Health financing for poor people: resource mobilization and risk sharing
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Washington, DC
World Bank [u.a.]
2004
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | Includes bibliographical references and index |
| Beschreibung: | xxi, 446 p. graph. Darst. 26 cm |
| ISBN: | 0821355252 |
Internformat
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| 245 | 1 | 0 | |a Health financing for poor people |b resource mobilization and risk sharing |c ed. Alexander S. Preker ... |
| 264 | 1 | |a Washington, DC |b World Bank [u.a.] |c 2004 | |
| 300 | |a xxi, 446 p. |b graph. Darst. |c 26 cm | ||
| 336 | |b txt |2 rdacontent | ||
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| 500 | |a Includes bibliographical references and index | ||
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| 650 | 4 | |a aPoor |a xMedical care |a zDeveloping countries | |
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Contents
Foreword xv
Dean T. Jamison
Preface xvii
Acknowledgments xxiii
PART 1 GLOBAL AND REGIONAL TRENDS 1
K 1. Rich Poor Differences in Health Care Financing 3
Alexander S. Preker, Guy Carrin, David Dror, Melitta Jakab,
William C. Hsiao, and Dyna Arhin Tenkorang
Overview and Context 4
Conceptual Underpinnings for Community Based Action
in Health Care Financing 9
Methodology for Assessing Impact, Strengths, and Weaknesses 14
Discussion of Main Findings from Background Reviews 24
Conclusions and Recommendations 41
Appendix 1A Statistical Data (Summary Tables) 44
X 2. Review of the Strengths and Weaknesses
of Community Financing 53
Melitta Jakab and Chitra Krishnan
Methods 54
What Is Community Based Health Financing? 59
Performance of Community Based Health Financing 68
Determinants of Successful Resource Mobilization,
Social Inclusion, and Financial Protection 84
Concluding Remarks 92
Appendix 2A Performance Variables Reported
in the Reviewed Studies 93
Appendix 2B Core Characteristics of Community Financing
Schemes from the Review of the Literature 100
vi Contents
V 3. Experience of Community Health Financing
in the Asian Region 119
William C. Hsiao
What Is Community Financing? 122
A Summary of the Value Added by Types
of Community Financing Schemes 133
A Review of Selected Asian Community Financing Schemes 135
4. Experience of Community Health Financing
in the African Region 157
Dyna Arhin Tenkorang
Conceptual Framework 161
Evidence 171
Discussion 185
Conclusion 192
PART 2 COUNTRY CASE STUDIES USING HOUSEHOLD
SURVEY ANALYSIS 1"
S' 5. Analysis of Community Financing
Using Household Surveys 2®1
Melitta Jakob, Alexander S. Preker, Chitra Krishnan,
Pia Schneider, Francois Diop, Johannes Paul Jutting,
Anil Gumber, M. Kent Ranson, and Siripen Supakankunti
Background 203
Methods 209
Results 216
Discussion 222
Concluding Remarks ' 225
Appendix 5A List of Reviewed Survey Instruments 226
6. Financial Protection and Access to Health Care
in Rural Areas of Senegal 231
Johannes Paul Jutting
Health Insurance in Rural Sub Saharan Africa 232
Research Design and Methodology 235
Results 238
Conclusions 247
7. Community Based Health Insurance in Rwanda 251
Pia Schneider and Frangois Diop
Background 253
Data Sources and Methodology 254
' Results 258
Discussion and Conclusion 272
Contents vii
8. The SEWA Medical Insurance Fund in India 275
M. Kent Ramon
Methods 277
Results 280
Discussion 285
9. The Potential Role of Community Financing in India ^ 293
Anil Gumber
Community Financing in India and the SEWA Program 295
Research Design and Methodology 301
Results 302
10. Impact of the Thailand Health Card 315
Siripen Supakankunti
Methods 326
Discussion 335
Conclusions and Recommendations 352
PART 3 EXPENDITURE GAPS AND DEVELOPMENT TRAPS 359
