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Health insurance is a form of coverage that provides financial protection against the cost of medical expenses and healthcare services. It is typically offered by private insurance companies and can also be provided by government programs in some countries. The abstract of health insurance can be summarized as follows: Health insurance aims to help individuals and families manage the expenses related to medical care and healthcare services. It operates on the principle of risk pooling, where many individuals pay premiums into a collective fund that is then used to cover the healthcare costs of those who require medical treatment. Health insurance plans vary in terms of coverage, cost, and benefits. They typically include provisions for hospitalization, doctor visits, prescription medications, preventive care, and other healthcare services. Some plans may also offer additional benefits such as dental and vision coverage. To access healthcare services covered by health insurance, individuals usually pay a monthly or annual premium. In addition, they may be responsible for deductibles, co-payments, and co-insurance, which are the portion of the medical expenses they must pay out of pocket. Health insurance provides individuals with financial security by reducing the burden of medical costs. It can help protect against high medical bills resulting from unexpected illnesses, accidents, or chronic conditions. Additionally, having health insurance often allows individuals to access a broader range of healthcare providers and facilities. It is important to note that health insurance policies often have limitations, exclusions, and pre-existing condition clauses. These factors can impact coverage and may require individuals to meet certain criteria or wait for a specified period before receiving full benefits.

Universal Health Coverage (UHC) as a health policy goal is gaining added currency in the policy agendas of many Low and Middle-Income Countries (LMIC) following the onslaught of the coronavirus (COVID-19) pandemic. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without suffering financial hardship. Whereas most industrialised countries have achieved UHC through the implementation of various traditional health financing mechanisms, most LMIC have not made significant progress in providing financial protection against the costs of illness for majority of the population due to limited fiscal space and or lack of political commitment to raise government revenues and increase fiscal space for health. While the onslaught of COVID-19 refreshes the call for reform of countries' health financing policies to reflect the healthcare needs of the population, the debate about the type or combination of health financing models to employ in LMIC has yet to reach a consensus. This review critically analyses five health financing models to ascertain their appropriateness in providing financial risk protection against the cost of illness, especially in this era of COVID-19. Given the limited fiscal space for health in LMICs, we argue that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms. Moreover, because the creation of fiscal space is context-specific, and UHC is a political issue rather than technical, securing strong political support is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.

The COVID-19 pandemic has exposed health system funding challenges across many developing countries. The needed infrastructure to effectively respond to the pandemic was absent in many developing countries. This has resulted in policymakers resorting to various strategies to mobilise sufficient resources in response to the pandemic, especially in the early stages. This paper reviewed Ghana's efforts to mobilise domestic and external resources for the health sector in response to the pandemic. The paper also assessed lessons from these strategies and highlights how these lessons could be leveraged to sustain financing for the health sector. Using evidence from desk reviews, we demonstrate the existence of fiscal space through external sources, partnership with non-state actors, and effective public financial management (budget space). We also show that the COVID-19 pandemic presents an important momentum to drive future investment in health infrastructure across developing countries.

