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
This document provides an overview of health insurance schemes in low and middle income countries. It defines low, lower middle, and upper middle income countries based on GNI per capita. It then discusses the types of health insurance schemes commonly implemented in LMICs, including social/national health insurance funded through taxes and contributions, private health insurance, and community-based health insurance. The document also discusses factors that affect enrollment in these schemes and provides examples of specific country implementations, challenges faced, and opportunities to expand coverage.
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
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.
The document discusses health insurance and community health insurance (CHI) schemes in India. It outlines the Rashtriya Swasthya Bima Yojana (RSBY) scheme launched by the Indian government in 2007 to provide health insurance to below poverty line (BPL) families. The key objectives of RSBY are to facilitate health insurance projects in all districts to provide BPL workers and their families up to Rs. 30,000 of annual health coverage. It also discusses issues around regulating private health insurance and ensuring financial sustainability and coverage of key diseases.
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
Community Health Financing as a Pathway to Universal Health Coverage: Synthes...HFG Project
Community-based health insurance (CBHI) emerged in West Africa the 1990s as a grassroots response among rural and poor communities to fees charged by private and public clinics and hospitals. Three countries – Ghana, Senegal, and Ethiopia – have leveraged CBHI in different ways to expand publicly funded coverage to the informal sector in rural and urban settings. This paper synthesizes the experiences from these three countries to illustrate the role that CBHI can play in UHC.
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
This document provides an overview of health insurance schemes in low and middle income countries. It defines low, lower middle, and upper middle income countries based on GNI per capita. It then discusses the types of health insurance schemes commonly implemented in LMICs, including social/national health insurance funded through taxes and contributions, private health insurance, and community-based health insurance. The document also discusses factors that affect enrollment in these schemes and provides examples of specific country implementations, challenges faced, and opportunities to expand coverage.
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
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.
The document discusses health insurance and community health insurance (CHI) schemes in India. It outlines the Rashtriya Swasthya Bima Yojana (RSBY) scheme launched by the Indian government in 2007 to provide health insurance to below poverty line (BPL) families. The key objectives of RSBY are to facilitate health insurance projects in all districts to provide BPL workers and their families up to Rs. 30,000 of annual health coverage. It also discusses issues around regulating private health insurance and ensuring financial sustainability and coverage of key diseases.
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
Community Health Financing as a Pathway to Universal Health Coverage: Synthes...HFG Project
Community-based health insurance (CBHI) emerged in West Africa the 1990s as a grassroots response among rural and poor communities to fees charged by private and public clinics and hospitals. Three countries – Ghana, Senegal, and Ethiopia – have leveraged CBHI in different ways to expand publicly funded coverage to the informal sector in rural and urban settings. This paper synthesizes the experiences from these three countries to illustrate the role that CBHI can play in UHC.
Health Financing Functions: Risk PoolingHFG Project
Presentation by Dr. Elaine Baruwa, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
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
Health insurance and cost containment in Canadian health Systemiyad shaqura
This is a power-point presentation which is about the health insurance, financing and cost containment in Canadian Health System according to most recent data.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
Universal Health Coverage (UHC) in Senegal: Implementation Status and OutlookHFG Project
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
“Follow the money” in order to better understand the framework for global health governance: this presentation by Dr. Tim Mackey employs IHME-coordinated research while teaching the evolution of global health financing.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
Decentralizing Health Insurance in Nigeria: Legal Framework for State Health ...HFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Jonathan Eke. More: https://www.hfgproject.org/hcf-training-nigeria
2.doh transition plan to achieve mdg 4 5 032510 lzl_dohpsecp
The document summarizes the Philippines' health financing system and outlines strategies to improve principles of solidarity, equity, quality, and cost containment. It discusses how PhilHealth aims to provide universal coverage but faces challenges of weak social solidarity and inequity. A new Health Care Financing Strategy 2010-2020 is introduced with goals like increasing resources, sustaining universal membership, allocating resources efficiently, shifting payment methods, and securing facility autonomy. Initial outputs include a new administrative order, consideration of strategic expenditure estimates, and ongoing work to strengthen various programs.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
This document discusses Pakistan's health care financing system. It outlines how funds are mobilized and allocated to different regions and populations. It also describes the mechanisms for paying for health care. The document analyzes factors like public vs private expenditure, sources of funds, and financial protection. It provides statistics on total health expenditure as a percentage of GDP and per capita. It also examines funding allocation between federal, provincial and district levels and between government and private/NGO sectors. The document evaluates inequities in access between rich and poor areas and recommends targeting taxes and financing methods to improve access for underserved groups.