11. Deficit Financing of Health Care for the Poor 361
Alexander S. Preker, John C. Langenbrunner, and Emi Suzuki
Progress toward Achieving the MDGs 361
Key Drivers of Accelerated Progress toward Achieving
the MDGs 366
Estimating the Cost of Achieving the MDGs 373
Financing the Expenditure Gap 384
Conclusions 389
12. Impact of Risk Sharing on the Attainment
of Health System Goals 397
Guy Carrin, Riadh Zeramdini, Philip Musgrove, Jean Pierre Poullier,
Nicole Valentine, and Ke Xu
Health System Goals and Functions in a Nutshell 398
The Organizational Form of Health Financing
and Its Link to the Attainment of Health System Goals 399
Organization of Health Financing in the World 400
Modeling the Impact of the Organizational Form
of Health Financing on Health System Attainment
Indicators 401
Community Risk Sharing Arrangements: Further Need
to Measure Their Impact 410
Concluding Remarks 411
Appendix 12A Statistical Data 412
viii Contents
About the Coeditors and Contributors 417
The Coeditors 417
Other Contributing Authors 418
Index 427
BOXES
1.1 Revenue Mobilization 26
1.2 Strengths of Community Financing Schemes 28
1.3 Weaknesses of Community Financing Schemes 30
2.1 Definitions of Community Health Financing 61
2.2 Contribution of CF Schemes to Operational Revenues 70
2.3 The Bamako Initiative 72
2.4 Turning Potatoes and Labor into Cash Revenues
in Bolivia 86
2.5 Poor Management in the Nkoranza Scheme 89
4.1 Ghana's Policy Thrusts to Enable Evolution
of Community Health Insurance 193
11.1 Millennium Development Goals (1990 2015) 362
FIGURES
1.1 Less Pooling of Revenues in Low Income Countries 5
1.2 Flow of Funds through the System 5
1.3 Low Income Countries Have Weak Capacity to Raise Revenues 6
1.4 Out of Pocket (OOP) Expenditure and Poverty
without Risk Sharing 7
1.5 Pro Rich Bias of Public Subsidies in Many Low Income
Countries 8
1.6 Determinants of Financial Protection, Health,
and Social Inclusions 15
1.7 Hospitalization and Impoverishment 33
1.8 Stages of Financial Protection 42
2.1 Analytical Framework 58
3.1 Feasibility of Establishing Community Financing
and the Amount the Average Person Is Willing to Pay
as a Function of Expected Gains and Social Capital 124
3.2 Plausible Relationship between Locus of Control
and Economic and Quality Gains 127
3.3 The Trade Offs between Health Gains and Risk Protection
by Type of Service Funded 133
4.1 Relationships between Stakeholders and the Scheme 167
4.2 Percentage of Community Enrolled, by Distance 179
4.3 Premiums, Participation, and Revenues: Predictions
for Option C 187
4.4 Willingness to Pay for Adult Insurance 188
4.5 Stages of Financial Protection and Supporting Policies 191
Contents ix
6.1 Urban and Rural Health Insurance Schemes
in Sub Saharan Africa, Year of Inception and Size 233
7.1 Monthly Monetary Expenditure per Capita 262
11.1 Millennium Development Goals, Global Aggregate 363
11.2 Strong Correlation between Wealth and Health across Time 365
11.3 Income and Child Mortality 367
11.4 Cost Effective and Affordable Public Health
and Clinical Services 369
11.5 Three Nonfinancial Determinants of Good Outcomes 372
11.6 Lack of Management Capacity, Adverse Incentives,
and Weak Institutions Break the Fulcrum 372
11.7 Expenditure Frontier and Six Countries 377
11.8 Production Frontiers for Total Expenditure
on Health Care (Using Best Performance
on Various Health Outcomes) 379
11.9 Production Frontiers for Public Expenditure
on Health Care (Using Best Performance
on Various Health Outcomes) 381
11.10 Income and Health Spending 385
11.11 Only 11 Percent of Global Spending
for 90 Percent of the World's Population 386
11.12 Low Income Countries Have Less Pooling of Revenues 387
11.13 Types of Private Financial Flows 388
TABLES
1.1 Conceptual Underpinnings of Community Financing
