Publication: Health Financing for Poor People : Resource Mobilization and Risk Sharing
Loading...
Date
2004
ISSN
Published
2004
Author(s)
Editor(s)
Abstract
Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Usually government taxation capacity is weak, formal mechanisms of social protection for vulnerable populations absent, and government oversight of the informal health sector lacking. In this context of extreme public sector failure, community involvement in the financing of health care provides a critical albeit insufficient first step in the long march towards improved access to health care by the poor and social protection against the cost of illness. Health Financing for Poor People stresses that community financing schemes are no panacea for the problems that low-income countries face in resource mobilization. They should be regarded as a complement to - not as a substitute for - strong government involvement in health care financing and risk management related to the cost of illness. Based on an extensive survey of the literature, the main strengths of community financing schemes are the extent of outreach penetration achieved through community participation, their contribution to financial protection against illness, and increase in access to health care by low-income rural and informal sector workers. Their main weaknesses are the low volume of revenues that can be mobilized from poor communities, the frequent exclusion of the very poorest from participation in such schemes without some form of subsidy, the small size of the risk pool, the limited management capacity that exists in rural and low-income contexts, and their isolation from the more comprehensive benefits that are often available through more formal health financing mechanisms and provider networks. The authors conclude by proposing concrete public policy measures that governments can introduce to strengthen and improve the effectiveness of community involvement in health care financing.
Link to Data Set
Citation
“Preker, Alexander S.; Carrin, Guy. Preker, Alexander S.; Carrin, Guy, editors. 2004. Health Financing for Poor People : Resource Mobilization and Risk Sharing. © World Bank. http://hdl.handle.net/10986/15019 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Social Inclusion and Financial Protection through Community Financing : Initial Results from Five Household Surveys(World Bank, Washington, DC, 2001-09)This paper provides empirical evidence regarding the performance of community-based health care financing in terms of (a) social inclusion and (b) financial protection. Five non-standardized household surveys were analyzed from India (two samples), Senegal, Rwanda, and Thailand. Common methodology was applied to the five data sets. Logistic regression was used to estimate the determinants of enrolling in a community financing scheme. A two-part model was used to assess the determinants of financial protection: part one used logistic regression to estimate the determinants of the likelihood of visiting a health care provider; part two used ordinary least-squares regression to estimate the determinants of out-of-pocket payments. The research finds: (a) Social inclusion. The findings suggest that community financing can be inclusive of the poorest even in the most economically deprived context. Nevertheless, this targeting outcome is not automatically attributable to the involvement of the community; rather it depends on key design and implementation characteristics of the schemes. (b) Financial protection. Community financing reduces financial barriers to health care as demonstrated by higher utilization and simultaneously lower out-of-pocket expenditure of scheme members controlling for a range of socioeconomic variables. The paper concludes: (a) Social inclusion. Design and implementation characteristics of community financing schemes matter to achieve good targeting outcome-community involvement alone does not guarantee social inclusion. Further research is needed to delineate which design and implementation characteristics allow better inclusion of the poor. (b) Financial protection. Prepayment and risk sharing, even on a small scale, reduce financial access barriers.Publication Timor-Leste Poverty Assessment : Poverty in a New Nation - Analysis for Action, Volume 1. Main Report(Washington, DC, 2003-05)Timor-Leste has achieved enormous progress in rehabilitating its economy, reconstructing its infrastructure, reintegrating its refugees and building the key elements of a sustainable political process in an environment of internal peace. It now faces many challenges of nation-building and of overcoming the deprivation affecting the lives of the poor. This report written in two volumes lays out the challenge of poverty reduction in Timor-Leste. It is based on the first nationally-representative household survey collected during August to December 2001. The report's objectives are modest: to set a baseline for the new country on the extent, nature and dimensions of poverty; and to assist the decision making of the newly elected government and its efforts in formulating, implementing and monitoring its Poverty Reduction Strategy. The overall objective was not to lay out the elements of poverty strategy but rather to present evidence on the basis of which the Timorese can define and refine their own poverty reduction strategy. The key challenge lies now in formulating a poverty monitoring plan that includes both quantitative and participatory elements, and lays out the institutional arrangement for data analysis and reporting to ensure that the collected data inform policy making and program design.Publication The Long March to Universal Coverage : Lessons from China(World Bank, Washington DC, 2013-01)The march to Universal Health Coverage (UHC) in China is unparalleled. Since the establishment of the State Council Medical Reform team in 2006,4 the basic objective of China's health reforms has been to provide the whole nation with basic medical and health care, while ensuring equal access to, and affordability of, health services. The Chinese government announced the national three-year reform plan in 2009, after which the country has made remarkable progress toward achieving nearly universal health coverage. The recent health reform initiatives under the 12th Five-Year Plan (2011-2015) continue to center on five areas. Building on recent experience, more effort is directed toward a structural change of the health system and building an environment that will facilitate policy implementation. This includes optimizing resource distribution, encouraging hospital competition, strengthening regulation and accountability, and enhancing human resources and information technology. While China has successfully extended the breadth of Health Coverage to the Poor (HCP), its scope (the comprehensiveness of services covered) and depth (the degree of financial risk protection) appear to be insufficient. Hospital admissions have increased significantly; suggesting improved access, up to 50 percent of current admissions may be amenable to more cost-effective outpatient care. Thus, it is critical to look into problems beyond the HCP program design, such as institutional arrangements, intergovernmental transfers, and supply constraints. This case study concludes with a discussion of the impacts of HCP and the needed next steps to advance HCP as an intermediate objective to the country's longer-term goals of equitable access and high quality of services.Publication Establishing Private Health Care Facilities in Developing Countries : A Guide for Medical Entrepreneurs(2007)This book is a practical guide for medical professionals who are interested in establishing health care facilities in developing countries. It is intended for individuals and organizations with little or no business experience who are seeking guidance on how to turn a general idea into concrete reality. The author's goals in writing the book were modest. The guide does not provide an exact roadmap for building a hospital or other type of health care facility, nor is there any guarantee that the new entrepreneur who follows the approach described will be able to obtain financing from investors. Rather, the book is designed as an introductory resource with which to begin the process.Publication Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Bangladesh(World Bank Group, Washington, DC, 2014-09)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.