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
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
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
Views on the proposed National Health Insurance Scheme for UgandaMakaire Fredrick
Community Health Insurance (CHI) schemes pool members' health and financial risks to provide access to quality healthcare services. CHI is implemented through Community Health Insurance Schemes (CHIS) which are non-profit organizations that enroll community members and collect premiums to pay for their healthcare. Save for Health Uganda (SHU) operates 50 CHIS across several districts that insure about 150,000 people. The schemes educate communities about insurance, collect premiums, contract healthcare providers, and pay for members' care. CHI is seen as a model for Uganda's proposed National Health Insurance Scheme by providing coverage to informal workers not reached by employer-provided insurance.
This document discusses various models of healthcare financing. It describes major models including the National Health Service model, Social Health Insurance model, Community-Based Health Insurance, Voluntary Health Insurance, and Out-of-Pocket Payments. For each model, it provides information on the source of revenue, groups covered, how risks are pooled, and who provides care. It also discusses how systems have evolved from relying more on private insurance and out-of-pocket payments in low-income countries to utilizing government budgets and social health insurance in middle-income and high-income countries.
health services.pptx ecology and health careSumaiyaJabin5
This document discusses different healthcare systems around the world. It outlines four main models: the Beveridge model, used in the UK and other European countries with government-run healthcare funded by taxes; the Bismarck model, seen in Germany and other countries with mandatory public health insurance funded by payroll taxes; the National Health Insurance model of Canada and Taiwan with a single public payer but private providers; and the out-of-pocket model common in developing areas where individuals pay for their own care. The document also describes different levels of healthcare from primary to tertiary care and lists some major healthcare agencies around the world.
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
Health Financing Functions: Risk PoolingHFG Project
Presentation by Dr. Elaine Baruwa, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
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
Health insurance and cost containment in Canadian health Systemiyad shaqura
This is a power-point presentation which is about the health insurance, financing and cost containment in Canadian Health System according to most recent data.
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
The HSFR/HFG project worked with the Government of Ethiopia from 2013-2018 to improve Ethiopia's health care financing system and expand access to health services. Key achievements included increasing the proportion of health facilities managing funds and services through boards representing communities, expanding revenue retention at health centers and hospitals, and piloting community-based health insurance. The project aimed to increase utilization of primary health services, enroll more people in insurance, and reduce out-of-pocket costs through technical support across Ethiopia's decentralized health system. Challenges remained in expanding reforms and improving health indicators, but the project strengthened sustainability by building local capacity and engaging stakeholders.
Universal Health Coverage (UHC) in Senegal: Implementation Status and OutlookHFG Project
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
“Follow the money” in order to better understand the framework for global health governance: this presentation by Dr. Tim Mackey employs IHME-coordinated research while teaching the evolution of global health financing.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
Decentralizing Health Insurance in Nigeria: Legal Framework for State Health ...HFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Jonathan Eke. More: https://www.hfgproject.org/hcf-training-nigeria
2.doh transition plan to achieve mdg 4 5 032510 lzl_dohpsecp
The document summarizes the Philippines' health financing system and outlines strategies to improve principles of solidarity, equity, quality, and cost containment. It discusses how PhilHealth aims to provide universal coverage but faces challenges of weak social solidarity and inequity. A new Health Care Financing Strategy 2010-2020 is introduced with goals like increasing resources, sustaining universal membership, allocating resources efficiently, shifting payment methods, and securing facility autonomy. Initial outputs include a new administrative order, consideration of strategic expenditure estimates, and ongoing work to strengthen various programs.
