The document discusses alternative forms of health financing being tested or used in various countries to help people afford healthcare and avoid poverty from medical costs, such as community-funded insurance, microcredit services for insurance, taxes on goods like tobacco, and prioritizing resources currently spent on non-essential activities. Examples of health financing systems used in African countries include general tax revenue, donor funding, mandatory and voluntary insurance, community-based insurance, and exemptions from fees. While increasing tax revenue is difficult, improving tax compliance and efficiency along with gradually introducing alternative financing options may help fund healthcare.
Health financing within the overall health systemHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Prof. Tanimola Akande and Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Health financing within the overall health systemHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Prof. Tanimola Akande and Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Exploring the Potential Role Of Community Health Insurance Schemes In A Natio...David Lambert Tumwesigye
Exploring the Potential Role Of Community Health Insurance Schemes In A National Health Insurance Scheme-Presented to CHI practitioners of the Uganda Community Based Health Financing Association
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Exploring the Potential Role Of Community Health Insurance Schemes In A Natio...David Lambert Tumwesigye
Exploring the Potential Role Of Community Health Insurance Schemes In A National Health Insurance Scheme-Presented to CHI practitioners of the Uganda Community Based Health Financing Association
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Kenya Mobilizing financial resources needed for health in the SDG eraDeepak Mattur
- In 2015 the UN General Assembly formally accepted a new set of 17 measurable Sustainable Development Goals (SDGs), ranging from ending world poverty to achieving gender equality and empowering women and girls by 2030. The SDG target 3 encompasses 9 sub targets focussed on ensuring healthy lives and well-being for all. These goals set by the proposed SDGs are ambitious and challenging. It will not be achieved with a business-as-usual approach.
- ODA in Kenya: In 2013, ODA for Health reached its highest level at US$ 934 million. However, the outlook of future aid to Kenya remains flat.
- The share of government expenditure on health in Kenya has not shown a commensurate increase with its increase in GDP. The share has actually declined from 46% of the Total Health Expenditure in 2000 to 46% in 2000. Government needs to increase its share of health expenditure to meet the rising healthcare demands.
- At current level of health expenditure at US$ 1.9 BN, there exists an annual funding gap of US$ 1.4 BN to meet the needs of Healthcare services.
- Kenya needs to consider several instruments of innovative financing in order to achieve its financing needs for Health. Some of the potential options presented in this digital artefact are raising additional taxes, Debt-swaps and social bonds.
- There is a hope that Kenya will make a paradigm shift in its approach to health financing and the Healthcare financing gap in Kenya will be filled in with additional sources generated through innovative financing instruments.
Follow the Money: Making the Most of Limited Health ResourcesHFG Project
Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs).
With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis.
In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
Policymakers can influence public and private health spending to improve efficiency, quality, equity, and expand access to life-saving health services. To succeed, however, governments need evidence around their health financing landscape. More and more, policymakers are appreciating the value of health resource tracking –that is, a range of methods, data collection initiatives, and estimation tools aimed at measuring the flow of funds to and through the health system.
Follow the Money: Making the Most of Limited Health ResourcesHFG Project
Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs).
With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis.
In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
A Pathway to Achieve Health Insurance in Africa finalAlaa Hamed
A presentation on the potential to develop a roadmap to achieve universal health insurance in Africa. It discusses the status of universal health insurance in African countries especially Sub-Saharan Africa and the five key pillars to achieve UHI: the package, the coverage, the financing, the providers and the accountability
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Introduces commercial law, its history and development alongside its principles. Also explains African and Islamic commercial law as distinct legal systems for commercial dealings. The slides also introduce the Sale of Goods Act (UK, 1979)
Debt Restructuring and Cross Class Cram Down rule.pptxLyla Latif
These slides consider debt restructuring; its conditions and key stages, and the CCCD (cross-class cram down) rule through which a restructuring plan can at the discretion of the court be imposed on an entire class of dissenting creditors or members. Several restructuring plans are examined modelled along equity preservation, equity dilution and other options set out under the UK's Corporate Insolvency and Governance Act 2020.
