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  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Lessons from Japan
    (Washington, DC: World Bank, 2014-09-25) Ikegami, Naoki; Ikegami, Naoki
    In 2011, Japan celebrated the 50th anniversary of its own achievement of universal health coverage (UHC). On this occasion, the government of Japan and the World Bank conceived the idea of undertaking a multi-country study to respond to this growing demand by sharing rich and varied country experiences from countries at different stages of adopting and implementing UHC strategies, including Japan itself. This led to the formation of a joint Japan-World Bank research team under the Japan-World Bank partnership program for UHC. The program was set up as a two-year multi-country study to help fill the gap in knowledge about the policy decisions and implementation processes that countries undertake when they adopt UHC goals. This report brings together 10 in-depth studies on different aspects of Japan's UHC experience, using a common framework for analysis focused on the political economy of UHC reform, and the policies and strategies for addressing challenges in health financing and human resources for health. Japan's commitment to UHC played a key role in the country's economic recovery after World War second, and helped ensure that the benefits of economic growth were shared equitably across the population.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Vietnam
    (World Bank Group, Washington, DC, 2014-09) Barroy, Helene; Jarawan, Eva; Bales, Sarah
    Vietnam is regarded as a development success story. Political and economic reforms ( Doi Moi ) launched at the end of the 1980s have transformed the country from one of the poorest in the world to a lower middle-income country in a quarter century, with per capita income of $1,130 (World Bank, 2013). Over the past 10 years, Vietnam has seen average annual economic growth of nearly 8 percent. Poverty tumbled from 58 percent in 1993 to 12 percent in 2009. Economic development and innovative policy interventions led to steep gains in health outcomes and access to health care, although large disparities persist between the rich and poor, and between poorer and better-off regions (Vietnam General Statistics Office 2011b). Infant mortality declined from 30 to 16 per 100,000 live births, and under-five mortality rates from 42 to 25 per 100,000 live births, between 2001 and 2009 (Vietnam General Statistics Office 2011a, 2011c). Vietnam has shown strong political commitment toward universal health coverage (UHC), making it a national goal for 2014. A major challenge lies now in expanding coverage to the non-covered population (64 percent had coverage in 2012) while addressing the model s financial sustainability.
  • Publication
    Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)
    (World Bank Group, Washington, DC, 2014-09) Bump, Jesse; Sparkes, Susan; Tatar, Mehtap; Celik, Yusuf; Aran, Meltem; Rokx, Claudia
    Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey s health system has few if any parallels in scope and speed. Before the reforms, Turkey s aggregate health indicators lagged behind those of OECD member states and other middle-income countries. The health financing system was fragmented, with four separate insurance schemes and a Green Card program for the poor, each with distinct benefits packages and access rules. Both the Ministry of Labor and Social Security and Ministry of Health (MoH) were providers and financiers of the health system, and four different ministries were directly involved in public health care delivery. Turkey s reform efforts have impacted virtually all aspects of the country s health system and have resulted in the rapid expansion of the proportion of the population covered and of the services to which they are entitled. At the same time, financial protection has improved. For example, (i) insurance coverage increased from 64 to 98 percent between 2002 and 2012; (ii) the share of pregnant women having four antenatal care visits increased from 54 to 82 percent between 2003 and 2010; and (iii) citizen satisfaction with health services increased from 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic improvements there is still space for Turkey to continue to improve its citizens health outcomes, and challenges lie ahead for improving services beyond primary care. The main criticism to reform has so far come from health sector workers; the future sustainability of reform will rely not only on continued fiscal support to the health sector but also the maintenence of service provider satisfaction.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Thailand
    (World Bank Group, Washington, DC, 2014-09) Patcharanarumol, Walaiporn; Tangcharoensathien, Viroj; Wibulpolprasert, Suwit; Suthiwisesak, Peerapol
    Thailand, an upper-middle-income country with a population of 69.5 million in 2012, achieved its health-related Millennium Development Goals by the early 2000s. The health care delivery system has received significant investments in the past three or four decades and now offers extensive health infrastructure coverage that reaches even the most rural and remote areas, in a publicly dominated health system. However, ensuring equity among the three main public insurance programs and assuring fiscal sustainability are the major challenges facing the current system.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Bangladesh
    (World Bank Group, Washington, DC, 2014-09) World Bank
    Bangladesh is a low-income country with gross national income of $1,940 per capita in purchasing power parity (PPP) in 2011. It has made great strides in economic and social development outcomes, particularly in health, and is on track to achieving most of the health-related Millennium Development Goal (MDG) targets. Under-five mortality has been cut by half in the last decade (to 46 deaths per 1,000 live births in 2011). It has also strongly invested in and promoted family planning programs since the 1950s. Fertility rates have fallen sharply to 2.2 births per woman in 2011. But despite this drop, its population is projected to grow to 202 million by 2050 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2013). About one-third of the population is still poor. Bangladesh spends about 3.8 percent of GDP on health, while public spending accounts for one-third of total health expenditures (THE). Out-of-pocket (OOP) spending constitutes about 60 percent of THE, with evident implications for financial protection, especially among the worse off. The country faces multiple challenges in improving efficiency and quality across health, human resources for health (HRH) being a key bottleneck at all levels. However, it provides an example of a country that is in the initial phases of exploring mechanisms to improve health services coverage and financial protection to its population, with a commitment to achieving universal health coverage (UHC) by 2032, and one that has innovative approaches to addressing key health care issues, including equity and citizen engagement.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Brazil