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
Many governments are scaling up health benefit plans, such as social health insurance, to increase population health coverage. This brief presents findings from a mapping between the services covered under the country’s prominent health benefit plan(s) to the country’s Essential Package of Health Services. The mapping analyzes the extent to which the plan(s) cover essential services.
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
This document discusses Pakistan's health care financing system. It outlines how funds are mobilized and allocated to different regions and populations. It also describes the mechanisms for paying for health care. The document analyzes factors like public vs private expenditure, sources of funds, and financial protection. It provides statistics on total health expenditure as a percentage of GDP and per capita. It also examines funding allocation between federal, provincial and district levels and between government and private/NGO sectors. The document evaluates inequities in access between rich and poor areas and recommends targeting taxes and financing methods to improve access for underserved groups.
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
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
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
Views on the proposed National Health Insurance Scheme for UgandaMakaire Fredrick
Community Health Insurance (CHI) schemes pool members' health and financial risks to provide access to quality healthcare services. CHI is implemented through Community Health Insurance Schemes (CHIS) which are non-profit organizations that enroll community members and collect premiums to pay for their healthcare. Save for Health Uganda (SHU) operates 50 CHIS across several districts that insure about 150,000 people. The schemes educate communities about insurance, collect premiums, contract healthcare providers, and pay for members' care. CHI is seen as a model for Uganda's proposed National Health Insurance Scheme by providing coverage to informal workers not reached by employer-provided insurance.
This document discusses various models of healthcare financing. It describes major models including the National Health Service model, Social Health Insurance model, Community-Based Health Insurance, Voluntary Health Insurance, and Out-of-Pocket Payments. For each model, it provides information on the source of revenue, groups covered, how risks are pooled, and who provides care. It also discusses how systems have evolved from relying more on private insurance and out-of-pocket payments in low-income countries to utilizing government budgets and social health insurance in middle-income and high-income countries.
health services.pptx ecology and health careSumaiyaJabin5
This document discusses different healthcare systems around the world. It outlines four main models: the Beveridge model, used in the UK and other European countries with government-run healthcare funded by taxes; the Bismarck model, seen in Germany and other countries with mandatory public health insurance funded by payroll taxes; the National Health Insurance model of Canada and Taiwan with a single public payer but private providers; and the out-of-pocket model common in developing areas where individuals pay for their own care. The document also describes different levels of healthcare from primary to tertiary care and lists some major healthcare agencies around the world.
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
Evolution of CBHI towards Universal Health Coverage (UHC) – Achievement and C...HFG Project
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
This document discusses various options for healthcare financing in Nigeria. It outlines direct government financing through taxation or budget allocations. It also discusses out-of-pocket expenses, health insurance (including the National Health Insurance Scheme), donor funding, and voluntary contributions. The National Health Insurance Scheme aims to improve access to healthcare for Nigerians through compulsory contributions from formal sector employers and employees and voluntary community-based programs. However, over 90% of Nigerians still rely on out-of-pocket payments, which can reduce access and cause financial hardship.
Health care financing involves accumulating, mobilizing, and allocating funds to cover the health needs of individuals and communities. The document discusses various principles and mechanisms of health care financing including revenue collection from taxes, insurance, and out-of-pocket payments. It also discusses risk pooling, where funds are pooled to spread financial risk across populations, and purchasing, where pooled funds are used to purchase services from providers. The objectives of health care financing are to maintain access to basic services, improve quality, and create incentives for efficient use of services.
This document discusses different models of healthcare systems around the world. It describes four main models: the Bismarck model used in Germany and other countries, where private insurance plans are regulated by the government; the Beveridge model used in the UK with government-provided and tax-funded healthcare; the National Health Insurance model used in Canada with a universal government-run insurance program; and the out-of-pocket model used in many developing countries where most cannot afford medical care. The document then examines the healthcare systems of several countries in more depth and discusses challenges facing Nepal's system.
The document discusses and compares the health care policies of Canada, Taiwan, and Germany. Canada's single-payer system is funded through federal and provincial revenues and guarantees universal coverage. Taiwan implemented its National Health Insurance program in 1995 to improve access through a social insurance model with premiums based on income. Germany offers public and private health insurance options, with most citizens covered by the mandatory not-for-profit public option regulated to focus on service rather than price competition.