This is a course outline that I prepared for teaching at the University of Nairobi. Content is built around discussion the meaning and types of pensions available, their regulatory framework, examining pension issues as part of human right and employment laws.
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
Latino Buying Power - May 2024 Presentation for Latino CaucusDanay Escanaverino
Unlock the potential of Latino Buying Power with this in-depth SlideShare presentation. Explore how the Latino consumer market is transforming the American economy, driven by their significant buying power, entrepreneurial contributions, and growing influence across various sectors.
**Key Sections Covered:**
1. **Economic Impact:** Understand the profound economic impact of Latino consumers on the U.S. economy. Discover how their increasing purchasing power is fueling growth in key industries and contributing to national economic prosperity.
2. **Buying Power:** Dive into detailed analyses of Latino buying power, including its growth trends, key drivers, and projections for the future. Learn how this influential group’s spending habits are shaping market dynamics and creating opportunities for businesses.
3. **Entrepreneurial Contributions:** Explore the entrepreneurial spirit within the Latino community. Examine how Latino-owned businesses are thriving and contributing to job creation, innovation, and economic diversification.
4. **Workforce Statistics:** Gain insights into the role of Latino workers in the American labor market. Review statistics on employment rates, occupational distribution, and the economic contributions of Latino professionals across various industries.
5. **Media Consumption:** Understand the media consumption habits of Latino audiences. Discover their preferences for digital platforms, television, radio, and social media. Learn how these consumption patterns are influencing advertising strategies and media content.
6. **Education:** Examine the educational achievements and challenges within the Latino community. Review statistics on enrollment, graduation rates, and fields of study. Understand the implications of education on economic mobility and workforce readiness.
7. **Home Ownership:** Explore trends in Latino home ownership. Understand the factors driving home buying decisions, the challenges faced by Latino homeowners, and the impact of home ownership on community stability and economic growth.
This SlideShare provides valuable insights for marketers, business owners, policymakers, and anyone interested in the economic influence of the Latino community. By understanding the various facets of Latino buying power, you can effectively engage with this dynamic and growing market segment.
Equip yourself with the knowledge to leverage Latino buying power, tap into their entrepreneurial spirit, and connect with their unique cultural and consumer preferences. Drive your business success by embracing the economic potential of Latino consumers.
**Keywords:** Latino buying power, economic impact, entrepreneurial contributions, workforce statistics, media consumption, education, home ownership, Latino market, Hispanic buying power, Latino purchasing power.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
when will pi network coin be available on crypto exchange.DOT TECH
There is no set date for when Pi coins will enter the market.
However, the developers are working hard to get them released as soon as possible.
Once they are available, users will be able to exchange other cryptocurrencies for Pi coins on designated exchanges.
But for now the only way to sell your pi coins is through verified pi vendor.
Here is the telegram contact of my personal pi vendor
@Pi_vendor_247
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
The secret way to sell pi coins effortlessly.DOT TECH
Well as we all know pi isn't launched yet. But you can still sell your pi coins effortlessly because some whales in China are interested in holding massive pi coins. And they are willing to pay good money for it. If you are interested in selling I will leave a contact for you. Just telegram this number below. I sold about 3000 pi coins to him and he paid me immediately.
Telegram: @Pi_vendor_247
how to sell pi coins effectively (from 50 - 100k pi)DOT TECH
Anywhere in the world, including Africa, America, and Europe, you can sell Pi Network Coins online and receive cash through online payment options.
Pi has not yet been launched on any exchange because we are currently using the confined Mainnet. The planned launch date for Pi is June 28, 2026.
Reselling to investors who want to hold until the mainnet launch in 2026 is currently the sole way to sell.
Consequently, right now. All you need to do is select the right pi network provider.
Who is a pi merchant?
An individual who buys coins from miners on the pi network and resells them to investors hoping to hang onto them until the mainnet is launched is known as a pi merchant.
debuts.