Schemes 10
1.2 Summary Statistics of the Literature Reviewed,
by Publication Type 17
1.3 Core Characteristics of the Community Based
Financing Schemes 19
1.4 Characteristics of Five Survey Instruments 20
1.5 Types of Community Based Financing 25
1.6 Number of Studies That Examined Core
Health Financing Subfunctions 25
1.7 Studies That Looked at Ways to Prevent Impoverishment 27
1.8 Studies That Looked at Ways to Combat Social Exclusion 27
1.9 Potential Value Added by Types of Community Financing
Schemes 32
1.10 Statistically Significant Determinants of Inclusion
in Community Financing 36
1.11 Summary Findings: Statistically Significant Determinants
of Utilization and Out of Pocket Expenditure Patterns 38
1.12 Estimation Results for the Basic Models 44
1.13 Estimation Results for the Enlarged Models 45
2.1 Summary Statistics of the Literature Reviewed,
by Publication Type 55
x Contents
2.2 Summary of Literature Reviewed on Community Based
Health Financing Schemes, Based on Nature of Study
and by Region 56
2.3 Selection Criteria to Assess the Performance
of Community Based Health Financing 59
2.4 Often Encountered Forms of Community Financing 65
2.5 Summary of Case Studies by Modalities 66
2.6 Cost Recovery from Prepaid Premiums 74
2.7 Summary of Findings: Who Is Covered
by CF Arrangements? 75
2.8 Summary of Findings: Does CF Reduce the Burden
of Seeking Health Care? 79
2.9 Determinants Associated with Effective Revenue Collection
and Financial Protection 84
2.10 Performance Variables Reported in the Reviewed Studies 93
2.11 Core Characteristics of Community Financing Schemes,
from the Review of Literature 100
3.1 How Community Members Valued Service Availability,
Quality, Risk Protection, and Costs 125
3.2 A Typology of Selected Characteristics
of Community Financing Schemes 129
3.3 Assessment of Potential Value Added by Selected Types
of Community Financing Schemes 134
3.4 Potential Value Added by Types
of Community Financing Schemes 136
3.5 Prevalence and Benefits of Community Health Financing
in Five Provinces, 1991 139
3.6 Prevalence and Benefits of Community Health Financing
in 30 Poor Counties, 1993 140
3.7 Management of Community Health Financing
in 30 Poor Counties, 1993 140
3.8 Community Health Financing by Source in Selected
Counties and Provinces, 1991 and 1993 143
3.9 Two Prototype Benefit Packages for China's Rural Poor 144
3.10 Current Financing of Health Spending by Source
in China's Poverty Regions 145
3.11 Percentage of 2,236 Surveyed Community Leaders Citing
Major Reasons for Lack of Rural Community Financing 145
4.1 Scheme Design Options 168
4.2 An Example of Goals Matched to Design Options 169
4.3 Features of "Potentially Large Population" Schemes
for Informal Sector Households 172
4.4 "Potentially Large Population" Schemes' Financial
Risk Protection Performance 184
5.1 Socioeconomic Characteristics of Rwanda, Senegal, India,
and Thailand, 1999 204
5.2 Health Outcomes and Expenditures in Rwanda, Senegal,
India, and Thailand, 1999 209
Contents xi
5.3 Characteristics of Five Survey Instruments 210
5.4 Statistically Significant Determinants of Inclusion
in Community Financing 217
5.5 Summary Findings: Statistically Significant Determinants
of Utilization and Out of Pocket Expenditure Patterns 221
5.6 Reviewed Surveys for 21 Countries 227
6.1 Hospitalization Fees for Members and Nonmembers
at St. Jean de Dieu Hospital 235
6.2 Selection Criteria for Mutual to Be Included in the Survey 235
6.3 Overview of Variables Used 239
6.4 Marginal Coefficients for Determinants of Participation
in Mutual Health Insurance (Household Level) 240
6.5 Marginal Coefficients for Determinants of Participation
in Mutual Health Insurance (Individual Level) 243
6.6 Probability of Hospitalization and Determinants
