Financing universal health care in developing countries

Background: The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with health insurance ownership among Kenyan women.
Methods: Data came from the 2008-09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15-49 years. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership.
Results: Being employed in the formal sector, being married, having secondary education and higher, belonging to the middle and rich wealth status categories and residing in a female-headed household were associated with having health insurance. However, divorced, separated or widowed women were significantly less likely to have health insurance (OR= 0.4; p<0.05) compared to their counterparts who were never married.
Conclusion: As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among women of different socio-demographic backgrounds.

In the past decade, accelerated, yet insufficient progress in child mortality reduction to reach MDG 4 and a rapid increase in development assistance for health (DAH) to resource-poor settings for financing child health-related activities have been observed. Given the increase in DAH to child medical care from 1.67 billion in 2003 to 4.44 billion in 2010 (in constant 2010 US$), tracking of donor funding to child health is crucial for assessing aid effectiveness in improving child health.

This study provides new time-series cross-country estimates for global development assistance to child health with a new definition based on a demographic model of determinants of child survival over an extended time series from 1995 to 2010. Data comes from several sources, including the OECD's Creditor Reporting System. Unlike previous studies, we estimate aid from non-medical sectors, such as sanitation, food, and nutrition, which directly influence child health. Our study uses a multi-disciplinary approach to estimate DAH and improves the estimates in terms of their comparability and completeness. We conduct a descriptive study on the portion of assistance allocated to countries with the highest child mortality rates and expect to see an increase of DAH to child health both at the global level and in countries with high mortality rates.

Financial literacy is the ability to understand finance, where one has the awareness, knowledge and skills to make decisions about savings, investments, borrowings and expenditure in an informed manner. Thus, this present paper, the financial literates refer to those women who have a bank saving account, have knowledge on loan programs in a bank, and have any knowledge of health insurance. It has hypothesized that those financially literates are more likely to utilize various health care services than the non-financial literates especially maternal health. Therefore fore, an attempt has been made to study the financial literacy and their utilization for govt. or private health care services for ANC. Uni-variate, bi-variate analysis and multivariate analysis were done for the study. The Northern region women belonging to the Muslim religion community who are residing in urban areas are more likely to be financially illiterate than those of women from the Southern region from belonging to the Hindus, Christians and other religious group who are residing in an urban areas. Financially literates were more likely to visit any healthcare services than the financially illiterates. Financial illiterates were more likely to utilize government health care while the financial literates tend to use the private health care systems.

On 1993, the Government of Puerto Rico had been providing direct healthcare services for almost 50 years. Because of raising costs of healthcare technology, the government officers decided to stop financing direct healthcare services transforming its role to one of an insurer. It has been 18 (2010) years since the approval of the Puerto Rico Healthcare Reform of 1993 and the question still lies in public discussions and on professional meetings; Has the Government achieve all the objectives of the Healthcare Reform of 1993?. This research primary objective was to produce an answer to this unanswered question. DESIGN METHODS: Using case study and comparative analysis that included budget, economic, annual reports, among others a design was produced to achieve an effective assessment of the Puerto Rico Healthcare Reform. RESULTS: Since the government is still a direct provider of healthcare services not only an insurer and has not achieved a reduction of the public healthcare expenditures associated with the healthcare sector the objectives of the Healthcare Reform of 1993 have not ben met. CONCLUSION: After a thorough analysis of the data, it can be concluded that the objectives of the Healthcare Reform of Puerto Rico of 1993 have not been met, thus making this important reform a failure.

Money, or the lack of it, is likely to be the deciding factor in meeting global health targets. Using panel data for 22 OECD/DAC countries over the period 1996-2007, this paper analyzes the determinants of donor funding for reproductive health activities. Much of the previous research on this subject found a strong positive correlation between donor funding and GDP of donor countries. I use disaggregated data on donor funding to account for the fact that relative importance of aid determinants is likely to vary across specific funding categories. The results strongly support the notion that it is important to differentiate between restricted (earmarked) and unrestricted (non-earmarked) funding. There is undoubtedly some discretion over both types of funding. Nevertheless, unrestricted funding seems to be more responsive to economic developments in donor countries as demonstrated by the strong positive correlation of this type of funding with GDP. Unrestricted funds are thus easier to increase or cut according to discretionary criteria. Restricted funding, on the other hand, can be viewed as more undeliberate or non-discretionary. This finding has an interesting implication with regard to items in donor aid budgets that could be particularly affected in times of economic crisis.

Using a panel data set for four southern Indian states for the period 1993-94 to 2007-08, the paper empirically examines the important factors determining states’ expenditure on health and observes whether health is a luxury. Double log multiple panel regression equations have been specified for analysis. Feasible generalized least square estimator has been employed to estimate the coefficients with the option of first order panel specific auto-regressions. Per capita aggregate health expenditure and per capita expenditure on medical and public health are alternatively regressed on a set of explanatory variables like per capita GSDP, percapita central transfers from centre, infant mortality rate, population and number of primary health centres. The findings suggest that the change in health spending of the southern Indian states seems to have been determined by the states’ resource capacity, availability of resources in terms of central transfers and due to the pressure from demand side factor like rise in infant mortality rate. The health is not luxury in Indian context, as the income elasticity of aggregate health expenditure is found to be 0.697. The paper calls for strengthening states’ resource capacity, reprioritising budgetary allocation and more specific purpose central grants for increasing states spending on health .

Willingness to pay data are rarely collected or used as part of designing health insurance schemes in developing countries. The objective of this study was to assess household heads’ willingness to pay for community health insurance and its determinants in rural communities in Nigeria.
It was a descriptive cross-sectional study carried out among household heads in rural communities. Sample size of 360 was determined using Fishers formula and multistage sampling technique was used to select respondents. Semi structured interviewer administered questionnaire was used and data analysis was done using Epi-info version 3.4.1. Frequency tables and cross-tabulations were generated with a p-value pre-determined at less than 0.05.
The mean Willingness to Pay was 522.0 + 266.3 Naira and the allowable range for fixing premium is between 250 naira and 1,200 naira. The factors that affect Willingness to pay were age, sex, educational attainment, income, household size, and past health expenditure of household heads.
The amount of premium that should be fixed for Community Health Insurance in these rural communities should range between 250 naira to 1,200 Naira and a mechanism should be worked out such that there will be differential payment based on the age, sex, educational attainment, income, and household size in the registration.