Items in this collection
Restructuring Regional Health Systems In Russia
2010-10, Marquez, Patricio V., Lebedeva, Nadezhda
The delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.
Health Systems Strengthening Lessons from the Turkish Experience
2009-12, Chakraborty, Sarbani
In 2003, the Government of Turkey launched an Health Systems Strengthening (HSS) reform called the 'Health Transformation Program' (HTP). The HTP was designed to address these health system challenges. It was recognized at the outset that without system-wide reforms, significant and sustainable changes in health system performance could not take place. The overall objective of the HTP was to make the health system more effective by improving governance, efficiency, user and provider satisfaction, and long-term sustainability. The main elements of the HTP are: (i) establishment of a single purchaser in the health system; (ii) focusing the Ministry of Health (MoH) on stewardship functions; (iii) making the public sector health services delivery network autonomous; and (iv) strengthening human resources management and information systems in the health system. In its technical focus and paradigm, the HTP represents a classic 'textbook' approach to HSS which many Bank clients are trying to implement.
Setting Incentives for Health Care Providers in Serbia
2010-07, Cashin, Cheryl, Koettl, Johannes, Schneider, Pia
The Serbian Government plans to reform its provider payment system for health care by setting incentives for providers to improve the quality and efficiency of care. Funds for health care are currently allocated on the basis of the number of staff and beds at health facilities. This encourages health care providers to use more staff and beds to define their budgets but does not reward improvements in productivity, quality of care or health outcomes.
Competition in Health Insurance
2009-08, Schneider, Pia
This knowledge brief presents the key findings of a recent World Bank report on, 'health insurance and competition'. The report examines whether competition helps multiple insurers better manage health expenditures by, for example, contracting with more efficient providers or directing consumers towards less costly care (i.e. consumers who use generic drugs pay lower premiums or co-payments). The Netherlands, Switzerland, Slovakia, and the Czech Republic are some of the countries that already have multiple and competing insurance systems in place.
Tajik Child Health : All Hands on Deck
2009-12, Bakilana, Anne, Msisha, Wezi
Promoting and protecting the health of their families is a high priority of households in Tajikistan-half of all households identify health as the aspect of life that is of greatest concern to them. Thirty five percent, or 2.5 million of the total estimated population of 7.2 million people in the country, are under 15 years of age. The median age of the population is just 21.6 years (UN, 2008). Although fertility has fallen in recent years, the total fertility rate remains above three. Thus, policies to improve maternal and child health (MCH) outcomes are central to improving the health of the nation. Tajikistan faces considerable challenges in its quest to achieving the Millennium Development Goals (MDGs) for MCH over the next six years. The fourth MDG target of a two-thirds reduction in child mortality calls for Tajikistan to decrease its current under-five mortality rate (U5MR) of 79 deaths per 1000 live births to less than 30 per 1000, and the current Infant Mortality Rate (IMR) of 65 deaths per 1000 to under 25 per 1000. Countries with GDP levels similar to Tajikistan have made significantly better progress towards reaching their MDG targets. For instance, IMRs in the Lao People's Democratic Republic and Cambodia stand at 52 and 59 deaths per 1000 live births, respectively, compared to 65 per 1000 in Tajikistan. IMRs in neighboring Uzbekistan and the Kyrgyz Republic are 38 and 36 per 1000 live births, respectively. Similarly, with child mortality rates of 69 and 41 per 1000 live births respectively, Lao and the Kyrgyz Republic are in a better position than Tajikistan.
Mitigating the Impact of the Economic Crisis on Public Sector Health Spending
2009-08, Schneider, Pia
The current global financial crisis is having a substantial impact in Europe and Central Asia (ECA) where economic growth is beginning to dip, unemployment is rising and government revenues are being cut. The Gross Domestic Product (GDP) growth rate of the region is projected to decline by 4.7 percent in 2009 and the flow of remittances is also expected to slow down sharply, causing particular hardship to low-income groups. While countries with fiscal capacity have adopted stimulus packages to promote economic recovery, most ECA countries are financially constrained and have revised their government budgets, including in the health sector. Thus, as a result of the crisis, public spending on health may actually decrease in absolute amounts and in percentage of GDP. The health sectors in most ECA countries are mainly financed from public sources. In countries with low levels of public spending on health3, the majority of health services are paid for by patients. Any reductions in public health spending would thus only add to the out-of-pocket expenditures of patients, and may negatively affect access to care, particularly for the poor. There is increasing empirical evidence that public sector spending improves health indicators in low-income and transition countries, particularly in countries that have good governance systems in place.