of Expenditure in Case of Hospitalization 244
7.1 Community Based Health Insurance in Rwanda,
First Year Performance (July 1999 June 2000) 252
7.2 Summary Statistics: Independent Variables Used
to Determine Probability of CBHI 256
7.3 Summary Statistics of Explanatory Variables
for Probability of Professional Visit 257
7.4 Summary Statistics of Explanatory Variables
for Estimated Out of Pocket Spending per Episode
of Illness 259
7.5 Descriptive Sample Characteristics 260
7.6 Household Characteristics, by Income Quartile 261
7.7 Summary Statistics on Distribution of Monthly Monetary
Expenditures per Capita 261
7.8 Logit Regression Results for Households' Probability
to Demand Community Based Health Insurance
(Prepayment Schemes) 263
7.9 Probability of Using a Professional Provider
by Insurance Status 266
7.10 Logit Regression Results for Probability of at Least One
Professional Provider Visit for Members and Nonmembers 267
7.11 Average Health Expenditure per Sick Individual with
or without a Visit to a Professional Provider, by Health
Insurance Status and Expenditure Quartile,
in Pilot Districts 268
7.12 Log Linear Regression Results: Estimated Total Health Related
Expenditures per Episode of Illness for Sick Individuals
with and without a Visit 270
7.13 Log Linear Regression Results: Estimated Out of Pocket Health
Expenditures per Episode of Illness for Sick Individuals Who
Reported a Professional Visit in Past Two Weeks 271
8.1 Independent Variables Included in the Regression Analyses 279
8.2 Sample Characteristics 281
xii Contents
8.3 Hospital Utilization and Expenditure per Hospitalization
by SEWA Coverage 282
8.4 Regression Results for Equation 1, the Odds of Being
SEWA INS Based on Sociodemographic Variables 283
8.5 Regression Results for Equation 2, the Probability of Being
Hospitalized within the Last Year 284
8.6 Regression Results for Equation 3 286
8.7 Summary of Studies Looking at the Impact of CBHI
Schemes on Utilization and Out of Pocket Expenditures 289
9.1 Type of Health Care Burden on Households Covered
by Health Insurance Schemes 295
9.2 Salient Characteristics of Selected NGO Managed
Health Insurance Schemes 297
9.3 Prepayment and Insurance Mechanisms in Selected
NGO Managed Health Insurance Schemes 299
9.4 Coverage under SEWA Scheme 301
9.5 Overview of Variables Used 303
9.6 Determinants of Being Enrolled in SEWA Health Insurance
Plan among SEWA Members 306
9.7 Determinants of Being Treated and Use of Public
or Private Facility for Ambulatory Care 308
9.8 Determinants of Using Private Facility
for Inpatient Care 310
9.9 Determinants of Out of Pocket Expenditure on Treatment
by Type of Care 312
10.1 Health Service Utilization Pattern for Reported 111 Persons 316
10.2 Trend of Total per Capita Health Expenditure
(Public and Private Spending) 317
10.3 Percent Source of Health Care Financing
in 1984, 1986, and 1987 318
10.4 Budget Expenditures Classified by Program,
Fiscal Years 1994 96 318
10.5 Modification of Health Card Program: Rationale,
Objectives, and Activities 321
10.6 Unit Cost at Health Service Unit Used by Health Card
Member 325
10.7 Demographic and Socioeconomic Characteristics
of Health Card New Purchase and Health Card Nonpurchase 329
10.8 Demographic and Socioeconomic Characteristics of Health
Card Dropout and Continued Card Purchase 330
10.9 Demographic and Socioeconomic Characteristics of Health
Card Nonpurchase and Dropout Groups 331
10.10 Demographic and Socioeconomic Characteristics of Health
Card Nonpurchase and Health Card Purchase
(Dropout/Continued/New Purchase Groups) 332
10.11 Variables That Predict People Who Ever Purchased
a Health Card Versus Nonpurchase Group 336
Contents xiii
10.12 Variables That Predict Health Card Nonpurchase
