study participants on 'Value Added Tax' as a source of healthcare financing in Harare. This was done through the use of in-depth interview guides. A total of 25 participants took part in the study. Fifteen were members of the general public, 5 were cancer patients, and 5 were key informants representing public authority. Members of the general public and cancer patients were conveniently selected, while key informants were purposively selected. Data were analyzed descriptively and by grounded theory whereby codes were developed by induction. The general public and cancer patients perceived cancer treatment as generally unaffordable and showed readiness to pay for a cancer levy through VAT. Cancer patients expressed disappointment at the low support for cancer treatment compared to HIV treatment concerning the already established AIDS levy. Public authorities also perceived the VAT system as an appropriate programme for health care financing. This preliminary study found that a 'Value-Added-Tax' system could potentially be an acceptable model to finance public healthcare, including cancer treatment in highly informal settings like Zimbabwe.

Challenges and experiences in linking community level reported out-of-pocket health expenditures to health provider recorded health expenditures: Experience from the iHOPE project in Northern Ghana.

Out of pocket health payment (OOPs) has been identified by the System of Health Accounts (SHA) as the largest source of health care financing in most low and middle-income countries. This means that most low and middle-income countries will rely on user fees and co-payments to generate revenue, rationalize the use of services, contain health systems costs or improve health system efficiency and service quality. However, the accurate measurement of OOPs has been challenged by several limitations which are attributed to both sampling and non-sampling errors when OOPs are estimated from household surveys, the primary source of information in LICs and LMICs. The incorrect measurement of OOP health payments can undermine the credibility of current health spending estimates, an otherwise important indicator for tracking UHC, hence there is the need to address these limitations and improve the measurement of OOPs. In an attempt to improve the measurement of OOPs in surveys, the INDEPTH-Network Household out-of-pocket expenditure project (iHOPE) developed new modules on household health utilization and expenditure by repurposing the existing Ghana Living Standards Survey instrument and validating these new tools with a 'gold standard' (provider data) with the aim of proposing alternative approaches capable of producing reliable data for estimating OOPs in the context of National Health Accounts and for the purpose of monitoring financial protection in health. This paper reports on the challenges and opportunities in using and linking household reported out-of-pocket health expenditures to their corresponding provider records for the purpose of validating household reported out-of-pocket health expenditure in the iHOPE project.

Comparative analysis of indicators that determine the effectiveness of the implementation of socio-economic determinants of health in Europe and Ukraine

The introduction of national strategies aimed at improving the well-being of the population of the country is one of the current approaches to reforming the public policies of the countries of the world. It is the socioeconomic determinants of health that determine the conditions in which people are born, grow, live and getting old, as well as the spheres of influence on these conditions, such as public policy, state of economic development, demographic trends, etc.
 The aim. In this way, our research has focused on a comparative analysis of macroeconomic indicators that determine the effectiveness of socioeconomic determinants of healthсare in Europe and Ukraine, that are used to provide scientific justification for the construction of humanistic models for the provision of pharmaceutical care to the population in the context of the rapid stratification of Ukrainian society according to socioeconomic indicators.
 Materials and methods. The research methodology is based on the principles of systems analysis and an interdisciplinary scientific and systemic approach. The study used the empirical method, the method of comparative analysis and synthesis of statistical data, the graphical method.
 Results. A comparative analysis of the socioeconomic determinants of health in the countries of the European region and in Ukraine was carried out on three levels of indicators: the level of health-care expenditure, the structure of health-care expenditure and expenditure on medicines.
 The analysis revealed that in 2019, the average health expenditure of the countries analyzed was 8.2 % of GDP. Only two of the 34 countries - Ukraine and Turkey - have a rate below the 5 % that recommended by WHO.
 Public health financing schemes and compulsory health insurance are the main funding mechanisms in all countries, with the exception of Cyprus. Ukraine, Russia, Greece, Latvia and Bulgaria have the largest share of direct costs to patients as a source of health care financing.
 The results of the analysis of the medicine expenditure indicator as a proportion of total health expenditure showed that the highest level was in Bulgaria (35.4 %), the lowest in Denmark (6.4 %). Overall, five countries have high levels of pharmaceutical expenditures.
 In most European countries, the cost of purchasing medicines has been found to range from 346 to 619 USD per person per year. The highest value of this indicator from the European region is in Switzerland (894 USD per person), and the lowest is in Ukraine (73 USD).
 Based on the results of the comparative analysis, the countries were grouped according to key indicators into three categories - high, medium and low.
 Conclusions. A comparative analysis of key indicators of the socio-economic determinants of health in the country of the European region has been carried out

Ržište privatnog zdravstvenog osiguranja u debatama o reformi zdravstvenog sistema u postsocijalističkim zemljama