National health-insuraqnce-scheme-in-nigeria1Oby Atuanya
The National Health Insurance Scheme (NHIS) in Nigeria was established in 1999 to provide universal health care coverage. It aims to ensure all Nigerians have access to good health services, protect families from high medical costs, and ensure equitable distribution of health costs among income groups. The NHIS operates different programs to cover formal sector employees, informal workers, vulnerable groups, and others. It reimburses healthcare providers using capitation, fee-for-service, per diem, or case payment methods. The goal is for all Nigerians to be enrolled to improve health outcomes and reduce financial barriers to care.
The document summarizes a workshop that discussed approaches to expanding health coverage and financial protection for those in the informal employment sector. Countries presented experiences implementing different financing mechanisms, including community-based health insurance in Rwanda and taxation in Thailand. Key conclusions were that understanding the local context is important, and that balancing centralized and decentralized functions can enhance equity and accountability.
The document discusses various options for financing health care, including user charges, public subsidies, community financing, health insurance, and private sector involvement. It notes that while each method has strengths, none are fully adequate alone and that a mix of approaches is typically needed to meet a population's total health care needs.
Community health insurance in Uganda by Dr Sam Orach, UCMBachapkenya
Dr. Sam O. Orach discussed community health insurance in Uganda, noting its origins among burial groups in western and southwestern Uganda. There are now several types of community health insurance schemes in Uganda, though they all began as provider-managed schemes. The schemes provide benefits like reduced catastrophic health expenditures and better health seeking behaviors. However, they face challenges like lack of political will, inability of communities to match rising costs, and operating in an environment of perceived "free" government health services. Innovations like introducing performance-based financing could help improve community health insurance schemes in Uganda.
This document discusses health insurance, universal health coverage, social health insurance, and community-based health insurance. It begins by defining universal health coverage according to the WHO as access to health care services for all when needed at an affordable price. It then discusses the objectives of universal health coverage and characteristics of social health insurance and community-based health insurance. The remainder of the document provides details on designing social health insurance programs and initiating community-based health insurance schemes, including determining population coverage, benefits, financing, administration structures, and risk management strategies.
This document discusses health care financing in Ethiopia. It provides an overview of Ethiopia's health care financing reform established in 1998 which aimed to promote cost sharing. The key components of the reform included allowing health facilities to retain revenue, systematizing fee waivers for the poor, standardizing exemption services, outsourcing nonclinical services, revising user fees, initiating health insurance schemes, establishing private wings in public hospitals, and providing autonomy to health facilities through governing bodies. The document also covers definitions of health care financing, sources of financing, and payment methods like fee-for-service, capitation, and out-of-pocket payments.
hapter 5What Are the Governmental AlternativesThe United StatJeanmarieColbert3
hapter 5
What Are the Governmental Alternatives?
The United States has tried an alphabet soup of health policy options: HSAs, HMOs, IPAs, PPOs, POS plans, ACOs, and so on. Health care analysts often must look beyond specific organizational and financial alternatives and address issues at a higher level and deal with the threads of economic and political thought behind different proposals while considering the overall criteria of access, cost, and quality of care.
Politicians and businesspeople from outside the health care sector advocate many alternatives. To offset their tendency to ignore professional issues, in this chapter we discuss alternatives affecting professional status and roles and institutional responses to them. Table 5-1 presents an array of federal alternatives organized by their primary criteria—access, quality, or cost—and then by the economic philosophies behind them. The items in this array are not intended to be either mutually exclusive or collectively exhaustive; rather, the table provides a framework for looking at both the broad policy picture and specific health care actions taken at various times and places. Later in the chapter, another table (Table 5-3) summarizes policy alternatives added by state and local governments. Many of these alternatives were included as provisions of the Affordable Care Act (ACA). They are still included here, partly because they may be subject to reconsideration in the future.
