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Publications

Filtering by Category: Health finance

Key Message Brief 6: Lessons from results-based financing to improve health services in Afghanistan

Future Health Systems

The Afghanistan experience of nearly 15 years of contracting for health services has demonstrated both how results-based financing (RBF) can serve to increase utilisation of health services and the equity in use, as well as the limitations and failings of RBF approaches to work consistently.

Future Health Systems (FHS) findings, generated through robust experimental and quasi-experimental studies in a rapidly changing context, suggests that attention to scheme design (especially to address demand side concerns, supply side capabilities, and the size and mechanisms of payments) and implementation (timeliness and communication about payments) are critical.

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‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

Future Health Systems

Ekirapa-Kiracho E, Paina L, Kananura RM, Mutebi A, Jane P, Tumuhairwe J, Tetui M and Kiwanuka SN (2017) ‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda, Global Health Action, 10:sup4, 1347311, DOI: 10.1080/16549716.2017.1347311

Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups.

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Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Future Health Systems

Mutebi A, Kananura RM, Ekirapa-Kiracho E, Bua J, Kiwanuka SN, Nammazi G, Paina L and Tetui M (2017) Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services, Global Health Action, 10:sup4, 1347363, DOI: 10.1080/16549716.2017.1347363

Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. This article aimed to understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.

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Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh

Future Health Systems

Iqbal M, Chowdhury AH, Mahmood SS, Mia MN, Hanifi SMA and Bhuiya A (2017) Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh, Global Health Action, Vol 10, Issue 1, DOI: 10.1080/16549716.2017.1287398

Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals’ pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI.

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What does the end of Africa's boom mean for Universal Health Coverage?

Future Health Systems

Achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.

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Saving money, saving lives: community saving groups lead to improvements in maternal and newborn health care in Uganda

Future Health Systems

Future Health Systems (FHS) work on maternal and newborn health in the poorest districts of eastern Uganda has contributed to a story of community empowerment where people have learnt to prioritise, prepare and save money for childbirth. This increases the likelihood of delivery in a health facility, and therefore the chances of a healthy pregnancy and safe childbirth under skilled care.

Strengthening capacity to enhance delivery: implementation of payment reform in China

Future Health Systems

In 2002, China launched a voluntary health insurance scheme to provide financial protection to people affected by disease-related illness. Future Health Systems (FHS) work in Hanbin County, western China, has drawn on innovative methods from implementation and participatory research to train and support local policymakers, managers and health professionals in the evidence-based implementation of the scheme.

Drug-resistant tuberculosis control in China: progress and challenges

Future Health Systems

Long Q, Qu Y, and Lucas H (2016) Drug-resistant tuberculosis control in China: progress and challenges, Infect Dis Poverty. 2016; 5: 9. doi: 10.1186/s40249-016-0103-3

Abstract

Background: China has the second highest caseload of multidrug-resistant tuberculosis (MDR-TB) in the world. In 2009, the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.

Discussion: China is facing high prevalence rates of drug-resistant TB and MDR-TB. MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment. Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs. The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment. However, this programme has a fixed timeline and cannot provide a long term solution. In 2009, the Bill and Melinda Gates Foundation, in cooperation with the National Health and Family Planning Commission of China, started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment, alongside increased health insurance benefits for patients, in order to contain medical costs and reduce financial barriers to treatment. Although these efforts appear to be in the right direction, they may not be sufficient unless (a) domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and (b) appropriate incentives are given to both health facilities and their care providers.

Summary: Along with the on-going Chinese health system reform, sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.

Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China

Future Health Systems

Pan Y, Chen S, Chen M, Zhang P, Long Q, Xiang L, and Lucas H (2016) Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China, Infect Dis Poverty. 2016; 5: 7. doi: 10.1186/s40249-016-0102-4

Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, the authors aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes.

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Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China

Future Health Systems

Zhou C, Long Q, Chen J, Xiang L, Li Q, Tang S, Huang F, Sun Q, and Lucas H (2016) Factors that determine catastrophic expenditure for tuberculosis care: a patient survey in China, Infect Dis Poverty. 2016; 5: 6. doi:  10.1186/s40249-016-0100-6

Tuberculosis (TB) often causes catastrophic economic effects on both the individual suffering the disease and their households. A number of studies have analyzed patient and household expenditure on TB care, but there does not appear to be any that have assessed the incidence, intensity and determinants of catastrophic health expenditure (CHE) relating to TB care in China. That will be the objective of this paper.

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Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China

Future Health Systems

Li Q, Jiang W, Wang Q, Shen Y, Gao J, Sato KD, Long Q, and Lucas H (2016) Non-medical financial burden in tuberculosis care: a cross-sectional survey in rural China, Infect Dis Poverty. 2016; 5: 5. doi:  10.1186/s40249-016-0101-5

Treatment of tuberculosis (TB) in China is partially covered by national programs and health insurance schemes, though TB patients often face considerable medical expenditures. For some, especially those from poorer households, non-medical costs, such as transport, accommodation, and nutritional supplementation may be a substantial additional burden. In this article the authors aim to evaluate these non-medical costs induced by seeking TB care using data from a large scale cross-sectional survey.

