Publication:
Jamaica’s Effort in Improving Universal Access within Fiscal Constraints

Loading...
Thumbnail Image
Files in English
English PDF (1.35 MB)
1,090 downloads
English Text (93.83 KB)
61 downloads
English PDF (3.2 MB)
111 downloads
English Text (152.15 KB)
21 downloads
Published
2013-01
ISSN
Date
2013-05-02
Editor(s)
Abstract
Jamaica's primary health care system was a model for the Caribbean region in the 1990s. Because of it, Jamaicans enjoy relatively better health status than people in other countries of similar income level in the Caribbean region. However, Jamaica's health system is being severely challenged by persistent and reemerging infectious diseases and by the rapid increase in noncommunicable diseases (NCDs) and injuries. At the same time, the country has suffered from low economic growth and carries a high debt burden, which leaves limited fiscal space for improving health care. The Government of Jamaica has been trying to sustain the gain in health outcomes and improve access to health care for its population in an environment of constrained resources during the last decade. With the establishment of the Jamaica National Health Fund (NHF) in 2003 and the abolition of user fees at public facilities in 2008, the Government of Jamaica has taken steps toward achieving universal coverage. This study reviews the achievements and challenges in expanding universal access in Jamaica and assesses the impact of the NHF's drug-subsidy programs and the abolition of user fees on universal access, and discusses policy options for achieving universal coverage.
Link to Data Set
Citation
Chao, Shiyan. 2013. Jamaica’s Effort in Improving Universal Access within Fiscal Constraints. UNICO Studies Series;No. 6. © World Bank. http://hdl.handle.net/10986/13290 License: CC BY 3.0 IGO.
Digital Object Identifier
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Integrating the Poor into Universal Health Coverage in Vietnam
    (World Bank, Washington DC, 2013-01) Dao, Huong Lan; Somanathan, Aparnaa; Tien, Tran Van
    This case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Peru
    (World Bank Group, Washington, DC, 2014-09) Medici, Andre C.; Vermeersch, Christel; Narvaez, Rory
    Peru is an upper middle-income country that has experienced fast economic growth (average of 6.9 percent per year from 2004 to 2013, according World Developing Indicators, WDI) combined with a reduction in poverty and inequality over the past decade. Economic growth was led by exports and domestic demand, generating an increase in private investment, attracting foreign capital, and strengthening public finances. The population living in poverty and extreme poverty fell from 58.7 percent and 16.4 percent in 2004 to 25.8 percent and 6 percent in 2012, respectively (INEI 2014a). Inequality has also decreased, with the Gini index declining from 0.503 in 2004 to 0.48.1 in 2010 (WDI).
  • Publication
    The Nuts & Bolts of Jamkesmas, Indonesia’s Government-Financed Health Coverage Program for the Poor and Near-Poor
    (World Bank, Washington DC, 2013-01) Harimurti, Pandu; Pambudi, Eko; Pigazzini, Anna; Tandon, Ajay
    This case study describes and assesses Jamkesmas, Indonesia's government-financed health coverage program for the poor and near-poor. It provides a detailed description of the scope, depth, and breadth of coverage provided under Jamkesmas, and highlights ways in which the program interacts with the rest of Indonesia's health system. It also summarizes and discusses evidence on whether Jamkesmas is attaining its stated objectives of removing financial barriers and improving access to health care by the poor and near-poor, what could be improved, and what lessons can be learned from the experience of Jamkesmas that could help inform Indonesia's quest for universal coverage. The primary theme underlying the study is that supply-side constraints and supply-side subsidies have not been leveraged to increase the effectiveness of the Jamkesmas program. There are significant geographic deficiencies in the availability and quality of the basic benefits package, especially for those living in relatively remote and rural locations of the country, and this limits the effective availability of benefits for many Jamkesmas beneficiaries. The remainder of the case study is organized as follows. Section two provides general background and information on health system outcomes in Indonesia. Section three is an overview of health care financing and delivery. Section four describes the institutional architecture of Jamkesmas. Section five highlights the process of targeting, identification, and enrolment of beneficiaries under the program. Section six focuses on the role of public financing. Section seven outlines the basic benefits package. Section eight provides an overview of the information environment of Jamkesmas. Section nine discusses the special theme of supply-side constraints and supply-side subsidies that dilute the effectiveness of the Jamkesmas program. Section ten discusses the pending agenda around some of the architectural and operational features of Jamkesmas in the context of universal coverage.
  • Publication
    Government Spending and Central-Local Relations in Thailand's Health Sector
    (World Bank, Washington, DC, 2012-08) Hawkins, Loraine; Lindelow, Magnus; Osornprasop, Sutayut