and Dropout Groups Versus Continued and New
Card Purchase Groups 337
10.13 Variables That Predict Health Card Nonpurchase Versus
New Card Purchase Group 338
10.14 Variables That Predict New and Continued Health Card
Purchase Versus Health Card Dropout Group 339
10.15 Demographic and Socioeconomic Characteristics
of Health Care Seekers by Whether or Not They
Possess Health Card 341
10.16 Frequency of Card Use among Card User Group 343
10.17 Health Care Seeking Pattern in the Past Three Months
among Card Users and Noncard Users 343
10.18 Multiple Regression Model 344
10.19 Logistic Regression Model: Variables that Predict Health Card
Usage among Card Users 345
10.20 Attitudes toward Health Card Program of Cardholders
and Noncardholders 346
10.21 Attitudes toward Health Card Program of Cardholders
and Noncardholders (Mean Score) 347
10.22 Health Card Utilization Rate 348
11.1 Public Expenditure on Health Needed to Be More Like
Frontiers 378
11.2 Total Health Expenditure Gap in US\$ (in Millions)
to Achieve Frontier Expenditure Levels
(Countries with GDP US\$7,000 per Capita) 383
11.3 Public Health Expenditure Gap in US\$ (in Millions)
to Achieve Frontier Expenditure Levels
(Countries with GDP US\$7,000 per Capita) 383
12.1 Descriptive Statistics (Full Samples) 402
12.2 Descriptive Statistics (Restricted Samples) 404
12.3 Classification of Countries by Degree of Risk Sharing
in the Health Financing System 412
12.4 Estimation Results for the Basic Model 413
12.5 Estimation Results for the Enlarged Models (Summary) 414 |
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| genre | (DE-588)4143413-4 Aufsatzsammlung gnd-content |
| genre_facet | Aufsatzsammlung |
| geographic | Pays en développement rasuqam Entwicklungsländer (DE-588)4014954-7 gnd |
| geographic_facet | Pays en développement Entwicklungsländer |
| id | DE-604.BV019758513 |
| illustrated | Illustrated |
| indexdate | 2025-01-28T11:12:20Z |
| institution | BVB |
| isbn | 0821355252 |
| language | English |
| lccn | 2003057160 |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-013084906 |
| oclc_num | 834992962 |
| open_access_boolean | |
| owner | DE-703 |
| owner_facet | DE-703 |
| physical | xxi, 446 p. graph. Darst. 26 cm |
| publishDate | 2004 |
| publishDateSearch | 2004 |
| publishDateSort | 2004 |
| publisher | World Bank [u.a.] |
| record_format | marc |
| spelling | Health financing for poor people resource mobilization and risk sharing ed. Alexander S. Preker ... Washington, DC World Bank [u.a.] 2004 xxi, 446 p. graph. Darst. 26 cm txt rdacontent n rdamedia nc rdacarrier Includes bibliographical references and index Armoede gtt Assurance-maladie rasuqam Financement rasuqam Financiering gtt Gezondheidszorg gtt Minorités - Soins médicaux - Pays en voie de développement Pauvre rasuqam Pauvres - Soins médicaux - Pays en voie de développement Santé publique - Pays en voie de développement - Finances Santé publique rasuqam Service social rasuqam Services sociaux - Pays en voie de développement - Finances Soins médicaux rasuqam Économie de la santé - Pays en voie de développement Économie de la santé rasuqam Gesundheitswesen aPoor xMedical care zDeveloping countries aPublic health zDeveloping countries xFinance aMedical economics zDeveloping countries aMinorities xMedical care zDeveloping countries aHuman services zDeveloping countries xFinance Öffentliches Gesundheitswesen (DE-588)4139691-1 gnd rswk-swf Gesundheitsausgaben (DE-588)4210266-2 gnd rswk-swf Pays en développement rasuqam Entwicklungsländer (DE-588)4014954-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Entwicklungsländer (DE-588)4014954-7 g Öffentliches Gesundheitswesen (DE-588)4139691-1 s Gesundheitsausgaben (DE-588)4210266-2 s DE-604 Preker, Alexander S. 