Any analysis of health financing issues has to begin with sound estimates of the level and flow of resources in a health system, including total levels of spending, the sources of health expenditures, the uses of funds in terms of services purchased, and in terms of who purchases them. The analysis should also aim at understanding how these resource flows are correlated with health system outcomes, including those of improving health, reducing health inequalities, and reducing the incidence of catastrophic health expenditure. National Health Accounts (NHA) provide a framework to collect, compile, and analyze such data on all types of health spending in a country―and so create a robust evidence base for policy making. Although NHA data delineate the key financial metrics of a health system, the collection of these data have not been institutionalized in most developing countries. The root problems are often the same: insufficient resources to collect, collate, analyze and produce information on spending; poor development of health and other information systems; low levels of local capacity to interpret information to meet policy needs; and inadequate demand for data within countries. Furthermore, in many low- and middle-income countries, NHA activities have been conducted as ad hoc, donor-driven initiatives. Since 2008, the World Bank has been coordinating a global initiative to identify bottlenecks to the institutionalization of NHA, and to learn lessons in countries at different stages on the journey towards this institutionalization. The focus has been less on the production of NHA and more on its relevance as a tool to enable policy makers develop and implement evidence-based decisions, and better measure the impact of health reforms, especially those related to health financing. This report has been developed through a consultative process, involving experts and policy makers from more than fifty low-, middle- and high-income countries, large and small, in all corners of the world, development partners and World Bank staff globally. The report represents a synthesis of lessons learned from country experiences and is intended to serve as a strategic guide to countries and their development partners as they design and implement their strategy to develop nationally relevant and internationally comparable data, collected in a routine and cost-effective manner.

Creating Evidence for Better Health Financing Decisions: A Strategic Guide for the Institutionalization of National Health Accounts (Directions in Development - Human Development)

Business & Money

Maeda, Akiko

Nagpal, Somil

Norris Harrit, Margareta

Mabuchi, Shunsuke

Siadat, Banafsheh

Economics

World Bank Publications

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.

Government-Sponsored Health Insurance in India: Are You Covered? (Directions in Development - Human Development)

La Forgia, Gerard

Insurance

The quest for universal health coverage (UHC) has gathered real momentum over the past decade, with countries on every continent now taking part. This is welcome news, since a lack of universal coverage means that hundreds of millions of people around the world either do not get the health care services they need, or they have to pay dearly for them, often falling into poverty as a result. But the UHC agenda also poses an enormous challenge to policy makers across the globe, and many countries are eager to learn from the experiences of others as they undertake the long journey toward UHC. Going Universal: How 24 Developing Countries Are Implementing Universal Health Coverage Reforms from the Bottom Up draws on a wealth of new evidence to help enrich the global knowledge base on UHC. It provides a synthesis of UHC reform programs that placed a special focus on expanding coverage in ways inclusive of the poor. The main objective was to document and analyze their experiences based on a systematic data collection effort that sought to capture in great detail how they have been implementing UHC reforms. The main chapters oer an in-depth analysis of how countries are addressing five key challenges: covering people, expanding benefits, managing money, improving the supply of health care services, and strengthening accountability. The UHC reform programs described in the volume are new, massive, and transformational. Most were launched during the past decade, and together they now cover more than 2 billion people. But most importantly, the authors find that the programs are fundamentally changing the way health systems operate, offering the potential to achieve greater equity and better results for the money spent. The authors identify key risks that lie ahead, as well as an emerging agenda that requires more country and global learning. Overall, this book offers those contributing to the achievement of UHC worldwide a valuable new resource to help chart a way forward.

Going Universal: How 24 Developing Countries are Implementing Universal Health Coverage from the Bottom Up

Medical Books

Smith, Owen

Cotlear, Daniel

Tandon, Ajay

Cortez, Rafael

Administration & Medicine Economics

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