Political economy factors are important in determining the adoption and implementation of health policies. Yet these factors are often overlooked in the development of policies that have the potential to influence health.Political economy analysis provides a way to take into consideration political and social realities, whether at the community, subnational, national, regional or global levels. We aim to demonstrate the value of political economy analysis and to promote its wider use in technical programmes of work.We provide examples from across a range of World Health Organization areas of work, including participatory governance, health financing, health taxes, malaria prevention and control, capacity-building and direct country support.Existing examples of how political economy analysis can be incorporated into technical support demonstrate the variability of this analytical approach, as well as its potential to support policy progress. Applying political economy analysis within the specified programmes of work has enabled more contextually relevant technical support to enhance the likelihood of advancing countries' health-related objectives.Embedding political economy into technical work has many benefits, including: enhancing voice and participation in health policies; supporting the adoption and implementation feasibility of technically sound policies; and building capacity to incorporate and understand political factors that influence health-related priorities.Les facteurs liés à l'économie politique jouent un rôle crucial dans l'adoption et la mise en œuvre de mesures sanitaires. Pourtant, ces facteurs sont souvent négligés lors de l'élaboration de politiques susceptibles d'avoir un impact sur la santé.Analyser l'économie politique représente un moyen de tenir compte des réalités politiques et sociales au niveau communautaire, infranational, national, régional ou international. Nous voulons démontrer l'importance de l'analyse de l'économie politique et promouvoir son usage dans les programmes techniques de travail.Nous donnons des exemples issus d'une série de domaines traités par l'Organisation mondiale de la Santé, parmi lesquels la gouvernance participative, le financement de la santé, les taxes sanitaires, la prévention et la lutte contre la malaria, le renforcement des capacités et l'appui direct aux pays.Les exemples portant sur l'intégration de l'analyse de l'économie politique dans l’appui technique illustrent la variabilité de cette approche analytique, mais aussi sa potentielle contribution aux progrès politiques. Appliquer une analyse de l'économie politique à des programmes de travail spécifiques a permis de fournir un soutien technique adapté au contexte, augmentant ainsi les chances d'avancement des pays vers la réalisation des objectifs en matière de santé.Incorporer l'économie politique dans le travail technique comporte de nombreux avantages: amélioration de la représentation et de la participation dans le cadre des mesures sanitaires; meilleures possibilités d'adoption et de mise en œuvre de politiques solides sur le plan technique; et enfin, renforcement des capacités afin de comprendre et d'inclure les facteurs politiques qui ont une influence sur les priorités relatives à la santé.Los factores de economía política son importantes para determinar la adopción y aplicación de las políticas sanitarias. Sin embargo, se suelen ignorar estos factores cuando se elaboran políticas que pueden influir en la salud.El análisis de economía política permite tener en cuenta las realidades políticas y sociales, ya sea a nivel local, subnacional, nacional, regional o mundial. El objetivo de este proyecto es demostrar el valor del análisis de la economía política y promover su uso generalizado en los programas técnicos de trabajo.Se ofrecen ejemplos de diversas áreas de trabajo de la Organización Mundial de la Salud, como la gobernanza participativa, la financiación sanitaria, los impuestos sanitarios, la prevención y la contención del paludismo, la creación de capacidades y el apoyo directo a los países.Los ejemplos existentes de cómo se puede incorporar el análisis de economía política al apoyo técnico demuestran la variabilidad de este enfoque analítico, así como su potencial para apoyar el progreso de las políticas. La aplicación del análisis de la economía política en los programas de trabajo especificados ha permitido que el apoyo técnico sea más pertinente según el contexto para aumentar la probabilidad de avanzar en los objetivos sanitarios de los países.Integrar la economía política en el trabajo técnico tiene muchos beneficios, entre los que se incluyen: potenciar las opiniones y la participación en las políticas sanitarias; apoyar la adopción y la viabilidad de la aplicación de políticas técnicamente sólidas; y crear capacidad para incorporar y comprender los factores políticos que influyen en las prioridades sanitarias.تعد عوامل الاقتصاد السياسي ذات أهمية في تقرير اعتماد السياسات الصحية وتنفيذها. إلا أنه غالبًا ما يتم تخطي هذه العوامل عند تطوير السياسات التي لديها القدرة على التأثير على الصحة.يوفر تحليل الاقتصاد السياسي وسيلة لوضع الحقائق السياسية والاجتماعية في الاعتبار، سواء على مستوى المجتمع، أو المستوى دون الوطني، أو الوطني، أو الإقليمي، أو العالمي. نحن نهدف إلى إظهار قيمة تحليل الاقتصاد السياسي، وتعزيز استخدامه على نطاق أوسع في البرامج الفنية للعمل.نحن نقدم أمثلة عبر مجموعة من مجالات عمل منظمة الصحة العالمية، بما في ذلك الحوكمة المشتركة، والتمويل الصحي، والضرائب الصحية، والوقاية من الملاريا ومكافحتها، وبناء القدرات، والدعم المباشر على مستوى الدولة.إن الأمثلة القائمة لكيفية دمج تحليل الاقتصاد السياسي في الدعم الفني، توضح تنوع هذا الأسلوب التحليلي، فضلاً عن قدرته على دعم تقدم السياسة. إن تطبيق تحليل الاقتصاد السياسي ضمن برامج العمل المحددة قد أتاح المزيد من الدعم الفني ذي الصلة بالسياق، لتعزيز احتمالية الارتقاء بالأهداف المتعلقة بالصحة في الدول.إن دمج الاقتصاد السياسي في العمل الفني له العديد من الفوائد، بما في ذلك: تعزيز الرأي والمشاركة في السياسات الصحية؛ ودعم اعتماد سياسات سليمة من الناحية الفنية وجدوى تنفيذها؛ وبناء القدرات لدمج العوامل السياسية التي تؤثر على الأولويات المتعلقة بالصحة، وفهمها.政治经济因素在决定采纳和实施卫生政策方面发挥重要作用。然而，在制定可能影响卫生的政策时，这些因素往往被忽视。.政治经济学分析提供了一种考虑政治和社会现实的方法，无论是在社区、地方、国家、地区还是全球层面。我们的目的在于说明政治经济学分析的价值，并促进其在技术性工作计划中更广泛的使用。.我们提供一系列来自世卫组织工作领域中的示例，包括参与式治理、卫生筹资、医疗税、疟疾预防和控制、能力建设和直接国家支持。.有关如何将政治经济学分析纳入技术支持的现有示例表明该分析方法的可变性，以及该方法在支持政策进展方面的潜力。在特定工作计划中应用政治经济学分析，可以提供更加因地制宜的技术支持，以促进实现国家卫生相关目标的可能性。.将政治经济学融入技术工作有许多益处，包括：增强对卫生政策的发言权和参与度；支持采用和实施技术完备政策的可行性；建设能力以纳入和理解影响卫生相关优先事项的政治因素。.Факторы политической экономии играют важную роль в определении принятия и осуществления политики в области охраны и укрепления здоровья. Однако эти факторы часто упускаются из виду при разработке политики, которая способна повлиять на охрану здоровья.Политэкономический анализ позволяет учитывать политические и социальные реалии как на уровне сообщества, так и на субнациональном, национальном, региональном или глобальном уровне. Авторы ставят перед собой цель продемонстрировать ценность политэкономического анализа и способствовать его более широкому использованию в технических программах работы.В статье приводятся примеры из различных областей деятельности Всемирной организации здравоохранения, включая управление на основе широкого участия, финансирование здравоохранения, налоги на здравоохранение, профилактику малярии и борьбу с ней, наращивание потенциала и прямую поддержку стран.Существующие примеры того, как политэкономический анализ может быть включен в техническую поддержку, свидетельствуют об изменчивости этого аналитического подхода, а также о его потенциале для поддержки прогресса в политике. Применение политэкономического анализа в рамках указанных программ работы позволило получить техническую поддержку, более соответствующую контексту, для повышения вероятности достижения странами целей, связанных со здравоохранением.Внедрение политэкономии в техническую работу имеет ряд преимуществ, в том числе повышение роли и участия в политике здравоохранения, поддержка принятия и реализации технически обоснованной политики, наращивание потенциала для учета и понимания политических факторов, оказывающих влияние на приоритеты в области здравоохранения.

