Sustainable Health Financing Research Articles

An alternative framework for analyzing financial protection in health.

A greater focus on the role of health systems in health, development, and economic growth has led health policy research and analysis, domestic and global, to scrutinize health financing, insurance, and financial protection. Two World Health Reports (2000 and 2010) [1],[2] have called for evaluating health system performance in terms of health financing, and the World Health Organization's (WHO) 64th World Health Assembly reiterated the need for sustainable health financing and universal coverage worldwide [3]. With this increased focus has come closer examination of conventional frameworks and measures of financial protection in health both from academic [4] and policy [5] circles. Consensus had developed among academic and policy analysts on two primary metrics, catastrophic and impoverishing spending, for financial protection. Both methods use as a measure the percentage of out-of-pocket health spending in households' overall spending. They differ in the way medical spending is deemed problematic: catastrophic spending is above a threshold percentage, while impoverishing spending pushes a household below the poverty line. Both metrics are helpful indicators of the absolute and relative level of household out-of-pocket health care spending and have been employed in multiple studies worldwide [6]–[10]. Our research group conducted a study focusing on a modification of these metrics—the out-of-pocket spending burden ratio using household equivalent income derived from the Organisation for Economic Co-operation and Development (OECD) Equivalence Scale [11]. But the consensus has given way, and critiques of the conventional approach now run wide and deep. Critics include those who are most invested and who have employed these methodologies [5],[7], and those who argue that estimates of household health expenditures themselves are subject to considerable variability depending on survey design [12]. This article proposes a multidimensional financial protection profile that offers a more holistic view of health spending, one that goes beyond the level of spending to cover aspects directly related to health care, such as health care access and insurance utilization, and examines broader impacts on current and longer-term household consumption. This multidimensional approach aims to help policy makers understand the larger context of household health spending and make health and social policy adjustments to mitigate damaging effects.

Albania: Health Care System in the Course of Health Reform. An Overview of Health Insurance System

This paper introduces and analyses in general the Health Care System (HCS) focusing particularly on the Health InsuranceSystem (HIS) in Albania, as a country in a period of transition. The Government of Albania is in the process of reforming andmodernizing its healthcare sector and is moving towards the establishment of a more sustainable health financing insurance system. Theaim is to obtain a clear referential structure for the further development of the health insurance system and for the establishment ofeffective, managing and administrative capacities This paper is prepared by exploring the published literature and collecting data throughsecondary sources. Several data sources have been used to describe the health performance in Albania. The review includes severalreferences and, by covering OECD countries The concepts included here serve us to better know and understand the actual situation ofHIS, and what is more to be included in a “general plan” for the preparation of the directives for the organization, implementation,observation and evaluation of the steps that have to be undertaken for the reformation of the health insurance in Albania. Albaniashould develop an explicit, comprehensive revenue collection strategy that considers all available methods, such as direct taxation, indirecttaxation, social security contributions, voluntary health insurance, and user charges, in order to optimize revenue collection.

Health insurance coverage and health care access in Moldova

In 2004, the Moldovan government introduced mandatory (social) health insurance (MHI) with the goals of sustainable health financing and improved access to services for poorer sections of the population. The government pays contributions for non-employed groups but the self-employed, which in Moldova include many agricultural workers, must purchase their own cover. This paper describes the extent to which the Moldovan MHI scheme has managed to achieve coverage of its population and the characteristics of those who remain without cover. The 2008 July-October enhanced health module of the Moldovan Household Budget Survey was used. The survey uses multi-stage random sampling, identifying individuals within households within 150 primary sampling units. Numbers and characteristics of those without insurance were tabulated and the determinants of lack of cover were assessed using multivariate regression. 3760 respondents were interviewed. Seventy-eight per cent were covered by MHI. Factors associated with being uninsured include being self-employed (particularly in agriculture), unemployed, younger age and low income. Respondents who were self-employed in agriculture were over 27 times more likely to be uninsured than those who were employed. Agricultural workers in Moldova are responsible for purchasing their own cover; most respondents cited cost as the main reason for not doing so. While being uninsured has an impact on utilization, financial barriers persist for those with insurance who seek care. The strengths and weaknesses of the MHI system in Moldova provide valuable lessons for policy makers in low- and middle-income countries addressing the challenges of achieving equitable coverage in health insurance schemes and the complex nature of financial barriers to access.

Abstract A87: The epidemiology of breast and cervical cancer: Pre-and post-National Health Insurance Scheme in Ashanti region of Ghana

Abstract Background: The relationship between breast and cervical cancer, inequality in income distribution and access to health care has attracted much attention during the last two decades. To reduce this problem of financial access to health care, Ghana's government is committed, and has introduced a convenient, affordable and sustainable health financing arrangement to protect the people, especially the poor, through the National Health Insurance Scheme (NHIS). Breast cancer and cervical cancer, once rare, is now becoming a major public health concern in Kumasi, Ghana. The introduction of the “cash and carry” system in 1992 compounded the problem of financial access to quality health care, and thus led to low utilization of health services especially, by the poor. This led to deteriorating health status for the people of Ghana. Though laudable, little is known about the efficacy of the health insurance in improving breast and cervical cancer care in Ghana. The purpose of this study was to examine the epidemiology of breast and cervical cancer both prior to and following the enactment of the NHIS. Time-Series data obtained from the Ghana Okonfo Anokye Teaching Hospital was utilized. Methods: This project consisted of two phases. Medical records of inpatient and outpatient records for the period of 2001 through 2009 in the hospital were reviewed. Phase 1 consisted of pre-NHIS and post-NHIS data compilation and aggregation, variable construction and univariate and bivariate descriptive statistics provided an overview of the state of the health care system in Ghana. Phase 2 consisted of a time series analysis on 2001-2009 data. The SAS Proc ARIMA was utilized to determine if significant changes in the demographic characteristics of inpatients and outpatients occurred after the institution of the NHIS. Results: Ghana recorded 0.54 outpatient visits per capita in 2005 (before national health insurance). The hospital admission rate was 36.5, per 1000 in 2005. Skilled obstetrical deliveries increased to 40.3% in 2005. It is against this background that trends in inpatient and outpatient medical visits were analyzed. Trends by gender, age, and diagnostic group were examined over an eight year period. Conclusions: Prior to 2006 the country instituted a national health insurance plan. This plan provided free health coverage to all citizens. Prior to the NHIS the predominant mode of payment for healthcare services was cash and carry. Rates of outpatient services provided and inpatient admissions have changed by age group, gender and by diagnosis after national health insurance in Ghana. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A87.

Supplying Health Microinsurance: Lessons from East Africa*

Health microinsurance[1] is a recent entrant in the effort to provide sustainable health financing products to low-income populations. Literature covering this area is sparse and limited to a focus on one delivery channel. Several other channels are beginning to show promise in this market, but these have not been carefully reviewed, compared, or contrasted. There is no significant literature that reviews these different models in a practical manner to aid institutions that are considering the development of a health microinsurance product. This study provides a better understanding of the effectiveness of these different models. It helps insurers and others to identify good and “bad” practices[2] within the various models so that they can: 1. decide which model is most appropriate for them, and 2. benefit from the key lessons of others.