Table 5-1 Illustrative Federal Government Health Policy Options
Access to Care
• Administered systems
• Universal coverage
• Expand or reduce eligibility or benefits
• Mandate coverage and services
• Captive providers
• Control insurance industry practices
• Mandate employer-based insurance coverage
• Consumer-driven competition
• Implement insurance exchanges
• Encourage basic plans with very low premiums for low-income workers and “young invincibles”
• Mandate individual coverage
• Allow states flexibility to reallocate federal funds for vouchers
• Oligopolistic competition
• Expand or contract coverages in entitlement and categorical programs
• Allow states to reallocate federal uncompensated care funds
• Eliminate ERISA constraints on the states
• Expand the capacity of the system
Quality of Care
• Administered system
• Mandate participation in quality improvement efforts in federal plans and programs
• Add more pay-for-performance incentives
• Select providers and programs on the basis of quality excellence
• Consumer-driven competition
• Encourage or mandate transparency of quality reporting in federal plans and programs
• Oversee licensure and credentialing of foreign-trained providers
• Oligopolistic competition
• Work reporting of quality care and adverse events into purchasing specifications for federal programs and disseminate to the public
• Encourage wider use of health information technology
Cost of Care
• Administered system
• Use full bargaining power in negotiation of ...
The document provides an overview of the German healthcare system. It describes how the system is based on both public and private insurance, with public insurance covering around 88% of the population. Public insurance is funded through income-related contributions from employers and employees. The system aims to provide equal coverage to all citizens regardless of income or age. It covers a wide range of medical services and utilizes various strategies to ensure quality of care and reduce disparities.
This document discusses universal health coverage (UHC), which aims to provide access to good quality health services for all members of a society while protecting people from financial hardship due to health costs. UHC can be defined by who and what services are covered and how much of the cost is covered. The WHO defines UHC as access to effective health services without financial hardship. Achieving UHC requires an efficient health system providing services, workers, and medicines to the population as well as a financing system to protect people from health costs. Various funding models like compulsory insurance, tax-based financing, and social health insurance can be used. Egypt has both public and private healthcare sectors working towards UHC.
Health systems around the world - Memoona ArshadHuzaifa Zahoor
More people have gained access to essential health services such as immunization, HIV antiretroviral care, family planning, and malaria-prevention bed nets in the last decade. This is promising news, but development has been uneven: there are significant differences in service availability not only between countries, but also within them. Half the world's population can't afford the care it needs to stay safe on any given day.
Overview of Community Based Health Insurance LessonsHFG Project
Presentation during the Institutionalizing Community Health Conference in Johannesburg, South Africa, on March 28th, 2017. This presentation gives an overview of Community-based Health Insurance (CBHI), and explores country experiences and lessons with CBHI in Rwanda, Ghana, and Senegal.
This document summarizes a presentation on health financing strategies for achieving universal health coverage given by Sourav Goswami and moderated by Dr. Subodh Gupta at MGIMS, Sevagram on June 8th, 2017. The presentation discusses key aspects of health financing policy including universal health coverage goals of access, quality, and financial protection. It covers topics such as revenue raising, risk pooling, purchasing of health services, benefit package design, and principles of rationing health resources. Examples from countries like Moldova and Chile are provided. The current scenario of health financing in India is also summarized, highlighting high levels of out-of-pocket spending and a need to increase public financing to achieve equitable access to
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
Similar to Practical concepts and strategies to increase and maintain financial protection and access to health care (20)
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
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2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
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This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
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Practical concepts and strategies to increase and maintain financial protection and access to health care
1. 1 |
FINANCIAL PROTECTION AND IMPROVED ACCESS TO HEALTH CARE:
PEER-TO-PEER LEARNING WORKSHOP
FINDING SOLUTIONS TO COMMON CHALLENGES
FEBRUARY 15-19, 2016
ACCRA, GHANA
Day I, Session VI
2. 2 |
Practical concepts and strategies to
increase and maintain financial
protection and access to health care
Dr. Laurent MUSANGO
3. 3 |
Why financial protection?
Financial protection has been the motivation for past and current health reforms in
many countries, being considered as a responsibility of the government:
– Social health insurance systems currently being developed in Europe
– NHS in the U.K.