Objectives. To assess whether medical crowdfunding use and outcomes are aligned with health financing needs in the United States. Methods. We collected data on 437 596 US medical GoFundMe campaigns between 2016 and 2020. In addition to summarizing trends in campaign initiation and earnings, we used state- and county-level data to assess whether crowdfunding usage and earnings were higher in areas with greater medical debt, uninsured populations, and poverty. Results. Campaigns raised more than $2 billion from 21.7 million donations between 2016 and 2020. Returns were highly unequal, and success was low, especially in 2020: only 12% of campaigns met their goals, and 16% received no donations at all. Campaigns in 2020 raised substantially less money in areas with more medical debt, higher uninsurance rates, and lower incomes. Conclusions. Despite its popularity and portrayals as an ad-hoc safety net, medical crowdfunding is misaligned with key indicators of health financing needs in the United States. It is best positioned to help in populations that need it the least. (Am J Public Health. 2022;112(3):491–498. https://doi.org/10.2105/AJPH.2021.306617 )

Most developed countries provide publicly-financed insurance for many health services for their populations although there is considerable variation across countries in the types of services covered, eligible population groups and whether co-payments are levied. The Irish healthcare system, with a complex mix of public and private financing of healthcare services, offers a useful case study for an examination of the impact of type of health insurance cover on population health. In this paper, we investigate the extent to which type of health insurance cover is associated with all-cause, cause-specific, and amenable mortality using data on a representative survey of the population aged 50+ from the Irish Longitudinal Study on Ageing (TILDA) matched to administrative data on death registrations. The results show that those without public or private health insurance have a higher risk of all-cause and cancer mortality. However, there is no evidence that type of health insurance cover affects mortality risk from causes that are considered amenable to healthcare intervention, although this analysis was based on a much smaller sample size. This analysis provides important evidence for a country that is implementing reforms to its financing and delivery structures in order to move towards a system of universal healthcare.

The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.