I'll provide you the Telegram username
@Pi_vendor_247
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
Resume
• Real GDP growth slowed down due to problems with access to electricity caused by the destruction of manoeuvrable electricity generation by Russian drones and missiles.
• Exports and imports continued growing due to better logistics through the Ukrainian sea corridor and road. Polish farmers and drivers stopped blocking borders at the end of April.
• In April, both the Tax and Customs Services over-executed the revenue plan. Moreover, the NBU transferred twice the planned profit to the budget.
• The European side approved the Ukraine Plan, which the government adopted to determine indicators for the Ukraine Facility. That approval will allow Ukraine to receive a EUR 1.9 bn loan from the EU in May. At the same time, the EU provided Ukraine with a EUR 1.5 bn loan in April, as the government fulfilled five indicators under the Ukraine Plan.
• The USA has finally approved an aid package for Ukraine, which includes USD 7.8 bn of budget support; however, the conditions and timing of the assistance are still unknown.
• As in March, annual consumer inflation amounted to 3.2% yoy in April.
• At the April monetary policy meeting, the NBU again reduced the key policy rate from 14.5% to 13.5% per annum.
• Over the past four weeks, the hryvnia exchange rate has stabilized in the UAH 39-40 per USD range.
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
The European Unemployment Puzzle: implications from population agingGRAPE
We study the link between the evolving age structure of the working population and unemployment. We build a large new Keynesian OLG model with a realistic age structure, labor market frictions, sticky prices, and aggregate shocks. Once calibrated to the European economy, we quantify the extent to which demographic changes over the last three decades have contributed to the decline of the unemployment rate. Our findings yield important implications for the future evolution of unemployment given the anticipated further aging of the working population in Europe. We also quantify the implications for optimal monetary policy: lowering inflation volatility becomes less costly in terms of GDP and unemployment volatility, which hints that optimal monetary policy may be more hawkish in an aging society. Finally, our results also propose a partial reversal of the European-US unemployment puzzle due to the fact that the share of young workers is expected to remain robust in the US.
Introduction to Indian Financial System ()Avanish Goel
The financial system of a country is an important tool for economic development of the country, as it helps in creation of wealth by linking savings with investments.
It facilitates the flow of funds form the households (savers) to business firms (investors) to aid in wealth creation and development of both the parties
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
2. +
The Need for Alternative Forms of
Health Financing
A host of innovative schemes to cushion the poor against the
financial risks of getting sick, such as low-interest loans,
medical-savings accounts and insurance financed by a
community-funded risk pool, are being tested in several
countries.
Theresa Braine,
Bulletin of the World Health Organisation, Volume 84:2006
3. +
Why?
Every year an estimated 25 million households — more than
100 million people — are plunged into poverty when they or
their relatives become ill and they must struggle to pay for
health-care services out of their own pockets.
World Health Organisation, 2014
4. +
Definitions of Health Financing
Mobilisation of health care financing
Allocation of funds to the regions and population groups and for
specific types of health care
Mechanisms for paying health care
Hsaio, W and Liu, Y, 2001
5. +
Sources of Health Financing
Health is financed through private expenditure, public expenditure and/or
external aid
Public expenditure includes all expenditure on health services by
central and local government funds spent by state owned and
parastatal enterprises as well as government and social insurance
contributions
where services are paid for by taxes, or compulsory health insurance
contributions either by employers or insured persons or both this
counts as public expenditure.
Voluntary payments by individuals or employers are private expenditure.
External sources refer to the external aid which comes through bilateral
aid programme or international non governmental organizations
6. +
How is Health Financed?
General revenue or earmarked taxes
Social insurance contributions
Private insurance premiums
Community financing
Direct out of pocket payments
Preethi Pradhan
7. +
Alternative Forms of Financing
Health
Sales taxes: Ghana funded its national health insurance
partly by increasing the value-added tax (VAT) by 2.5%.
"Sin" taxes, particularly on tobacco and alcohol: a 50%
increase in tobacco tax alone would yield an additional
US$1.42 billion just 22 low income countries for which
sufficient data exists.
A currency transaction levy would be feasible in many
countries.