    (World Bank Group, Washington, DC, 2014-09) Lindelow, Magnus
    Over the last 20 years, Brazil has seen profound economic, political, and demographic changes. After a period of military dictatorship (from 1964 to 1985), political and economic stability was achieved in the mid-1990s. The country has urbanized, improved access to water and sanitation, achieved solid economic growth, and reduced income inequality. It was one of the first Latin American countries to establish universal health coverage (UHC) as a fundamental right, based on the principles that health care is a duty of the state and should be free at the point of use. The reform in the late 1980s created the Unified Health System (Sistema Único de Saúde, or SUS) and was based on the principle that health care should be free at the point of use to all Brazilian citizens.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Turkey
    (World Bank Group, Washington, DC, 2014-09) Aran, Meltem; Ozceli, Ece Amber
    Turkey is an upper middle-income country that has seen rapid economic growth and development over the last decade. In a relatively short period, it has essentially achieved universal health insurance (UHI) coverage of the population, high levels of financial protection and equity, and high and rising levels of consumer satisfaction, while significantly improving health outcomes. The universal health coverage (UHC) strategy, embedded in its Health Transformation Program (HTP), was initiated in 2003 to improve the effectiveness of the health system through improved governance, efficiency, and user and provider satisfaction.
  • Publication
    Vietnam : Learning from Smart Reforms on the Road to Universal Health Coverage
    (World Bank Group, Washington, DC, 2014-08) Barroy, Helene; Jarawan, Eva; Bales, Sarah
    Universal Health Coverage is a powerful framework for a nation aiming to protect their population against health risks. However, countries face multiple challenges in implementing, achieving and sustaining UHC strategies. Sharing and learning from diverse country experiences may enable to foster global and country progress toward that goal. The study seeks to contribute to the global effort of sharing potentially useful lessons to address policy concerns on the design and implementation of UHC strategies in LMICs. Vietnam is one of the LMICs that have taken relatively quick and effective actions to expand health coverage and improve financial protection in the last two decades. The country study, first, takes stock of UHC progress in Vietnam, examining both the breadth and the depth of health coverage and assessing financial protection and equity outputs (chapter one). Chapter two includes an in-depth analysis of some of the major success strategies and policy actions that the country took to expand health coverage and financial protection for all, including for the poor. Chapter three focuses on some of the UHC-related challenges that the country faces in pursuing expansion and sustaining UHC. Vietnam s experience suggests that, moving toward greater UHC outputs, the system must be constantly adjusted, and that UHC strategies must be adaptive, those used in the past to cover the formal sector and the poor may turn out inadequate to reach the uninsured in the informal sector.
  • Publication
    A Political Economy Analysis of Turkey's Health Transformation Program
    (World Bank, Washington, DC, 2014-07) Bump, Jesse B.; Powers Sparkes, Susan
    Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have reshaped the health system. Understanding the political economy of this process is important for the future of Universal Health Coverage (UHC) in Turkey, and also for many other countries and the development agencies that assist them. This report analyzes the historical context and complex political economy challenges of the reform. Our findings are based on stakeholder interviews and a review of literature. First, we identified five contextual factors that were important in bringing health reform to the policy agenda in Turkey, and were helpful in sustaining the reform during adoption and implementation: (1) a long history of reform plans and attempts; (2) fiscal pressure to reform the social sectors; (3) public support for health reform; (4) strong economic growth; and (5) favorable demographic conditions. Second, we assessed four political economy challenges central to the reform and the strategies used by the Ministry of Health (MoH) to overcome them. First, the MoH built public support for reform among the broad base of beneficiaries by focusing on highly visible and fast changes. Second, the MoH overcame well-organized interest group opposition to the reforms by splintering their support or delegitimizing their views. Third, Turkey asserted its own domestic priorities over those of the IMF and World Bank in cases of direct conflict. Fourth, the MoH circumvented potential political and institutional opposition to the large expansion of benefits and coverage through a carefully sequenced adoption and implementation plan that could be executed mostly without requiring the support of other ministries. This analysis also highlights important trade-offs made by the MoH with respect to the redistribution of resources, quality of care, financial sustainability, and physician satisfaction, which will all have to be considered as Turkey enters its next phase of health system development.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : A Synthesis of 11 Country Case Studies
    (Washington, DC: World Bank, 2014-06-25) Maeda, Akiko; Araujo, Edson; Cashin, Cheryl; Harris, Joseph; Ikegami, Naoki; Reich, Michael R.
    The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.