Debates on the reform of health care fi nancing in the former socialist countries during the period of social transformation were conducted as part of a wider debate regarding changes in the overall social system. Existing financing models and innovative measures were reviewed. As part of such discussions, the voluntary health insurance market also received a lot of the attention. Diff erent views were expressed in the debates that were conducted during the 1990s, from seeing a suitable supplementary source of health care funding to those who highlighted the constraints in its implementation and modest results that can be expected. As one of the criteria for assessing the suitability of this mechanism, we could review what has been achieved so far in its application. Th e paper looks at the ground covered and the situation in the former socialist countries at the end of the second decade of this century, with particular reference to Serbia and countries in its surroundings. When it comes to Serbia it can be expected that the limiting factors from the last ten years will be still manifested in the future. It is estimated that there are weak prospects of activating voluntary health insurance as a way to alleviate the problems of insuffi cient fi nancing of the health care system.

Generating Financial Resources for Health

The majority of developing countries in Asia have been making reforms to their health systems for decades but have still failed to achieve their targets for universal health coverage (UHC), that is, ensuring that all people obtain the health services they need without suffering financial hardship when paying for them, and the health- and poverty-related Sustainable Development Goals (SDGs). Countries in Asia rely on a mixture of healthcare financing sources, such as government general revenue, social health insurance (SHI), external funding, private health insurance and out-of-pocket (OOP) payments. Asian countries generally spend between 1% and 10% of their national GDP on health. There are variations in government investment in health as a proportion of total health expenditure across countries, from 23.4% in Japan to Myanmar’s 4.8%. Many governments in Asia have introduced various types of publicly financed health insurance schemes (SHI). The private sector, in providing healthcare, has expanded rapidly, because many national health systems are not able to cope with rising costs, especially for co-payment, and the increasing demand for services. The introduction of private health insurance has reduced OOP payments and, in the long run, could evolve a broader SHI system. As a result of the low levels of government spending, OOP payments by health consumers constitute a large share of health expenditures, amounting to more than US$0.5 trillion or US$80 per capita annually. Rapid increases in development assistance for health (DAH) since 2000 have resulted in major health gains in the poorest countries, yet DAH levels have stagnated in recent years. DAH must evolve to help accelerate progress toward UHC.

Voluntary health insurance as a source of funding for the health care system: the world’s experience and Ukraine

In the conditions of insufficient budgetary financing of the health care system and low quality of medical care in the state medical establishments of Ukraine, the importance of extra-budgetary sources of financing becomes increasingly relevant. One such source is voluntary health insurance. The aim of the paper is to compare the state and structure of medical financing in developed countries and in Ukraine, to study the global experience in the functioning of the voluntary health insurance market, and to calculate the potential capacity of the voluntary health insurance sector in Ukraine. For mathematical calculations, 20 absolute indicators of the state of the voluntary health insurance sector, as well as macroeconomic indicators, were used. The annual values of absolute indicators for the period 2010–2019 were used in forming the array of input data. Based on the experience of foreign countries, the paper substantiates the development of the voluntary health insurance in Ukraine as an extra-budgetary source of health care funding. The capacity of the voluntary health insurance sector was defined by the authors as the maximum possible amount of insurance premiums that insurers can receive in the process of selling voluntary health insurance products. The calculations made it possible to conclude that the voluntary health insurance market in Ukraine has the potential for development, as evidenced by the predominance of the potential capacity of the voluntary health insurance segment over its real indicator.

Implications of COVID-19 Pandemic for Health Financing System in Ghana

This article examined the impact of the COVID-19 pandemic on the health financing system in Ghana. The COVID-19 pandemic presents two different crises—a health crisis and an economic crisis, and these have implications for the health financing system in Ghana. The pandemic is likely to have adverse effects on the various sources of healthcare financing, including government support, donor support, national health insurance scheme (NHIS) and out-of-pocket payments, which will impact the general delivery of healthcare in the country. Government support to the health sector in general is likely to be rechannelled into fighting the pandemic considering the declining tax and other non-tax revenues as well as huge expenditure commitment. Donor support is also likely to be scaled down and existing funds redirected into dealing with the COVID-19 pandemic. The NHIS will be affected, as many subscribers are not likely to renew their health insurance policies because of the fear of contracting the coronavirus when they visit health facilities. Also, the non-attendance at health facilities by health consumers will impact out-of-pocket payments and the hospitals’ ability to generate sufficient internal resources for their operations. A number of useful recommendations are proffered with the aim of improving health financing system in Ghana during and post-COVID-19 pandemic.

