Social Reinsurance


Book Description

Annotation This volume views community-based microinsurance as an incremental first step to improved financial protection and better access to health services for the poor. While community-based financing can be structured in various ways, this volume focuses on reinsurance as a mechanism for improving micro-level health insurance units. It outlines strategies and policies that can be applied by countries and donors to improve access to health care services.




Ghana National Health Insurance Scheme


Book Description

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.




Health Systems Financing


Book Description

"This World Health Report was produced under the overall direction of Carissa Etienne ... and Anarfi Asamoa Baah ... The principal writers were David B. Evans ... [et al] -- t.p. verso.




The Impact of Health Insurance in Low- and Middle-Income Countries


Book Description

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.




The Cash Dividend


Book Description

This book provides in-depth descriptions and analysis of how cash transfer programs have evolved and been used in Sub-Saharan Africa since 2000. The analysis focuses on program features and implementation, but it also highlights political economy issues and current knowledge gaps.




Historical Perspectives on the State of Health and Health Systems in Africa, Volume II


Book Description

This book focuses on Africa’s challenges, achievements, and failures over the past several centuries using an interdisciplinary approach that combines theory and fact and evidence-based practices and interventions in public health, and argues that most of the health problems in Africa are not a result of scarce or lack of resources, but of the misconceived and misplaced priorities that have left the continent behind every other on the globe in terms of health, education, and equitable distribution of opportunities and access to (quality) health as agreed by the United Nations member states at Alma-Ata in 1978.




Reaching the Poor with Health, Nutrition, and Population Services


Book Description

This volume presents eleven case studies that document how well or poorly health, nutrition, and population programs have reached disadvantaged groups in the countries of Africa, Asia, and Latin America where they were undertaken. The studies were commissioned by the Reaching the Poor Program, undertaken by the Word Bank in cooperation with the Bill and Melinda Gates Foundation and the Dutch and Swedish governments, in an effort to find better ways of ensuring that health, nutrition, and population programs benefit the neediest. These case studies, reinforced by other material gathered by the.




Health Financing Revisited


Book Description

This overview of health financing tools, policies and trends--with a particular focus on challenges facing developing countries--provides the basis for effective policy-making. Analyzing the current global environment, the book discusses health financing goals in the context of both the underlying health, demographic, social, economic, political and demographic analytics as well as the institutional realities faced by developing countries, and assesses policy options in the context of global evidence, the international aid architecture, cross-sectoral interactions, and countries' macroeconomic frameworks and overall development plans.




Health Financing in the Republic of Gabon


Book Description

Gabon is an upper middle income country, with reasonable spending on health, however, its health outcomes resemble that of a country that is low / low-middle income. Where has Gabon gone wrong, and what are the challenges that Gabon is facing in improving health outcomes? Gabon is an emerging economy, while it has achieved high economic development it still has not achieved living standards and health outcomes seen in upper middle income countries. Gabon faces low life expectancy (63 years), levels as seen in other low income countries. It is in an early stage of an epidemiological transition. Fertility rates remain high, and mortality rates are starting to decline. It has a high burden from communicable diseases. While HIV incidence and tuberculosis incidence has started to show positive results, Malaria incidence continues to remain high. There are cost-effective interventions available to prevent many of the communicable diseases the country faces. These interventions require multi-sector approaches, behavioral change programs, outreach services, community development, and a primary health care focus.




Chronic Non-communicable Diseases in Ghana


Book Description

Chronic non-communicable diseases (NCDs) such as hypertension, stroke, diabetes and cancers, are major causes of disability and death in Ghana. NCDs are not only public health problems. They are also developmental problems, because the rising prevalence of long-term chronic conditions has major social and financial implications for affected individuals, families, healthcare providers and the government. This University of Ghana Readers volume from the Regional Institute for Population Studies presents social and medical science research on Ghanas NCD burden. The body of multidisciplinary research spans the last fifty years and offers important insights on NCD prevalence and experience as well as cultural, health systems and policy responses. This volume will be an essential resource for researchers and students in the health sciences, healthcare providers, health policymakers, and lay individuals with an interest in Ghanas contemporary public health challenges.