The strategy will guide whos technical support and collaboration with the member states in the area of health financing and create. Health care financing and the sustainability of health systems. The kakwani index is an equity index used to show how distant a financing source is from. Using data across the oecd, i find that almost all financing choices are compatible with efficiency in the delivery of health care, and that there has been no consistent and systematic relationship between financing and cost containment. The answer to the question of who must pay for health care and how lies in the moral fabric and the value system of a society. Analysis of the health system in slovenia evaluating health.
Health care financing, efficiency, and equity sherry a. Investing in health has a high rate of economic return share of world gdp allocated to health has increased from 3% in 1948 to 9. The risk of che is inversely related to the share of outofpocket payments oop in total health expenditure. Analyzing health equity using household survey data. In order to treat them equally, they would all be given the same size box to stand on to improve their lines of sight. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and outofpocket payments. Contribution to health care finance has been considered a redistribution of the disposable income of households 15, 16. Health care financing and the sustainability of health. There is, however, some discussion of the concept and definition of equity. One of the main challenges of all health systems is achieving equity in healthcare financing. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts.
Cambodia is currently introducing a number of significant. Decentralizing health care 201 7 financing health in lowincome countries 209 health spending by region 211 the cost of the millennium development goals 214 public sources of revenue for health 218 private sources of revenue for health 227 equity and ef. Promoting equitable health care financing in the african context. Jul 18, 2015 for example, tax simulation models from south africa find that although increased taxes on either general income, consumption, or both, could expand health coverage, consumption taxes would reduce access to nutrition and health care for poorer households. The paper surveys the economics literature on equity in health care financing and delivery. View all video blogs innovation is key to providing quality, affordable healthcare. In the past decade, the countries of southeast asia and other regions have made siginificant progress on the health care front. Health care financing was regressive at the start of our study period, with households in the bottom 20 percent of income paying 26. Defining terms the principal choices for financing a health care system are general revenues, social insurance financing, private insurance financing, and outofpocket payments. Equity in financing and use of health care in ghana, south africa, and tanzania. In particular, it examines inequalities in health outcomes, health behavior and health care utilization.
There is an implicit assumption that health care produces health. It is expected that the strategy will facilitate policy dialogue on health care financing both at the regional and country levels. The path to universal coverage, who is supporting countries in developing of health financing systems that can bring them closer to universal coverage. Equity financing and debt financing relevant to pbe paper ii management accounting and finance dr.
Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. The equity model equity is a representation of ownership in an enterprise allocated to individuals or other entities in the form of ownership units or shares. Health care expenditure involves money spent from all sources for the entire health sector, regardless of who operates or provides the services. In considering the impact on equity of health care financing options it is equally important to ask who pays.
Innovation is key to providing quality, affordable healthcare. The kakwanis progressivity index 16, widely used in public finance, is a frequent tool of assessment for equitable financing. Equity in health care can take many forms but may most usefully relate to health care financing according to ability and access to health care services according to need who 2012. This paper proposes a framework for thinking about equity in health financing. Financing universal health coverageeffects of alternative. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. H42,h51,i18 abstract this paper examines the efficiency and equity implications of alternative health care system financing. Improving equity in health care financing in china during the. Financing health in lowincome countries poverty magni. This book shows how to implement a variety of analytic tools that allow health equity along different dimensions and in different spheres to be quantified. Health systems financing, world health organization, 20 avenue appia, 1211 geneva 27, switzerland. The empirical sections cover the literature on equity in health care financing progressivity and horizontal equity of health care financing arrangements, equity in health care delivery. Equity can be used as a financing tool by forprofit businesses in exchange for ownership control and an expected return to investors.
Zelelew, hailu 2012 health care financing reform in ethiopia. Health care financing an overview sciencedirect topics. Health economics and financing for developing countries aims. Health care financing, efficiency, and equity nber working. Guided by the world health assembly resolution wha64. This study undertook a combined analysis of both financing and benefit incidence to explore the distribution of health care benefits and financing burden across socioeconomic groups. Centre for health policy, university of the witwatersrand and health economics and financing program, london school of. Reflections on and alternatives to the world health organizations fairness of financing index adam wagstaff development research group and human development network world bank without wishing to incriminate them in any way, i am grateful to deon filmer, maureen lewis, and martin. Improving quality and equity abstract ethiopia endorsed a health care financing strategy in 1998 that envisioned a wide range of reform initiatives. General revenue financing here refers to a system of revenue collection through a broad based tax. Analysis of the health system in slovenia evaluating. Chapter 34 equity in health care finance and delivery.
Analysis of universal health coverage and equity on health. Promoting equitable health care financing in the african. Health inequities therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. The aim of this project is to evaluate equity in health care financing across both public and private sectors in cambodia. Home equity conversion and the financing of longterm care. Home equity conversion for the elderly is a means for elderly homeowners to draw down a portion of their accumulated wealth without having to sell their homes andor move. The conventional categorisations of finance sources for health. Challenges in health equity for indigenous peoples in canada. Health inequities have their roots in unequal access or exposure to social determinants of health such as education, healthcare, and healthy living and working conditions michigan health equity roadmap pdf.
