Financing universal health care in developing countries

With the longevity improvements it is pertinent to know whether the extended years of life are going to be spend in healthy or worsened state. Financing health which is one of the critical determinants of health outcomes is further determined by population structure as the higher prevalence of morbidity among elderly causes elevated health expenditure which turns into more requirement of money under the assumption that the elderly are treated equally to younger. With longevity improvements and age structural transition the old aged population is expected to grow from 6.7 (2001) to 19.1 percent by 2050 in India. This needs a simultaneous future growth of health expenditure in India. The study found that though, number of healthy years has increased but this increase is not in the same pace as increase in life expectancy. Moreover, age structure transition has role in health spending and if it is taken into account in projection, health spending will reach at 6.5 percent as percent to GDP in 2050. Though, per capita health spending is found to be significantly higher among elderly, its contribution is very high among young population because of large size.

After seven years of implementation, the National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment coverage within the 10 regions of Ghana with different rural-urban populations. Recent research has identified the determinants of enrolment in the NHIS to include income, age, marital status, employment status, self rated health status and perceived quality of health care services. Implementation problems such as delays in the production and distribution of NHIS ID cards, long waiting times, poor staff attitude, inadequate information on NHIS benefit package and delays in reimbursing health providers has significant deepened the fiscal and coverage challenges of the NHIS and threatens the long term sustainability of the scheme.
Using a sample of 7,084 individuals from the COHEiSION Project baseline survey and employing logistic regression, separate estimations are performed on the rural-urban samples to determine whether there are rural-urban differences in the determinants of demand for health insurance in Ghana. Due to differences in economic and social opportunities, we expect differences in insurance covariates among rural and urban dwellers which will aid in the formulation of policy interventions to address low enrolment in rural and urban populations.

A central restructuring of intergovernmental relations following decentralization in Indonesia is, among others, about financial system. Unacceptable share of local Budget to family planning is widely occurring. Huge discrepancy is unavoidable. Specific Allocation Fund/SAF allows direct financing from central to the local government limited to finance physical infrastructure. It has been implemented since 2008 with persistent increase in its total budget covering 377 districts. This study aims to analyze the management of the SAF for family planning in 6 provinces during 2010-2011. The information derived from in-depth interviews and focus group discussions with various stakeholders at provincial and district levels as well as analysis of current SAF policy and secondary data. Along with the story that SAF provision gives “hope” to the districts, this financing system is temporary to the low resource settings. Even so no guarantee can be hold that rich districts will provide adequate budget for family planning program to survive. A boarder viewpoint need to be considered and the scheme of this financing need to be re-designed in such a way that this fund mechanism empowers districts to be more responsible in bringing the program adaptive to the local demand.

How far the coverage of health insurance available to Indians, both in rural and urban areas? Who can afford to pay for health insurance coverage? This study examines health insurance scenario of India by analyzing the trends and patterns and household characteristics of health insurance policy holders. The study utilized available data from the latest rounds of two nationally representative surveys DLHS (2007-08) and NFHS (2005-06). Only 5 percent of the households in India were covered under any kind of health insurance. Within the insurance schemes, the state owned health schemes are the most subscribed (39.2), followed by the Employee State Insurance Scheme (17 percent). Among the households belonging to the lowest economic categories, less than 3 percent were covered by any health scheme or health insurance. However, the recent trends show that the community health insurance targeting poor households are becoming much popular and it may be the most appropriate way of supporting the families vulnerable to catastrophic health spending.

Maternal and child health programs are yet to achieve desired impact on the obstetric and newborn care services utilization from public-sector health facilities in Bangladesh. Home delivery and untrained providers largely contribute to the underutilization of the existing obstetric and newborn care services provided at facilities. Demand-side barriers particularly cost remains a key challenge to utilize MNCH care from facilities. This paper explore whether subsidized consumer cost increases utilization of obstetrics and newborn health service from facilities. Financial assistance in the form of coupon was provided to poor pregnant women to cover transportation and medical cost for receiving services from facilities. A rigorous process consisting of community assessment and use of poverty tool was employed to select eligible women. Three-fourths of the poor pregnant women were identified as eligible for coupon distribution from 20,833 pregnant women from 2 districts. Seventy nine percent coupons were utilized for receiving the ANC services followed by institutional delivery, PNC, and pregnancy complications care. The most cited reason for non-use of coupon is inadequate knowledge about the coupon and transportation cost. Round trip transportation costs and intensive advocacy at the community will increase the coupon use.