Background: The financing function within a health system is considered inherently complex, so it is of utmost importance to design a suitable future for this system given uncertainties and complexities of the environment. With regard to the current and future complicated conditions, health system financing is also likely to succeed if it can anticipate the impacts of effective factors in the future and further plan appropriate interventions ahead of time. Thus, the purpose of this study was to develop scenarios for the health system financing in Iran. Methods: This mixed-design research of exploratory future studies type was conducted using the scenario method. In this respect, the key variables were evaluated using a questionnaire from two aspects of importance and uncertainty as well as formation of a future studies group (focus group). Finally, sensitivity analysis was carried out through cross-impact balance (CIB) analysis using the Scenario Wizard (Version 4.31) software. Results: A total of 25 factors were selected based on the type and the position of the variables (driving force, bi-dimensional, risk, secondary leverage or modifiable-to-secondary leverage) over the diameter of the MICMAC chart. Considering the degree of significance and uncertainty, eight variables including all four driving force variables (oil sales and economic blockade, leadership and advocacy, bureaucracy and corruption, and possibility of using information technology in providing services), as well as the variables of resource sustainability, natural disasters, regional security, and specialization culture were chosen. Then, five variables were finalized as the key changes that would create the scenario based on sensitivity analysis and final expert opinions. According to the defined conditions, 270 scenarios were developed, of which fourteen scenarios were identified as poorly adaptable and five cases as highly adaptable. Conclusion: The best scenario identified in this study based on the degree of adaptation included the use of massive technology and oil sales, mediocre economic conditions with high probability of occurrence, strong leadership and advocacy, high regional security, as well as bureaucracy and low corruption with medium probability of occurrence.

Introduction:We examine the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S.Methods:This cross-sectional study ...

The aim: The purpose of the article is to study the challenges and prospects for the development of national health financing systems against the background of a pandemic. Materials and methods: Our research consists of two interrelated stages. At the first stage, the central task was to determine the size of the drop in world GDP. In the second part of the study, we focused on the definition of the essence of concession agreements in order to use t in the field of medical care. The key methods used in this study were data analysis, generalization, and comparison. Conclusions: National health financing systems in the vast majority of the world’s countries have experienced unprecedented pressures and problems both in terms of health insurance due to the huge losses of the insurance industry in 2020. In order to improve health care financing systems, it is necessary to update the forms, methods and tools of the insurance market functioning in terms of the health insurance segment, and to introduce new mechanisms for financing the medical sector in the process of combating the spread of coronavirus infection.

The COVID-19 pandemic triggered an economic shock just ten years after the shock of the 2008 global financial crisis. Economic shocks are a challenge for health systems because they reduce government revenue at the same time as they increase the need for publicly financed health care. This article explores the resilience of health financing policy to economic shocks by reviewing policy responses to the financial crisis and COVID-19 in Europe. It finds that some health systems were weakened by responses to the 2008 crisis. Responses to the pandemic show evidence of lessons learnt from the earlier crisis but also reveal weaknesses in health financing policy that limit national preparedness to face economic shocks, particularly in countries with social health insurance schemes. These weaknesses highlight where permanent changes are needed to strengthen resilience in future: countries will have to find ways to reduce cyclicality in coverage policy and revenue-raising; increase the priority given to health in allocating public spending; and ensure that resources are used to meet equity and efficiency goals. Although many health systems are likely to face budgetary pressure in the years ahead, the experience of the 2008 crisis shows that austerity is not an option because it undermines resilience and progress towards universal health coverage.

Resumo Este artigo objetiva caracterizar as transferências financeiras no âmbito do Bloco da Atenção Básica para os municípios do estado de São Paulo, no período entre 2011 e 2017, e sua relação com a mudança de modelo de atenção na Atenção Primária à Saúde (APS). Trata-se de um estudo descritivo e exploratório, de natureza quantitativa e de corte longitudinal retrospectivo. Foram analisadas transferências ocorridas no âmbito do Piso da Atenção Básica Variável (PAB Variável), agregadas segundo vinculação com mudança de modelo. Também foram considerados cobertura de Estratégia Saúde da Família (ESF), número de visitas domiciliares e o percentual de municípios que aderiram ao Programa de Melhoria do Acesso de Qualidade da AB (PMAQ). Os resultados indicam a relevância que os Incentivos para mudança de modelo assumiram no financiamento da atenção básica no estado de São Paulo, em especial para municípios de pequeno porte, sugerindo o interesse da gestão municipal em implementar as medidas propostas. Contudo, constatam-se obstáculos para a identificação de mudança das práticas, de forma que o modelo de atenção em vigência não fica devidamente explicitado, a partir dos indicadores analisados. Conclui-se a necessidade de complementar a utilização do financiamento como dispositivo indutor de mudança de modelo com processos avaliativos voltados, especificamente, para a consolidação da APS abrangente. Abstract This article aims to characterize financial transfers within the scope of the Primary Care Block to the municipalities of the state of São Paulo, in the period between 2011 and 2017, and its relationship with the health care model change in Primary Health Care (PHC). This is a descriptive and exploratory study, of quantitative nature and with a retrospective longitudinal section. Transfers that occurred within the scope of the Variable Primary Care Floor (Variable PCF) were analyzed, aggregated according to its link with the model change. Family Health Strategy (FHS) coverage, number of home visits, and the percentage of municipalities that adhered to the Program for Access and Quality Improvement in Primary Care (PMAQ) were also considered. The results indicate the relevance of the Incentives for model change in the financing of primary health care in the state of São Paulo, especially for small municipalities, suggesting the interest of these municipalities in implementing the proposed measures. However, there are obstacles to identifying changes in practices, thus the current health care model is not properly explained from the analyzed indicators. In conclusion, complementing the use of funding as a model change-inducing device with evaluative processes specifically aimed at consolidating comprehensive PHC is needed.