– Thailand
– Republic of Korea
– US “Affordable Care Act,” now called informally “Obama Care”
– Examples in Africa: Botswana, Ghana, Gabon, and Rwanda.
4. 4 |
Concept Definition
Health insurance is a formal contract according to which the insured (the
beneficiaries) are protected against the costs associated with medical services
covered by the health insurance system (the benefits).
The Out-of-pocket expenses (OOP) are the amounts paid by households as a
percentage of overall health expenses. The financial protection is triggered when a
defined threshold is reached for OOP. – Expenses are considered “catastrophic” if
they exceed a certain fraction of the household income or spending power.
The protection against financial risks helps with catastrophic expenses resulting
from a covered event (illness, fire, car accident, etc.) It is one of the benefits of
insurance policies.
The premium is the amount to be paid based for the insurance coverage offered.
5. 5 |
Evolution (2001-2013) Paiements directs (OOP) dans la Région Africaine
Namibia
Equatorial Guinea
Mauritius
Uganda
Algeria
Sao Tome and Principe
Nigeria
Guinea
Madagascar
Chad
Zambia
Côte d'Ivoire
Kenya
Mali
Cabo Verde Republic of
Sierra Leone
Cameroon
Gabon
Ethiopia
Central African Republic
Eritrea
Mauritania
Region Average
Ghana
Niger
Benin
South Africa
Rwanda
Guinea-Bissau
Liberia
Congo
Senegal
Togo
Burundi
Lesotho
Swaziland
Comoros
Angola
Mozambique
Gambia
Burkina Faso
United Republic of Tanzania
DemocraticRepublic of the Congo
Botswana
Malawi
Seychelles
-80 -60 -40 -20 - 20 40 60 80 100 120
Changes (Relative to Period Average) in OOPs as percent of THE in Countries
in the African Region 2001 -2013
La plupart des pays
montrent une évolution
favorable à la diminution
des paiements directs
pour les services de santé
D’autres pays montrent par
ailleurs une augmentation
de OOP, ce qui est un
risque de tendance vers
les dépenses
catastrophiques de santé
et l’appauvrissement
6. 6 |
A Few Mechanisms of Financial Protection
National health insurance
Social health insurance
Community-based health insurance/Mutual health insurance
Free care
For-profit private health insurance
Combination of various mechanisms
7. 7 |
National Health Insurance
Context
– Managed by the government or delegated to a specific institution
– Funded by taxes/with compulsory insurance
– Benefits: services offered by the public sector
Pros
– Type of solidarity/financial risk protection covering all demographic groups
– The assessment of contributions is based on the level of revenues of the
household
– Simple management model for the government
Cons
– Political pressure and availability of tax revenues
– Lack of competition: potential inefficiencies in the delivery of care
8. 8 |
Social Health Insurance/
Compulsory Health Insurance (CHI)
Context
– Generally applies to employees (active or retired) of the public/private sector
– Sometimes applies to the employees of independently-managed state-owned
organizations
Pros
– Progressive improvement of the service package
– Protects members against catastrophic health expenses
Cons
– Coverage limited to the formal sector: works against equity when it comes to the
protection against financial risks
– Burden of contributions for members
– Complexity of management
– On the administrative level, it takes time to secure the vote of a CHI law, and this
can delay the launch of the system
9. 9 |
Social Health Insurance/
Compulsory Health Insurance (CHI)
A few concrete cases to gain a better insight
– Health insurance is sometimes called the Bismarck Model, reflecting
its German origin
– Countries like Germany, Colombia, and Korea have scaled up CHI
beyond government workers and workers of state-owned companies,
and they also include low-income populations. In Africa, Ghana and
Rwanda are relevant examples
– Most African countries are in the process of creating CHI (Cote
d’Ivoire, Benin, Ethiopia, Senegal, etc.)
– In those countries, health financing strategies include the informal
sector
10. 10 |
Community-based health insurance/Mutual health
insurance
Context
– Voluntary affiliation with prepayment and pooling of funds at a low level
– Small populations and limited amounts pooled
Pros
– Increase of the rate of use of the services by members,
– The subsidies paid by the government make affiliation potentially more
attractive
A few concrete cases to gain a better insight
– Mali and Senegal: subsidies paid by the government for the members
– In Rwanda and China, the subsidies are much more attractive, which makes
affiliation practically universal.