The unaffordable health care cost is believed to be one of the important causes of impoverishment in India. Using the data of WHO sponsored Study on Global AGEing and Adult Health (SAGE-India) of 2007, an attempt is made here to examine the health care expenditure, catastrophic health spending and the extent of health insurance coverage in rural and urban India. The survey covers about 10,000 households from six states of India. The analysis indicates that on an average , a household spent 13 percent of its income on health care. Among the households incurring catastrophic health expenditure, 24 percent became impoverished. Study also found that nine percent of non-poor households have become poor (impoverished) due to health spending. About 20 percent of households borrowed from their relatives and 8 percent sold their assets like land, furniture, livestock and jewellery to meet health care costs. According to this survey, the households having health insurance/policy are 5 percent in urban areas, it is only 1 percent in rural areas. The findings of the study convincingly illustrate the vulnerability of poor in India in the context of spiralling health care costs, privatization of medical sector, and lack of health insurance coverage.

This paper evaluates the health card subsidy, issued by Indonesian government after the financial crisis in 1997, benefits the elderly health care demand. The health card subsidy provided free access to health services; and was accepted at all health center or ‘puskesmas’. Using the Indonesia Socio-economic survey data (Susenas) for 2003, our results show health cards issued to the poor consistently caused increase the demand on health care facilities among the 55 year old population. Unfortunately, it is also found that the health card benefited wealthier individuals in their access of health centers or ‘puskesmas’.

Healthcare expenditure of Indian government is 1.2% of GDP which leaves a question mark on universal health coverage. India has one of the highest inefficient and iniquitous out of pocket expenditure in Asia. Health insurance is, thus, widely recognized and preferable mechanism to finance the health care expenditures. The present study attempts to recognize uninsured population and reasons for low health insurance cover. The study has used Longitudinal Ageing Study in India pilot data conducted by International Institute for Population Sciences, Harvard School of Public Health, and RAND Corporation in 2010. The study has used bivaraite and multivariate analysis on a sample of 1585 population which reflected embryonic stage of health insurance. People are not much aware about it and those who are aware are not actively participating due to affordability or accessibility issues. Sixty percent of study population considers financial issues important for purchasing health cover and thus a large section of the population is indirectly left out. The study emphasizes the need of increasing the awareness about health insurance to boost its demand. India has one of the highest domestic saving rates which if channelized into productive financial instrument can prevent the burden of catastrophic health expenditure.

Populations age globally. This is also the case in low and middle-income countries. In order to meet the challenges of rising chronic care needs for people suffering from non communicable diseases such as heart diseases, stroke, diabetes, visual impairment and dementia, the WHO urges to take action and get the right infrastructure in place. With the increasing ageing in Ghana there is an urgent need to assess determinants of demand for social health insurance for elderly (defined by WHO those 60 years of age and above) in order to assist policy makers and healthcare managers to anticipate timely and address the health protection needs of this growing group. Despite the achievements of Ghana’s National Health Insurance Scheme to enroll near to 70% of the population, recent data show that the actual active enrolment-rate is close to 34% (NHIA Annual Report 2011). With an exemption policy in place for the aged above 70 years of age, Ghana Government foresees protection for a certain group of elderly. This study provides empirical evidence of health seeking behavior and enrolment in social health insurance of 928 elderly above 50. It is expected to offer recommendations on effective policy interventions specifically targeting the aged populations.

Health financing in India is a critical issue in the wake of rapid demographic and epidemiological transition, low per capita pubic heath spending and rising health care cost. However, there are few studies that examine the role of changing age structure on health spending in India. The aim of this paper is to examine the effect of population growth and age structural transition on household health spending in India and states. It segregates the increased health expenditure due to changing age structure, increased hospitalization and medical cost (real) using decomposition analysis and projects future cost of medical care. The unit data from 52(25) and 60(25) rounds of National Sample Survey, Census of India 2001 and 2011 and Population Projection of Expert Committee 2001-26 are used in the analyses. Results suggest that the real cost of inpatient care has increased over time for all age groups. During 1995-2004, the changing age structure accounts 22% increase in real cost of hospitalization. The shift in age structure alone would lead to an increase of 47% in hospitalization cost, 43% in outpatient cost by 2021 and an increase of 63% in hospitalization cost and 58% of outpatient cost by 2026 at 2004 prices.