Publication: Dominican Republic: Implementing a Health Protection System that Leaves No One Behind
Loading...
Date
2018-01
ISSN
Published
2018-01
Author(s)
Editor(s)
Abstract
During the last 50 years, the Dominican Republic has experienced important economic growth, with rates higher than most Latin American countries. However, despite the substantial reduction in poverty and indigence in recent years, average wages within the formal sector remain extremely low, and a large proportion of the working-age population is outside the formal sector. The country introduced a structural health reform in 2001, which has been successful in affiliating 70 percent of the population to the Family Health Insurance, with a complete package of services with the same content for all, although with different forms of financing and provision of services. However, the public service network, which is legally in charge of providing care to the lower-income population, lagged in its restructuring process, with serious problems of quality, efficiency, and governance. Thus, although many of the coverage goals have been achieved, population health outcome indicators remain well behind most countries in the Latin America region. Another key aspect of the pending agenda to achieve greater health and financial protection within social insurance is the in-depth revision of the Basic Health Plan (Plan Básico de Salud). This revision’s objective would be built on guaranteed coverage of certain health conditions considered to be priorities, including the restructuring of the health care model to introduce rationality, control costs, reduce or eliminate funding differences between the Contributory Regime (Regimen Contributivo) and Subsidized Regime (Régimen Subsidiado), and increase public funding for the Subsidized Regime. It is necessary to ensure that the benefits provided in the Basic Health Plan are delivered; that is, that the services required by the population are effectively covered, which will also reduce out-of-pocket spending. It is necessary to monitor the financial situation of all entities of the health system and to continue strengthening institutional capacity to carry out the financial and technical audits of health providers. The permanent monitoring of the financial sustainability of the Family Health Insurance Subsidized Regime and the Basic Health Plan is fundamental, while a systematic analysis of the fiscal space is carried out.
Link to Data Set
Citation
“Rathe, Magdalena. 2018. Dominican Republic: Implementing a Health Protection System that Leaves No One Behind. Universal Health Coverage Studies Series;No. 30. © World Bank. http://hdl.handle.net/10986/29182 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 Challenges on the Path to Universal Health Coverage(World Bank, Washington, DC, 2018-01)The objectives of this case study are to assess how the poor fared as a result of recent efforts toward universal health coverage in Azerbaijan, and to provide an overview of the government’s planned additional reforms, in the context of a difficult economic and fiscal situation.The case study will first focus on how the poor have fared as a result of Azerbaijan’s efforts in the last decade to improve health coverage and population financial protection in case of illness. These efforts occurred during a period of strong economic performance driven by natural-resource-based economic growth. Thanks to improvements in oil and gas revenues, public expenditure on health increased six-fold since 2000. Although the organization and functioning of the system did not significantly change during this period, the additional resources were used to provide pharmaceuticals and medical supplies at no cost to the population and to refurbish the health care infrastructure. During this time, the number of drugs and medical supplies provided at no cost in inpatient care increased, while the list of outpatient care drugs and medical supplies that were provided at no cost to eligible population groups either increased or became more widely available.The positive economic and fiscal outlook the country enjoyed from the mid-2000s has significantly changed in the last two years due to a sharp decrease in oil prices. This difficult context, as well as continuous challenges in ensuring financial protection and access to services, has highlighted the need for health financing reform, as well as reform of the functioning and organization of the health system. In this context, the country recently renewed previous efforts toward implementation of a Mandatory Social Health Insurance scheme, which was mandated in 2007. To contribute to the country’s policy debates, the second objective of this case study is to discuss how this reform plan could further contribute to universal health coverage, and what challenges the country would face in its implementation.Publication Vietnam : Learning from Smart Reforms on the Road to Universal Health Coverage(World Bank Group, Washington, DC, 2014-08)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 Expansion of the Benefits Package(World Bank, Washington, DC, 2018-01)The legacy of the Semashko system left Armenia with an oversized and overstaffed health system. Beginning in the 1990s the country focused on re-designing its health system in an attempt to rationalize resources. In order to improve the efficiency, access and quality of health care service provision, the Government undertook supply-side reforms. These reforms included: (a) strengthening Primary Health Care (PHC) provision; (b) downsizing excess hospital capacity; and, (c) changing provider payment mechanisms and introducing a purchaser-provider split.Armenia introduced the Basic Benefit Package (BBP) in 1999 for the socially vulnerable population to target the so-called socially important diseases. The package utilizes public resources to finance, through provider contracts, PHC and emergency services for all Armenian citizens, with co-payment exemptions for the poor and vulnerable. In addition, selected inpatient services are provided for free for the poor, vulnerable and other specific categories.Unfortunately, low public health spending levels and incomplete demand-side health financing reform have resulted in serious shortcomings in financial risk protection outcomes. Armenia’s public health financing is among the lowest in the region. High co-payments for BBP covered services, lack of in-patient care coverage for the non-vulnerable population and outpatient pharmaceuticals for all, have resulted in household out-of-pocket (OOP) spending being the predominant source of financing