Jun 09, 2008 health care financing systems are proportional if individuals or households with different atp are spending the same proportion of atp in financing health care. The incidence of financing and health system viability has only recently become a major topic of health policy 6, not only in europe 7 and the uk 8 but also in the us 9 and canada 10. Equity is espoused in many national health policy statements but is a complex concept and is difficult to define. Improving this situation is a very important goal in the mexican health democratization process, in the context of health care reform. Health inequities therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health. Who health financing for universal coverage and health. These criteria, which are explained briefly in the following paragraphs, are used in the analysis of health care financing presented in the main section of this report.
We propose the following principles to help achieve equity in health care. This paper discusses the implications of the way health care resources are raised, pooled and spent. Health financing systems are critical for reaching universal health coverage. Lowincome countries face 56 percent of the global disease burden but account for only 2 percent of global health spending world bank 2005. Health care financing, efficiency, and equity request pdf. Our important work through equity healthcare demonstrates that the private sector is playing a major role in developing marketbased solutions to both improve the quality of healthcare and contain its costs.
Research article open access new evidence on financing equity. This fundamental, but rather overlooked, concept in the economics of health policy needs to be actively debated as sustainable development goals gain traction in post2015 policy agenda. The framework aims to guide health financing policy decisions on the path toward universal health coverage uhc and reflects in addition to concepts of equity and fairness the values and principles inherent to this globally adopted goal united nations 2018. The focus is, for the most part, on empirical work, especially that involving international and temporal comparisons. Cambodia is currently introducing a number of significant financing mechanisms designed to promote access to. Given the reduction in available health funding, gom has instituted bypass fees for patients to skip referral and directly access care at major public hospitals. Universal health coverage ensures that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship has continued to dominate demate in health care.
One standard against which to assess the answer might be that only those who benefit fromuse health care i. Often a key aim for equity of financing is that it is progressive i. Equitable financing is a key objective of health care systems. This paper examines the efficiency and equity implications of alternative health care system financing strategies. Mar 01, 2012 little is known about health system equity in tanzania, whether in terms of distribution of the health care financing burden or distribution of health care benefits. Financing universal health coverageeffects of alternative tax structures on public health systems. Changes in the equity of us health care financing in the. It will be further developed after the forum to take account of. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern china, comparing the equity performance between urban and rural areas. The implementation of these reform initiatives was legalized through regional legislations and operationalized in line with. Progressive payments refer to the rich contribute a greater proportion of health care payments than the poor in comparison with their ability to pay atp. Financial sustainability as a major health care issue in the 21st century world is also discussed. Having an efficient health care system is morally important because health care is one important element that determines peoples health and good health is a central part of both.
Research article open access new evidence on financing. Fong chun cheong, steve, school of business, macao polytechnic institute company financing is a prior concern for operating any business, and financing is arranged before any business plans are made. Health equity, as defined by health people 2020, is the attainment of the highest level of health for all people. This paper discusses these issues, with specific focus on the equity principles underpinning the irish healthcare system. It is a deeply ideological and political question with undertones of social involvement, personal responsibility, and freedom of choice. Equity in health care financing is recognised as a main goal in health policy. A framework a paper prepared to inform development of the discussion paper for the forum washington, d. Conflicts between different definitions of equity are identified in theory and policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure che. Racism is an organized system, rooted in an ideology of inferiority that categorizes, ranks, and differentially allocates societal resources to human population groups williams, d. Equity, governance and financing after health care reform. Recommended by the commission on social determinants of health and others. Home equity conversion and the financing of longterm care weinrobe, maurice d home equity conversion and the financing of longterm care by maurice d. Canadas healthcare system, like the country itself, is a complex entity.
The methods of financing health care include tax supported, social security supported, employeremployee financed, charitable organizations, or consumer payment at the time of service. In the developed world, however, the ability to finance societys health care needs is a child of the 21 st century. Are health care payments more progressive in one health care financing system than in. Questions that the techniques can help provide answers for include the following. Abstract this report analyzes equity and financial protection in the health sector of zambia. The 10 countries which participated in the study denmark, france, ireland, italy, the netherlands, portugal, spain, switzerland, the u. The implementation of these reform initiatives was legalized through regional legislations and operationalized in. Efficiency, equity and equality in health and health care 1 three common es have high ethical and political content for health policy. Other definitions 2mobilization of funds for health careallocation of funds to the regions and population groups and for specific types of health caremechanisms for paying health care hsaio, w and liu.
Using data across the oecd, i find that almost all financing choices are. It will be further developed after the forum to take account of the discussion. In view of this, how important is this concept of health equity. With nearly 30% of financing for health from external resources, uganda is vulnerable to fluctuations in donor financing patterns. Have gaps in health outcomes between the poor and the. Asking the question, do you want health or health care. Current challenges and future prospects di mcintyre1, lucy gilson2, vimbayi mutyambizi1 1. Equity metrics, as applied to data for health and health systems, needs to be integrated into all health system policies and implementation strategies, and at every stage of any reform process. As the two papers in the lancet s series on canada. Health financing levers to move closer to universal health coverage lie in three interrelated areas. An international assessment of health care financing. Some health care finance concepts have ageneral meaning, while others relate specifically to the health care sector. Health care financing mechanisms are frequently judged on the basis of the extent to which they are feasible, equitable, efficient and sustainable.
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