WHO Health Systems Framework Research Articles

Mental health system financing in developing countries: Policy questions and research responses

To what extent does previous and existing health economics research directly address key health system financing issues facing mental health services in developing countries? By mapping WHO's health systems framework onto mental health, three key financing questions for mental health are identified: the sufficiency of resources for mental health; the protection of individuals or households against the economic consequences of mental ill-health; and the efficient use of available resources for mental health. Research efforts to date have mainly focused on the evaluation of intervention costs in relation to mental health outcomes (the efficiency question). There is a need to achieve a greater balance between economic analysis (aimed at identifying best buys) versus financial planning (scaling up the delivery or implementation of interventions shown to be cost-effective). In addition, a better understanding and clearer articulation of the negative impact of mental disorders at the household level is needed, together with ways of alleviating financial burden via appropriate and affordable pre-payment financing mechanisms.

Assessing the effect of the 2001-06 Mexican health reform: an interim report card

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.