This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap†? and a “provision gap†?: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes.
This book presents research findings on India’s major central and state government-sponsored health insurance schemes (GSHISs). The analysis centers on the GSHISs launched since 2007. These schemes targeted poor populations, aiming to provide financial protection against catastrophic health shocks, defined in terms of inpatient care. Focus is on two lines of inquiry. The first involves institutional and “operational” opportunities and challenges regarding schemes’ design features, governance arrangements, financial flows, cost-containment mechanisms, underlying stakeholder incentives, information asymmetries, and potential for impact on financial protection and on access to care and use by targeted beneficiaries. The second entails “big picture” questions on the future configuration of India’s health financing and delivery systems that have surfaced, due in part to the appearance of a new wave of GSHISs. In addition to gains in population coverage, reaching about 185 million low-income beneficiaries by 2010, the new crop of schemes introduced a demand-side approach to public financing while embracing several innovation features, at least for the Indian context. These include: defined entitlements, separation of purchasing from financing, patient choice of providers, impressive use of information and communication technology and engagement with the private sector in the areas of insurance, administration and provision. Strong political interest in the schemes is also evident, especially at the state level and is a driver of increased public expenditures for health. The schemes face a number of operational challenges that have emerged during implementation and are examined in the book. They will need to strengthen institutional and governance arrangements, purchasing and contracting capacities, monitoring systems, and cost containment mechanisms. They need to use their financial leverage to improve the quality of network providers. Beneficiaries also appear to have insufficient information on enrolment, benefits and providers. The book recommends a series of corrective measures to address these shortcomings. The book outlines a “pragmatic pathway” toward achieving universal coverage that takes as a starting point the current configuration of health financing and delivery arrangements in India, recent trends in government health financing as well as innovations and lessons from the recent GSHISs analyzed in this book. The book concludes with a review of issues for further research.
This book presents the first comprehensive review of all major government-supported health insurance schemes in India and their potential for contributing to the achievement of universal coverage in India are discussed.
This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap†? and a “provision gap†?: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes.
This book aims to help countries design and implement a legal framework for a viable private health insurance market, with rationale for insurance regulation, institutions involved, and standards and protections used in regulating private health insurance.
This report summarize the experience since 2008 of the global efforts coordinated by the World Bank to use National Health Accounts (NHA) to better assess sources and allocation of public, donor and private health expenditures and inform countries' health financing policies.
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