 

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Experience and problems of Urban Employee Basic Medical Insurance reform in China: Based on analysis of Policy documents and institutional environment/ 我国城镇职工基本医疗保险制度改革的经验与问题———基于对政策文件和制度环境的分析

Future Health Systems

This paper analyses the main policy documents of Urban Employee Basic Medical Insurance System (UEBMIS) over the past two decades and the institutional environment, experiences, and problems in the process of reform. The authors state that in the future, UEBMIS should proceed according to the guideline of ensuring basic demands, establishing a multi-level security system, and ensuring sustainability. It should also proceed according to the guideline of gradual advancement and piloting first. Top-level design and linkage reform should be improved, national data should be unified, and a data-evaluation system should be established.

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Difficulties and Challenges Faced in the Development of Urban and Rural Resident Medical Insurance for Catastrophic Diseases in China/ 我国城乡居民大病保险发展面临的困难与挑战

Future Health Systems

Through summarizing the new situation and new problems since the pilot implementation development of urban and rural medical insurance for catastrophic diseases in China, this article analyzes the nature of medical insurance for catastrophic diseases and the relationship among New Rural Cooperative Medical System and Basic Medical Insurance for urban residents, puts forward the main difficulties and the faced challenges in the development of medical insurance for catastrophic diseases.

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Lessons learnt during the process of setup and implementation of the voucher scheme in Eastern Uganda: a mixed methods study

Future Health Systems

In spite of the investments made by the Ugandan Government, the utilisation of maternal health services has remained low, resulting in a high maternal mortality (438 maternal deaths per 100,000 live births). Aiming to reduce poor women’s constraints to the utilisation of services, an intervention consisting of a voucher scheme and health system strengthening was implemented. This paper presents the lessons learnt during the setup and implementation of the intervention in Eastern Uganda, in order to inform the design and scale up of similar future interventions.

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Study on Policy of Medical Assistance (MA) for Catastrophic Diseases/ 重特大疾病医疗救助政策研究

Future Health Systems

Establishment of medical security and assistance mechanisms for catastrophic diseases is the focus of health care reform to tackle the large medical expense burden. Based on sorting out the stage of the development of China's severe illness security policy, point out the cotent and difficulties of the connection of medical assistance and medical insurance for catastrophic diseases, analyse the main problems of medical assistance for catastrophic diseases and give appropriate policy recommendations.

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The analysis of the effect of global budget on hospitalization costs of patients with medical insurance/总量控制对医保患者住院费用影响的探讨

Future Health Systems

This journal article aims to evaluate the impact of the global budget on health care costs of one pilot hospital by comparatively analyzing the data before and after the policy implementation, and then put forward proposals and suggestion for the improvement of the policy. 

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Catastrophic out-of-pocket payment for healthcare and implications for household coping strategies: evidence from West Bengal, India'

Future Health Systems

Using data from a household survey in West Bengal, the purpose of this paper is to identify the relative risks of catastrophic healthcare expenditures for different types of health need, and the impact of such expenditure on household coping strategies. It concludes that Catastrophic health spending is an important problem for the population in West Bengal. More attention is needed on the poverty-inducing effects of long-term expenditures on chronic illness, given that existing schemes only address hospitalization.

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Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

Future Health Systems

User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees.
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Targeting accuracy and impact of a community-identified waiver card scheme for primary care user fees in Afghanistan

Future Health Systems

User fees are a known common barrier to using health services, particularly among the poor. When fees are present, many facilities have waiver systems for poor patients to exempt them from paying. Targeting waivers to patients who need them most has been a challenge, especially in fragile states, where relevant data are limited and trust in institutions is low. An analysis of the asset index of beneficiaries indicated that although targeting was progressive, significant leakage and high levels of under-coverage occurred; 42% of cards were used by people in the wealthiest three quintiles, and only 19% of people in the poorest quintile received a card. Households with waiver cards reported higher rates of care-seeking for recent illnesses compared to those without cards (p = 0.02).
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Health insurance & responsiveness to communities & patients: The future of health systems in India

Future Health Systems

Providing protection from the financial risks of ill health is a growing priority to both reduce poverty and improve access to health care for Indians. Community Health Insurance (CHI) is clearly not a panacea for all the health financing and delivery challenges in India. Although Devadasan and colleagues did not find a significant association between CHI enrollment and patient satisfaction in their study, this does not mean that CHI is not worth pursuing. Rather, it raises the need to pay closer attention to how strategies are actually implemented, and to consider multiple perspectives and consequences when re-design programmes.
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