    This paper focuses on efficiency and equity in the financing of health services, and the evolving role of central and local government in the health sector. Thailand has seen significant improvements in health outcomes and succeeded in expanding the coverage of health protection schemes over the last decades. While the achievements of Thailand's health system are undeniable, this paper highlights three key challenges: (i) inequalities in utilization and spending under different health financing schemes and across geographic areas; (ii) mounting cost pressures; and (iii) fragmentation of financing and unresolved issues concerning the respective roles of central and local governments. This paper shows that although some of the differences in utilization and spending across schemes can be explained by the age profile of members, significant variations remain even after controlling for differences. It documents large variation in resources and spending across regions, both for the system as a whole and within the respective health financing schemes. In addition, the paper highlights pressures to increase government health spending that are primarily the result of rising spending in the Universal Coverage (UC) and Civil Servant Medical Benefit Scheme (CSMBS) schemes. Cost pressures are likely to persist due to rising incidence of chronic disease, population aging, continuing pressure from health workers for greater compensation, demands for expanded benefits under the respective schemes, and the rising expectations of patients. Finally, the paper argues for a more systematic and decisive approach to decentralization of prevention and promotion functions, based on more detailed specification of the roles and responsibilities of central and local government. It also suggests that the current approach to primary care decentralization through voluntary transfer of health centers has limited potential, and that there is a need to consider local management of networks of providers that combine both general hospital and primary care services.
  • Publication
    Thailand Public Finance Management Report
    (World Bank, Washington, DC, 2011-04) Hawkins, Loraine; Lindelow, Magnus; Osornprasop, Sutayut
    This discussion paper is one of five discussion papers for the Thailand public financial management report. It focuses on efficiency and equity in the financing of health services, and the evolving role of central and local government in the health sector. Over the last few decades, Thailand has seen significant improvements in health outcomes, reflecting sustained public investment in both infrastructure and human resources. Thailand has also succeeded in expanding the coverage of health protection schemes, culminating in the introduction of the Universal Coverage (UC) scheme in 2001. These efforts have broadened access to health services, contributed to greater and more equitable utilization, and helped reduce the financial burden and the risk of impoverishment associated with health care expenses. However, there are fewer data on broader measures of health system performance, including dimensions of quality. Overall, available evidence suggests a mixed picture. For instance, while there has been improvement in the management of chronic conditions, a significant number of cases remain undiagnosed or untreated. Similarly, Thailand has seen recent improvement in 2-year survival rates from cancer and heart attacks, but still lags far behind Organization for Economic Co-operation and Development (OECD) countries. While the achievements of Thailand's health system are undeniable, this paper highlights three key challenges: (i) inequalities in utilization and spending; (ii) mounting cost pressures; and (iii) fragmentation of financing and unresolved issues concerning the respective roles of central and local government. This paper provides evidence of regional differences in diagnosis and management of chronic disease, and of survival rates from cancer and heart attacks. These data do not suggest a strong relationship between the health system and spending on the one hand, and on quality or health outcomes on the other. Indeed, efficiency may be a greater concern, with over-provision now a growing problem in some parts of the health system. However, more evidence is needed on these issues. For example, while high levels of spending and utilization in the Civil Servant Medical Benefit Scheme (CSMBS) are often noted, it is less clear whether this is associated with better outcomes (e.g. higher cancer survival rates or improved health outcomes for the elderly). The implications of geographic disparities in spending in the Social Security Scheme (SSS) and the CSMBS also warrant further attention.

Users also downloaded

Showing related downloaded files

  • Publication
    Digital Africa
    (Washington, DC: World Bank, 2023-03-13) Begazo, Tania; Dutz, Mark Andrew; Blimpo, Moussa
    All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.
  • Publication
    Classroom Assessment to Support Foundational Literacy
    (Washington, DC: World Bank, 2025-03-21) Luna-Bazaldua, Diego; Levin, Victoria; Liberman, Julia; Gala, Priyal Mukesh
    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.
  • Publication
    Lebanon Economic Monitor, Fall 2022
    (Washington, DC, 2022-11) World Bank
    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
    World Development Report 2006
    (Washington, DC, 2005) World Bank
    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
    Argentina Country Climate and Development Report
    (World Bank, Washington, DC, 2022-11) World Bank Group
    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.