for health in the country. As Armenia is grappling with an aging society and a health care system struggling to adjust to morbidity and mortality epidemiological changes, its path to Universal Health Coverage (UHC) requires increased funding from prepaid pooled sources in order to sustain and make further progress on improving population health outcomes and financial risk protection.This paper examines the Armenian health system, with a focus on the BBP program. It takes stock of implemented reforms and analyzes the pending agenda. The paper is organized as follows. Section two provides a general overview of Armenia’s health system, focusing on financing and health service delivery. Section three describes the BBP program including its institutional architecture, beneficiary targeting, BBP services and fund management, and related information dissemination. Section four discusses the sustainability of the BBP program amidst economic, epidemiologic, and demographic challenges. The last section focuses on the pending agenda related to targeting, integrated care, and coverage of the non-vulnerable population.Publication Gabon Indigents Scheme(World Bank, Washington, DC, 2018-01)This paper briefly describes primary health care and accessibility to health care provision in Gabon, and the social health insurance architecture of the GIS. The paper is not intended to provide an analytical and detailed study on health insurance in Gabon. It simply aims to provide a description the GIS in terms of eligibility criteria, targeting, and registration of beneficiaries; special topics related to the management of public funds of the social insurance of the GIS; management of the services offered; and financial sustainability of the GIS. It contributes to the Universal Health Coverage Studies Series on sharing experiences in the field of universal health coverage.Publication Morocco’s Subsidized Health Insurance Regime for the Poor and Vulnerable Population(World Bank, Washington, DC, 2018-01)In Morocco, a reform process to establish universal health coverage (UHC) through nonsubsidized and subsidized social health insurance (SHI) was launched in 2002. This case study focuses on the subsidized SHI scheme, régime d’assistance médicale (RAMED). This program, which is Morocco’s flagship social protection and health program and which had the support of the King Mohamed VI, was piloted in 2008 and scaled up to the national level in 2012. As of November 2016, 6.35 million people - 19 percent of the population - had valid RAMED identification cards. RAMED relies on a sophisticated methodology to target poor and vulnerable households, combining proxy means testing and community targeting methods. This case study reviews RAMED’s achievements and identifies potential reforms to address the challenges RAMED is facing. After presenting details of the health financing and delivery systems and an overview of public health care, the case study reviews RAMED’s institutional arrangements, poverty targeting, enrolment and identification mechanisms, benefits package, and information environment system. The study concludes with a discussion of potential areas of improvements.
Users also downloaded
Showing related downloaded files
Publication The Mexican Social Protection System in Health(World Bank, Washington DC, 2013-01)With a population of 113 million and a per-capita Gross Domestic Product, or GDP of US$10,064 (current U.S. dollars), Mexico is one of the largest and highest-income countries in Latin America and the Caribbean (LAC). The country has benefited from sustained economic growth during the last decade, which was temporarily interrupted by the financial and economic crisis. Real GDP is projected to grow 3.8 percent and 3.6 percent in 2012 and 2013, respectively (International Monetary Fund, or IMF 2012). Despite this growth, poverty in the country remains high; with half of the population living below the national poverty line. The country is also highly heterogeneous, with large socioeconomic differences across states and across urban and rural areas. In 2010, while the extreme poverty ratio in the Federal District and the states of Colima and Nuevo Leon was below 3 percent, in Chiapas, Guerrero, and Oaxaca it was 25 percent or higher. These large regional differences are also found in other indicators of well-being, such as years of schooling, housing conditions, and access to social services. This case study assesses key features and achievements of the Social Protection System in Health (Sistema de Proteccion Social en Salud) in Mexico, and particularly of its main pillar, Popular Health Insurance (Seguro Popular, PHI). It analyzes the contribution of this policy to the establishment and implementation of universal health coverage in Mexico. In 2003, with the reform of the General Health Law, the PHI was institutionalized as a subsidized health insurance scheme open to the population not covered by the social security schemes. Today, the PHI covers all of its intended affiliates, about 52 million peoplePublication 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 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.Publication Doing Business 2014 : Understanding Regulations for Small and Medium-Size Enterprises(Washington, DC: World Bank Group, 2013-10-28)Eleventh in a series of annual reports comparing business regulation in 185 economies, Doing Business 2014 measures regulations affecting 11 areas of everyday business activity: Starting a business, Dealing with construction permits, Getting electricity, Registering property, Getting credit, Protecting investors, Paying taxes, Trading across borders, Enforcing contracts, Closing a business, Employing workers. The report updates all indicators as of June 1, 2013, ranks economies on their overall “ease of doing business”, and analyzes reforms to business regulation – identifying which economies are strengthening their business environment the most. The Doing Business reports illustrate how reforms in business regulations are being used to analyze economic outcomes for domestic entrepreneurs and for the wider economy. Doing Business is a flagship product by the World Bank and IFC that garners worldwide attention on regulatory barriers to entrepreneurship. More than 60 economies use the Doing Business indicators to shape reform agendas and monitor improvements on the ground. In addition, the Doing Business data has generated over 870 articles in peer-reviewed academic journals since its inception.Publication World Development Report 2011(World Bank, 2011)The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.