Solidarity levies - Gabon raised $30 million for health in
2009 by imposing a 1.5% levy on companies handling
remittances and a 10% tax on mobile phone operators.
Also, levy on airline tickets.
Health Systems Financing and the Path to Universal Coverage
World Health Organisation
8. +
Alternative Forms of Financing
Health
Continued
Resource prioritization. (Most resource rich countries in Africa allocate a large proportion of
their revenues to unsustainable and unproductive activities, such as fossil fuel subsidy.
This displaces resources needed to finance ‘useful’ development and also encourages
excessive consumption of fossil fuel; thereby elevating its negative consequences for the
environment)
Microcredit services to health insurance. (E.g., the Grameen Kalyan Health Program,
Bangladesh)
A share of VAT taxes and a voluntary contribution from businesses for health (proposed by
Italy).
Private capital through Public Private Partnerships.
Promoting faith based organisations as health care financiers.
9. +
Types of Health Financing Systems
in Africa
General tax revenue (budget allocation)
Donor funding
Mandatory health insurance (e.g., NHIF, Kenya)
Private voluntary employment based insurance
Community based health insurance (e.g., Central
& West Africa)
Out of pocket payments
Fee exemptions (e.g., Ghana)
10. +
Some Examples of Health
Financing in Africa
In 1995, the Uganda Ministry of Health introduced a regulation
for community based health financing, which empowers
communities to meet their health financing needs by pooling
resources. It is an alternative to a national insurance plan,
favouring local management of health financing and coverage
adjusted to community needs and resources.
Rwanda has extended its health insurance coverage through
Mutual health organisations
Gabon has implemented mandatory health insurance through
the National Health and Social Security Fund
Chad has exempted direct payment for emergency care
11. +
Continued
Burundi employs free health care and performance based
financing
Uganda has abolished user fees
Zanzibar as at July 2013 was carrying out a study to provide a
solid foundation upon which policy-makers could make an
informed and evidence-based decision on the establishment of a
health insurance scheme in Zanzibar as an element of health
financing reform for UHC in Zanzibar.
There is now political support for the African Public Health
Emergency Fund (APHEF). In July 2012 African leaders endorsed
its establishment at the 19th Ordinary Session of the Assembly of
the Heads of State and Governments of the African Union in Addis
Ababa, Ethiopia.
12. +
Conclusion
While it is difficult to increase tax revenue in African countries
due to the limited tax base and although it is often not feasible
or advisable to increase tax rates any further, it may be feasible
to improve tax compliance and the efficiency of the tax system
and then, to slowly introduce these alternative forms of
financing health.
Editor's Notes
Grameen Kalyan was created to remedy the grave financial burden of serious illness and general health conditions on poor members of Grameen Bank. GK’s primary goal is cost-effective welfare and healthcare services for its members as well as nonmembers living within its operational area. As an insurer and health service provider, GK implements an affordable health microinsurance scheme, running a network of community-based health centers and satellite clinics, managing a referral system for secondary and tertiary care, and coordinating outreach health services (domiciliary service) by community-based female health workers. GK’s operational cost recovery rate has reached 83% (at the stage of continuous expansion) in 2008, up from 38% in 1997.Key program components include: 1. Health microinsurance. This is pivotal in GK activities, ensuring target group participation and raising revenue for the program. The scheme employs a sliding scale fee structure. Nonmembers of Grameen Bank pay slightly more (300 taka or about $4.28) than members (200 taka or about $2.85), but there is no distinction in service and benefits, and each plan covers up to six members of a cardholder’s family. The plan provides free preventive care, family planning, and health education services to all, irrespective of enrollment. For health center visits enrollees pay 20 taka or about $0.29 and nonenrollees pay 50 taka or about $0.71. Enrollees also receive a discount on medicine and laboratory tests. In catastrophic circumstances enrollees can receive a subsidy from GK of up to 2,000 taka orabout $29. 2. Primary healthcare. GK’s health centers are usually attached to a Grameen Bank branch and provide primary healthcare using a staff of doctors, paramedics, managers, lab technicians, and community health assistants. Each center’s operational area corresponds to that of a Grameen Bank branch, an area with a radius of about eight kilometers. The center operates on an outpatient basis; providing treatment and advice and referring patients to a hospital when necessary. Medical staffs also organize weekly satellite camps for members in remote areas. The salary structure considers the distance of workplace from the capital city (that is, workers in more remote areas receive higher salaries). 3. Training and human resources development. GK has received technical support from development partners to implement a range of human resources development activities, including capacity building and monitoring, annual work plans, training materials, accounting and reporting, and networking at home and abroad.