11. 11 |
Community-based health insurance/Mutual health
insurance
Cons of the mutual health
insurance
– Limited service package, therefore limited
protection against financial risks
– Adverse selection; the mutual health
insurance organizations cover unbalanced
risks
– High level of fragmentation
– Generally speaking, the premium rate is
fairly standard (community rate),
regardless of the capacity to contribute
– The poorest populations are still excluded
– The coverage rate is low
12. 12 |
Free Care
Context and country examples
– Introduced as national policies in order to increase access to health
care between 2004 and 2011 in African countries so as help reach the
MDGs
• Universally free care: Liberia and Uganda (primary care), Zambia
(rural), Cote d’Ivoire (post-electoral)
• Targeted free care: sub-groups (mother/child) and
– Specific conditions or services (e.g.: vaccination; malaria, HIV,
TB, dyalisis, etc. )
– Many African countries (Benin, Cote d’Ivoire, Ethiopia, Ghana,
Nigeria, Rwanda, Senegal, Togo, and Uganda)
13. 13 |
Free Care
Pros
– Increase of use by exempted populations, but variations in the quality
of services and availability of drugs
– Easier access to services for the poor and vulnerable populations, or
for the entire population if free care is universal
Cons
– The tax-based sustainability of the system is doubtful, especially if free
care is universal
– Evidence of negative effects on non-exempted populations
14. 14 |
Equity Funds
– For the poor and vulnerable populations, with subsidies from the government
and/or development partners
Subsidies to help pay contributions to health insurance
– Exemptions from contributions granted to some population groups (third-party
payers)
Vouchers for health care
– Frequent approach for FP and antenatal care for poor households in order to enable
them to purchase health care services (Kenya, Senegal)
Conditional cash transfers
– Additional funds for the poor in exchange for meeting certain basic/primary
requirements, like health and education (e.g., vaccinations and antenatal care)
– Less frequent in Africa (A few exceptions – Zambia, Nigeria, & Namibia)
Other approaches targeting access to
health care for the poor
15. 15 |
For-profit private health insurance
Pros
– Offers social protection for its members and is a form of solidarity offering
protection against financial risks only to its members
– May be additional insurance added to other systems previously described
– May facilitate monitoring for the professional who manages this insurance
– The contribution is paid by the members, sometimes with help from their
employers
Cons
– Only people with high revenues can benefit from this insurance coverage
– Administrative costs are very high
– The benefit packages vary according to the contribution
Examples
– South Africa and Namibia are the African countries where this insurance
system is prevalent.
16. 16 |
Combination of Various Mechanisms
Context and country examples
– A system can also consist of a combination of financing mechanisms (social
insurance, community-based mutual health organizations, free care, etc.)
– For example, in Rwanda, Gabon, and China, this is often made possible by
the beneficiaries (through individual contributions) and by the government
(through subsidies or other innovating mechanisms to mobilize resources for
health).
Pros
– Allows coverage/access to health care to a substantial portion of the
population
– Applies the principle of solidarity if there is a resource-pooling system
Cons
– Difficult to manage
– Potentially prohibitive cost depending on the amount of the contribution
17. 17 |
Key Messages
National health insurance financed by taxes is a form of solidarity/protection against financial
risks that can target all population groups.
Social health insurance, which offers a coverage limited to the formal sector, works against
equity with respect to the protection against financial risks.
Efforts targeting nonprofit, voluntary systems (mutual health insurance) organized at the
community level should be downgraded. The programs, projects, and other initiatives helping
only mutual heath insurance organizations are not considered a priority any more, and they can
even be counterproductive.
Evidence shows that free care has no impact on the reduction of OOP or catastrophic expenses
for the households; it offers little or no protection against financial risks (this is revealed by a
study conducted in Uganda).
The combination of mechanisms with a legal structure at the national level regulating all health
insurance systems helps increase protection against financial risks and allows to reduce the
fragmentation of individual financing mechanisms.