Financing universal health care in developing countries

With the approval of the Puerto Rico Healthcare Reform of 1993, the Public Healthcare System of the island would be privatized to the highest bidder of the private sector or the NGO sector (third sector). This privatization process reached its end with the approval of a new law that prohibited the sale, or transfer of healthcare facilities from the public sector to any of the others. This paper seeks to point out the incidences and events that were part of the total dismantling of the Puerto Rico Regional Healthcare System and the long term consequences it has had for the population.

This paper, utilizing National Health Accounts framework attempts a profile of the health financing situation Sub-Saharan Africa countries. While Africa accounts for less than 0.9 percent of global health spending, the region carries over 43% of global burden of communicable diseases. The households bear the highest burden of healthcare financing, accounting for between 72% and 99% of private sources. The public and external sources account for around 33% and 30% of total health expenditure, respectively. With high poverty incidence in the continent, households are easily exposed to catastrophic spending risk. This calls for health financing reforms that emphasis pooling mechanism, especially social health insurance. Deviance to the Alma Alta Declaration, which laid precedence on preventive healthcare, curative healthcare generally, dominates in the allocation of healthcare funds. This has implication on the efficiency and effectiveness of healthcare delivery in African countries. Public facilities play a dominant role in provision of healthcare, which is arguably supported by the need to achieve greater equity in healthcare delivery. However, with the growing wave of public-private-partnership initiatives, it may be intuitively wise and efficient to increase private participation in the provision of healthcare.

Background: Allocations of the scarce resources at the district level in Ghana are not according to priority needs or the burden of disease. The Ghana Essential Health Intervention Project (GEHIP) seeks to introduce a qualitative and quantitative district health planning tool – District Health Planning Analysis and Reporting Tool (DiHPART) - to address gaps in service delivery and reduce maternal and under five mortality as the country strives to achieve the Millennium Goals. The planning tool was adapted and developed from a similar tool used in Tanzania as well as data from Navrongo Health Research Center and the Ministry of Health.
Objective: The objective for developing DiHPART is to give districts a planning tool for allocating healthcare resources according to burden of disease to facilitate rationale healthcare planning and decision making at the district level
Methodology: As an example of South-South collaboration, Ghana in 2003 started collaborative work with Tanzania to adopt the PlanRep, an integrated planning; budgeting and reporting software used by districts in Tanzania.Through the GEHIP project, GHS has adopted and customized the software for use in Ghana.
Results: The Ghana Health Service now has a tool that helps districts to develop plans and budget consistent with the national planning and budgeting.

At global development agenda, reduction of inequality in utilization of Reproductive and Child Health services across space has been accorded at top priority. In India, Reproductive and Child care is an essential component of its basic health care services. Using third round of District Level Household Survey(2007-08) data, this study examines variation in RCH services across different demographic, socio-economic groups and regions in Uttar Pradesh. The DLHS collected information on wide range of topics: fertility, family-planning, maternal and child health, living condition of household, health infrastructure and other variables. The study was carried out for six services namely Full antenatal care, Post natal care, Safe delivery, Contraceptive use, Unmet need of Family Planning and Child Immunization. For inter-district comparison a composite index of these services has been computed. The Bi-variate and multivariate analysis has been carried out for analysis. Preliminary results show that though utilization of reproductive and child health services has improved in state there is huge interstate and social group disparity in utilization of these services. The multivariate analysis on RCH services indicate that years of schooling and economic status are significant determinants of utilization of RCH services in Uttar Pradesh.

Diabetes is public a health problem in Mexico. A demographic and epidemiological profile of diabetes in adults as the basis evaluate the economic expenses of diabetes and their financial implications, as well as exploring projections of expenses of medical attention to this disease in Mexican adult population.Using National Health and Nutrition surveys, expenditure was estimated on hospital discharges and budgeting in health institutions. We estimated expenses in one medical office consultation were: 503.34 pesos in IMSS (approximately 39 USD), 372 pesos en ISSSTE (approximately 29 USD), 91 pesos in SSA (approximately 7 USD).