Community based health insurance schemes:
Community-based health insurance (CBHI) schemes (also called mutual health insurance, mutual health organisations, community-based pre-payment, community health funds etc.) take many different forms. They can broadly be defined as “any scheme managed and operated by an organization, other than a government or private for-profit company, that provides risk pooling to cover all or part of the costs of health care services” (Bennett, 2004) and generally include an element of community participation in their management or some form of democratic accountability of the management to the members. Most frequently, these schemes provide cover for those outside the formal employment sector and often serve rural communities. They may be linked with a particular health service provider (e.g. the scheme may only provide cover for services provided at the local hospital) or may cover services provided at a range of health facilities among which members can choose. These schemes primarily developed as an alternative to user fees, i.e. instead of paying a fee at the time of using a health service, community members make small pre- payments to the scheme which then cover the fee charged for the health services used. The majority of the oldest and largest CBHI schemes are to be found in Central and West Africa; the widespread development of such schemes in East and Southern Africa is a relatively new development.
Private voluntary employment based insurance:
This form of health insurance has been in existence for many decades (the first one being established in South Africa in 1889 (McLeod, 2005)) in a number of Southern African countries (particularly South Africa, Zimbabwe and Namibia) and is usually referred to as a ‘medical scheme’. Medical schemes began as non-profit organisations, as a way for private firms to provide for the health care needs of their employees. Contributions to the schemes were made by both employers and employees and were community rated. Initially, the vast majority of medical schemes were ‘closed schemes’ in that membership of each scheme was only open to employees of an individual company. This has changed over time (particularly in South Africa and to a lesser extent in Zimbabwe), with schemes becoming ‘open’, i.e. allowing anyone to join (except in some cases high risk individuals).
Fee exemptions:
There are a range of official exemptions in for example Ghana, including specific services (those for major communicable diseases, immunisations, antenatal and post-natal care) as well as certain services for specified demographic and socio-economic groups (children under five years, pregnant women, the elderly/people above 70 years and ‘paupers’). Most importantly, the Ghanaian government has an explicit mechanism for funding exemptions in that facilities can submit a statement of fee revenue ‘lost’ through exemptions and request reimbursement. This is a major innovation as exemptions are ‘unfunded’ in most countries, leaving health care providers with weak incentives to exempt patients from fees. Despite having a relatively comprehensive policy, there is considerable evidence that the exemption policy is poorly implemented. For example, one study in the Volta region of Ghana found that 84% of patients who were eligible for exemptions did not receive them (Nyonator and Kutzin, 1999). Another study found that almost half of the clients interviewed who were eligible for exemptions had in fact paid for services (Garshong et al., 2002). Research has also highlighted that the poor very seldom receive exemptions while the demographic categories (under-fives, elderly and pregnant women) are more frequently exempted (Adams et al., 2002).
Rwanda experience:
A strategy (ubudehe- collective work) is employed to select and manage destitute people in order to determine MHO contribution subsidizations and exemptions.
This approach is based on traditional values aimed at rallying the people around a collective and shared effort, with a view to improving their social conditions. In the past, the population living in the same smallest village level unit used to organize themselves to work in farms and build houses for poor people. Building on this practice was recognized and encouraged by some of the country’s development partners. Under the new organization, the community identifies destitute people itself and determines the assistance they need. The participation of government and development partners involves sending aid to such organized population groups that have identified their own needs, within the overall context of poverty alleviation.