Особенности правового регулирования финансового обеспечения здравоохранения на территории города Байконур

One of the main sources of health care financing in Russia is the means of compulsory medical insurance. Accumulation of financial resources of obligatory medical insurance occurs through functioning of Federal Fund of obligatory medical insurance, and direct management of them in the territory of subjects of the Russian Federation is carried out by territorial funds of obligatory medical insurance. At present, there are 86 territorial funds of compulsory medical insurance, but only 85 operate on the territory of our country. There is also a fund outside Russia - a territorial Fund of compulsory medical insurance of the city of Baikonur. The city of Baikonur is an administrative-territorial unit of the Republic of Kazakhstan, which is under lease and is endowed for this period with the status that corresponds to the city of federal importance of the Russian Federation. The article discusses the gaps in the legal regulation of budgetary relations between the Russian Federation and Baikonur city, especially the recognition of international treaties as sources of financial law and financial legal regulation of the compulsory health insurance, as well as issues of ensuring the rights of citizens of the Russian Federation in the process of legal regulation of financial providing of free medical care on the territory of Baikonur.

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

BackgroundEquity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time.MethodsThis retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time.ResultsThe findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP.ConclusionsThe current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

Healthcare Financing Sources in Central Europe

Purpose: The objective of the paper is to review historical developments and the current setup of healthcare financing models in Central Europe. Methodology: A systematic narrative approach has been taken with the research emphasis on a critical literature review and analyses of healthcare spending statistical data. Findings: A comparison between different models currently in place seems to suggest the existence of patterns leading to improved quality of the healthcare service proposition that is critically impacted by a financing model. Implications: The findings have practical implications since different results have been achieved in countries choosing different models but starting from practically the same point. That realisation should serve as a foundation for further work on this subject, potentially leading to adjustments to financing models chosen by some countries. Value: The paper offers a comparative analysis of the healthcare system financing evolution in four Central European Countries and an overview of their current state.

ОЦЕНКА УПРАВЛЕНИЯ ФИНАНСАМИ ГОСУДАРСТВЕННЫХ УЧРЕЖДЕНИЙ ЗДРАВООХРАНЕНИЯ

The actual problem of optimizing financial management in state budgetary healthcare institutions is considered. In the framework of the state policy, it is necessary to clearly define the limit of social guarantees provided at the expense of budgets, and to create new mechanisms for social protection of citizens. The implementation of this task largely depends on the condition and stability of the state and municipal finances, which are the main source of healthcare funding. The Federation entities and municipalities are independent in determining the list of target programs due to different priorities of socio-economic development, differences in the structure of state authorities and local governments. When forming the procedure for the development, implementation and evaluation of the effectiveness of targeted programs, the Federation entities and municipalities must find a balance between approaches of the federal government level, the specifics of the territory and the features of the existing system of state (municipal) managing its socio-economic development. The authorities of various levels are forced to limit the growth of budget expenditures against the backdrop of an unfavorable economic situation. The most important condition for the development of the budget system of the Russian Federation in such a situation is to increase the efficiency of the use of budget funds. Health expenditures account for about a quarter of territorial budget expenditures. Therefore, one of the most important issues of financing state medical budgetary institutions is financing from the funds received from the provision of paid services through active cooperation with insurance companies. The analysis of the structure of financial flows revealed trends and deviations from the planned values. The effect from cooperation of medical institutions with insurance companies is analyzed. Cooperation is based on the variation of two main variable factors - the discount and the expected increase in demand for services, which allows us to determine the effectiveness of project implementation both for individual groups of services and for the entire commercial activity of the hospital as a whole.

Equity in health-care financing in China during the progression toward universal health coverage

Financing equity has become a major policy goal in China's progression toward universal health coverage since the beginning of the 21st century. In this study, we examine the equity characteristics of health-care financing in a province in the middle of China, comparing the equity performance between urban and rural areas at two different points in time. Progressivity and the corresponding Kakwani index were used to assess four health-care financing sources: indirect and direct taxes, public health insurance, and out-of-pocket payments. Two rounds of surveys were conducted in 2008 (5650 individuals in 1800 households) and 2013 (11,250 individuals in 3598 households). Household socioeconomic status, health-care payments, and utilization information were recorded during household interviews. Total health-care financing was near proportional in 2008 and slightly progressive in 2013 in urban areas, whilst it was marginally progressive in both 2008 and 2013 in rural areas. The health-care financing system was more equitable in 2013 than in 2008. Overall, the performance of China's health-care financing has improved over the period 2008–2013. Using flat-rate contributions to fund health care is not equitable to the poor. Key measures to achieve equitable health-care financing distribution include improvements in the benefit packages offered by health-insurance schemes and provision of essential health services.

Specifičnosti privatnih izvora finansiranja zdravstvene zaštite

The two most important private sources of health care financing are voluntary health insurance and out-of-pocket payments made by users. Due to the constant increase in health care costs, these two sources are used either as a supplement to public forms of financing or as a predominant source of healthcare financing. Considering the basic characteristics of private sources of health care financing is important, among other things, for making the choice of the most appropriate combination of funding sources for this important system that affects the health of the population. Based on the analysis of the specifics of voluntary health insurance and out-of-pocket payments, in this paper we identify the factors that determine their presence and make recommendations for increasing the health care coverage.