This paper reviews the availability and accessibility of healthcare institutions in a geographically challenged and climatic shock prone region of the Indian Sundarbans. Given the apparent lack of preparedness of public health facilities particularly in the face of climate shocks such as the cyclonic storm and flood of Aila in 2009, the paper proposes an alternative healthcare delivery model in sync with the WHO recommendation in 1978 on Primary Health Care. The model reiterates the need for proper utilization of existing local health resource and advocates for channelizing these through an innovative service delivery model, custom made for the unique difficulties of the region and to enhance people’s resilience towards ever-increasing multifaceted
vulnerability.

This paper examined out-of-pocket expenses incurred by women for availing maternal health care services at public and private health facilities. This article used data from a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal health care. The survey was conducted in 2010 among 3300 women who gave birth within previous 12 months from starting date of data collection. Information on costs incurred to receive antenatal, delivery and postnatal care services were collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal health care services both at public and private facilities. On average, women paid US$3.6 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.4 at private health facilities. Similarly, women paid one and half times more for normal (US$42.3) and cesarean deliveries (US$136.2) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care did not vary significantly between public and private health facilities. Utilization of maternal care services can be improved if out-of-pocket expenses can be minimized.

This study compares ownership of health insurance among Ghanaian women with respect to material affluence and spatial location. The paper draws on the 2008 Ghana Demographic and Health Survey. Bivariate descriptive analysis and binary logistic regression estimation technique were used. In the bivariate descriptive, it is observed that the proportion of women not registered decreases with increase in material affluence. Spatially, the proportion of respondents not registered during the data collection was highest (70%) in the Coastal areas followed by Savannah and Forest belts. However, inferential analysis at the bivariate stage showed that the likelihood of registration was significant among respondents from the Savannah areas. Interacting material affluence with wealth, we notice that the gaps between the poorest and the non-poor in the Savannah widens significantly but the differences between the poor and least poor in the Forest zone are virtually non-extant. Our findings underscore the point that targeting the poor to improve equity in social health insurance such as the one operating in Ghana requires particular attention to proxy means (material affluence) and spatial targeting since choosing one over the other can obscure and result in ineffective policy prescriptions.

Pursuit of equity in health and health care has been the key feature of health policy in India. Despite the policy significance, the volume of literature on this important topic is very inadequate in the Indian context. This paper, for the first time seeks to provide evidence on horizontal inequity in health care utilization in 16 major states and north-eastern region of India. The number of outpatient care visits in the past 15 days, number of hospitalizations and length of stay in hospital over 12 months period were extracted from 60th round (2004) data of National Sample Survey. All these measures of health care utilization were standardized for need differences using demographic characteristics and morbidity indicators and controlling for other socioeconomic factors. Need standardized concentration indices were used to measure income related inequities in health care utilization. Absolute inequalities are found between states in the proportion of the population reporting a visit to an outpatient provider, from as low as 4 percent in Bihar to as high as 22 percent in Kerala. Notwithstanding, after standardization, no violation of principle of horizontal equity is found in outpatient care in many states. Significant inequity is observed with respect to the utilization of inpatient care, favouring the rich in all states except

The objective of this paper is to investigate whether the UC scheme in Thailand was associated to significant changes in the health consumptions and preventive activities of the general population. In order to isolate the impact of the UC reform on the variables of interest and to rule out other effects from long-run relation, we focus our analysis on the period just before and the period just after the introduction of the UC. The data are drawn from the 2001 and 2003 rounds of the Health and Welfare Survey (HWS). A differences in differences approach with Kernel matching was used, defining people working in the informal sector as the treatment group. Results show that: 1) preventive activities increased, 2) Inpatient care use increased, 2) outpatient care use was unaffected by the UC, 4) there was a switch from traditional to formal medicine. Furthermore, we find a significant reduction in out-of-pocket expenditure. Results show no clear sign of Moral Hazard and opportunistic behavior and confirm that the Thai UC as a successful story.