1951- Sonstige (DE-588)140490779 oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=013084906&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Health financing for poor people resource mobilization and risk sharing Armoede gtt Assurance-maladie rasuqam Financement rasuqam Financiering gtt Gezondheidszorg gtt Minorités - Soins médicaux - Pays en voie de développement Pauvre rasuqam Pauvres - Soins médicaux - Pays en voie de développement Santé publique - Pays en voie de développement - Finances Santé publique rasuqam Service social rasuqam Services sociaux - Pays en voie de développement - Finances Soins médicaux rasuqam Économie de la santé - Pays en voie de développement Économie de la santé rasuqam Gesundheitswesen aPoor xMedical care zDeveloping countries aPublic health zDeveloping countries xFinance aMedical economics zDeveloping countries aMinorities xMedical care zDeveloping countries aHuman services zDeveloping countries xFinance Öffentliches Gesundheitswesen (DE-588)4139691-1 gnd Gesundheitsausgaben (DE-588)4210266-2 gnd |
| subject_GND | (DE-588)4139691-1 (DE-588)4210266-2 (DE-588)4014954-7 (DE-588)4143413-4 |
| title | Health financing for poor people resource mobilization and risk sharing |
| title_auth | Health financing for poor people resource mobilization and risk sharing |
| title_exact_search | Health financing for poor people resource mobilization and risk sharing |
| title_full | Health financing for poor people resource mobilization and risk sharing ed. Alexander S. Preker ... |
| title_fullStr | Health financing for poor people resource mobilization and risk sharing ed. Alexander S. Preker ... |
| title_full_unstemmed | Health financing for poor people resource mobilization and risk sharing ed. Alexander S. Preker ... |
| title_short | Health financing for poor people |
| title_sort | health financing for poor people resource mobilization and risk sharing |
| title_sub | resource mobilization and risk sharing |
| topic | Armoede gtt Assurance-maladie rasuqam Financement rasuqam Financiering gtt Gezondheidszorg gtt Minorités - Soins médicaux - Pays en voie de développement Pauvre rasuqam Pauvres - Soins médicaux - Pays en voie de développement Santé publique - Pays en voie de développement - Finances Santé publique rasuqam Service social rasuqam Services sociaux - Pays en voie de développement - Finances Soins médicaux rasuqam Économie de la santé - Pays en voie de développement Économie de la santé rasuqam Gesundheitswesen aPoor xMedical care zDeveloping countries aPublic health zDeveloping countries xFinance aMedical economics zDeveloping countries aMinorities xMedical care zDeveloping countries aHuman services zDeveloping countries xFinance Öffentliches Gesundheitswesen (DE-588)4139691-1 gnd Gesundheitsausgaben (DE-588)4210266-2 gnd |
| topic_facet | Armoede Assurance-maladie Financement Financiering Gezondheidszorg Minorités - Soins médicaux - Pays en voie de développement Pauvre Pauvres - Soins médicaux - Pays en voie de développement Santé publique - Pays en voie de développement - Finances Santé publique Service social Services sociaux - Pays en voie de développement - Finances Soins médicaux Économie de la santé - Pays en voie de développement Économie de la santé Gesundheitswesen aPoor xMedical care zDeveloping countries aPublic health zDeveloping countries xFinance aMedical economics zDeveloping countries aMinorities xMedical care zDeveloping countries aHuman services zDeveloping countries xFinance Öffentliches Gesundheitswesen Gesundheitsausgaben Pays en développement Entwicklungsländer Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=013084906&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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