Users also downloaded
Showing related downloaded files
Publication Climate Change and Migration : Evidence from the Middle East and North Africa(Washington, DC: World Bank, 2014-07-15)Climate change is a major source of concern in the Middle East and North Africa (MENA) region, and migration is often understood as one of several strategies used by households to respond to changes in climate and environmental conditions, including extreme weather events. This study focuses on the link between climate change and migration. Most micro-level studies measure climate change either by the incidences of extreme weather events or by variation in temperature or rainfall. A few studies have found that formal and informal institutions as well as policies also affect migration. Institutions that make government more responsive to households (for example through public spending) discourage both international and domestic migration in the aftermath of extreme weather events. Migration is often an option of last resort after vulnerable rural populations attempting to cope with new and challenging circumstances have exhausted other options such as eating less, selling assets, or removing children from school. This study is based in large part on new data collected in 2011 in Algeria, Egypt, Morocco, Syria, and the Republic of Yemen. The surveys were administered by in-country partners to a randomly selected set of 800 households per country. It is also important to emphasize that neither the household survey results nor the findings from the qualitative focus groups are meant to be representative of the five countries in which the work was carried, since only a few areas were surveyed in each country. This report is organized as follows: section one gives synthesis. Section two discusses household perceptions about climate change and extreme weather events. Section three focuses on migration as a coping mechanisms and income diversification strategy. Section four examines other coping and adaptation strategies. Section five discusses perceptions about government and community programs.Publication Disease Control Priorities, Third Edition(Washington, DC: World Bank, 2016-04-06)This book focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. It also includes the transition to older childhood, in particular, the overlap and commonality with the child development volume.Publication Making Monitoring and Evaluation Systems Work : A Capacity Development Toolkit(World Bank, 2009)There are constant and growing pressures on governments and organizations around the world to be more responsive to demands from internal and external stakeholders for good governance, accountability and transparency, greater development effectiveness and delivery of tangible results. Governments, parliaments, citizens, the private sector, non-governmental organizations (NGOs), civil society, international organizations, and donors are all among stakeholders interested in better performance. As demands for greater accountability and results have grown, there is an accompanying need for useful and useable results-based monitoring and evaluation systems to support the management of policies, programs, and projects. Governments and other organizations have many different kinds of tracking systems as part of their management toolkits: good human resource systems, financial systems, and accountability systems. They also need good feedback systems. A results-based monitoring and evaluation (M&E) system is essentially such a feedback system; it is a management tool to measure and evaluate outcomes, providing information for governance and decision making. Many management systems have been missing a feedback component to enable them to track the consequences of actions. Building an M&E system gives decision-makers an additional management tool by providing feedback on performance as a basis for future improvement.Publication Changing the Face of the Waters : The Promise and Challenge of Sustainable Aquaculture(Washington, DC: World Bank, 2007)This study provides strategic orientations and recommendations for Bank client countries and suggests approaches for the Bank's role in a rapidly changing industry with high economic potential. It identifies priorities and options for policy adjustments, catalytic investments, and entry points for the Bank and other investors to foster environmentally friendly, wealth-creating, and sustainable aquaculture. The objectives of the study are to inform and provide guidance on sustainable aquaculture to decision makers in the international development community and in client countries of international finance institutions. The study focuses on several critical issues and challenges: 1) Harnessing the contribution of aquaculture to economic development, including poverty alleviation and wealth creation, to employment and to food security and trade, particularly for least developed countries (LDCs); 2) Building environmentally sustainable aquaculture, including the role of aquaculture in the broader suite of environmental management measures; 3) Creating the enabling conditions for sustainable aquaculture, including the governance, policy, and regulatory frameworks, and identifying the roles of the public and private sectors; and 4) Developing and transferring human and institutional capacity in governance, technologies, and business models with special reference to the application of lessons from Asia to Sub-Saharan Africa and Latin America.Publication Early Child Development, From Measurement to Action : A priority for Growth and Equity(Washington, DC: World Bank, 2007)The World Bank recently hosted a symposium on the priority of early child development (ECD) for economic growth and equity. The participants urged application of population-based tools and measures to assess the outcomes of children's early years and children's readiness for school. This study is derived from the symposium and is a valuable resource for policy makers, economists, donors, and investors, as well as researchers and practitioners in early child development. It summarizes the current neuroscience on early child development and major longitudinal studies, the rationale and urgency for greater investment, and countries' innovative funding strategies. The report consists of 15 chapters authored by ECD experts and leaders in the field. The chapters are grouped into five main parts relating to the: business imperative and societal benefits of ECD investments; lessons from evaluation of longitudinal ECD interventions; countries' experiences in monitoring ECD interventions; innovative approaches to countries' financing of ECD initiatives; and next steps on the ECD agenda for the next 5 years. A theme highlighted at the symposium and enlarged upon here is the urgent need for evidence- and population-based instruments and measures to monitor, evaluate, and compare ECD interventions over time and across settings.