Publication: Are Free Government Health Services the Best Way to Reach to Poor?
Loading...
Date
2004-09
ISSN
Published
2004-09
Author(s)
Editor(s)
Abstract
The paper asks whether the pursuit of universal coverage by a wide range of free government services constitutes the most promising approach to meeting the needs of disadvantaged population groups. The response given to that question is probably not. The record to date points clearly to the danger that the benefits of subsidized government health services will flow primarily to the better-off, rather than to the poor for whom the services are intended. While there is no perfect approach to dealing with this issue, the record also points to several approaches that can significantly ameliorate the situation. Two of them, discussed in the paper, are the adoption of targeting measures to increase the proportion of benefits from government expenditures that flow to the poor; and the development of alternative, self-sustaining service financing and delivery mechanisms to serve the better-off. Successful implementation of approaches like these would allow governments to focus their efforts to achieve universal free coverage on a limited number of interventions that are particularly important for poor groups.
Link to Data Set
Citation
“Gwatkin, Davison R.. 2004. Are Free Government Health Services the Best Way to Reach to Poor?. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank. http://hdl.handle.net/10986/13720 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Kenya : Reaching the Poor through the Private Sector, A Network Model for Expanding Access to Reproductive Health Services(World Bank, Washington, DC, 2005-05)This study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private medical providers. The Kisumu Medical and Educational Trust (KMET) program focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The central question addressed in this study is whether it is possible to offer reproductive health services through a network of private sector, for-profit providers without exacerbating inequity in access to these services.. The study also looked at a pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through KMET. And finally, an analysis of actual KMET clients was used to better understand the program's success in providing quality reproductive health care.Publication How to Pay? Understanding and Using Incentives(World Bank, Washington, DC, 2004-09)Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation. The authors argue that no one set of incentives will address the multiple objectives of purchasers, providers, and patients. As a result, purchasers and policymakers must understand and address policy objectives explicitly. With more sophisticated systems, part or all of the financial risk is transferred from the purchaser back to the provider and patient. Most observers caution against full risk but encourage some supply-side cost sharing only, with purchaser and provider sharing in risk arrangements to address moral hazard issues. Imposing high copayments or user fees is an alternative, but in developing countries that quickly erodes financial protection. More sophisticated payment systems may also lead to higher transaction costs and necessitate a greater capacity to use information and management systems. Finally, the best planned and implemented payment incentives and systems may fail due to a variety of other and related factors in health care delivery. Unless these issues are addressed, impacts of change in resource allocation and purchasing will be diluted or neutralized. Technicians and policymakers will need to address these potential "chokepoints" in any process of implementation and refinement.Publication Timor-Leste Health Sector Review : Appendices(Washington, DC, 2006-10-06)The Timor-Leste health sector review describes the accomplishments made by the government of Timore-Leste in the health sector since it separated from Indonesia, and analyzes the challenges still facing the government moving forward. Infant and maternal mortality, and malnutrition, are still important battles. Underutilization of services, and poor quality of services when available, are also reasons for the poor health quality indicators. Improving the quality or effectiveness of health services is difficult. However, now that most of the basic health care infrastructure is in place, the time is right for the Ministry of Health (MOH) to develop a system to monitor and upgrade the quality of health care services, starting with public sector services. One initiative put forth is health education delivered through various channels, which would make households better aware of the risks associated with certain health conditions or symptoms and the importance of using the available health services from government and NGO facilities. A second type of potential intervention is the introduction of conditional cash transfers, whereby the Government pays a subsidy to households in exchange for certain behaviors beneficial to society, such as having their children immunized. Carrying out the various interventions described above would require that the Government increased its spending on health services further.Publication Challenges in Financing Education, Health, and Social Protection Expenditures in Zimbabwe(Washington, DC, 2011-02-02)The Government of Zimbabwe (GOZ) faces difficult choices in managing the size of its civil service wage bill. The Government understands the need to watch the escalating wage bill carefully and put in place a strategy to steer it to a sustainable level as early as possible. Historical and international comparisons suggest that an overall wage bill of around 10 percent of GDP should be the medium-term target. This note illustrates that Zimbabwe could take immediate steps in 2010 and 2011 that will put it on the path of a sustainable level of wage bill in the medium-term. The focus of efforts to contain the wage bill should be on short-term measures because designing and implementing a medium-term approach to wage bill management would be too challenging in view of prevailing economic uncertainty and complex political reality. The note covers the staff employed by the Central Government, including uniformed services and staff employed by the Grant-in-Aided (GIA) institutions. The staff employed by local governments and public enterprises are excluded because direct transfers from the central budget to local government and public enterprises are rather small. (annex A has an outline of the institutional aspects of civil service in Zimbabwe). Given the paucity of information, the note does not make any recommendations specific to the GIA wage bill.Publication Improving Health Outcomes for the Poor in Uganda : Current Status and Implications for Health Sector Development(Washington, DC, 2004-06-30)This study shows that Uganda has similar or somewhat better health indicators than other African countries with a similar income level. However further effort is needed to address inequality in health outcomes and in the health system. Overall recommendations arising from this report, which are discussed in detail in Chapter 8, center on five areas: (a) prioritizing interventions that affect infant and maternal mortality, (b) improving health promotion and disease prevention practices at the family and community level through community mobilization and inter-sectoral collaboration, (c) mobilizing funds for the health sector including strategies that encourage risk polling mechanisms; (d) focusing on human resources and collaboration with the private sector to improve health service delivery, and (e) improving accountability through improving information systems and supervision.
Users also downloaded
Showing related downloaded files
Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.