The lack of a fully developed results-based financing model before implementation of a program in the health sector begins can lead to difficulty in communicating about the program to different actors involved and delay components of implementation., Key Messages The intended incentive structure of results-based financing (RBF) makes it particularly important that program implementers communicate to beneficiaries of a program before implementation begins about the nature of the program and that RBF will be used.Improved decision making and communication about the requirements and expectations of an RBF program can enhance stakeholders' knowledge and perceptions of the program, and ultimately make implementation easier. Key Findings The lack of a fully developed RBF model meant the program was more difficult to communicate to the different actors involved.The lack of knowledge of the RBF program and the existence of incentives raises doubts about whether the program incentivized actors for the intended targets. Key Implications Program managers should recruit stakeholders from all governments and organizations involved in program financing and implementation to participate in the design of RBF schemes so that they can effectively communicate the structure and indicators to different levels of their respective organizations.Program implementers using RBF should have a flexible plan in place for the RBF model before implementation begins, even if the plan might change., In 2015, the Zambian government and the Swedish International Development Cooperation Agency (Sida) signed an agreement in which Sida committed to funding a program for Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH). The program includes a results-based financing (RBF) model that aims to reward Zambian districts for improved district-wide results on relevant indicators with additional funding. We aimed to describe stakeholders' knowledge of the RBF model and perceptions of the incentive structure during the first 18 months of the program's implementation. This study illuminates the possible pitfalls of implementing an RBF scheme without giving attention to all necessary steps of the process. A qualitative case study was used and included a review of documents, in-depth interviews, and observations. From February–April 2017, we conducted 37 in-depth interviews, representing the views of 12 development partner agencies, government departments, and health facility staff throughout Zambia. We used a qualitative framework analysis. Findings show that the Zambian government and Sida had different perceptions on what levels of the health system RBF will incentivize and that most districts and hospital administrators interviewed were unaware of the indicators that the RBF was part of the RMNCAH program at all. The lack of knowledge about the RBF scheme among respondents suggests the possibility that the model did not ultimately have the necessary preconditions to create an effective incentive structure. These results demonstrate the need for improved communication between stakeholders and the importance of sufficiently planning an RBF model before implementation.

Background Universal health coverage is a challenge to horizontal equity in healthcare financing. Since 1998, China has extended its healthcare insurance schemes, and individuals with equal incomes but different attributes such as social status, profession, geographic access to health care, and health conditions, are covered by the same health insurance scheme. This study aims to examine horizontal inequity in the Chinese healthcare financing system in 2002 and 2007 using data from two national household health surveys. Methods Multi-stage stratified random sampling was used to select 3,946 households with 13,619 individuals in 2002, and 3,958 households with 12,973 individuals in 2007. A decomposition method was used to measure the horizontal inequity and reranking in healthcare finance. Results Over the period 2002–2007, the absolute value of horizontal inequity in total healthcare payments decreased from 997.83 percentage points to 199.87 percentage points in urban areas, and increased from 22.28 percentage points to 48.80 percentage points in rural areas. The horizontal inequity in social health insurance remained almost the same in urban areas, at around 27 percentage points, but decreased from 110.90 percentage points to 7.80 percentage points in rural areas. Horizontal inequity in out-of-pocket payments decreased from 178.43 percentage points to 80.96 percentage points in urban areas, and increased from 26.06 percentage points to 41.40 percentage points in rural areas. Conclusion The horizontal inequity of healthcare finance in China over the period 2002–2007 was reduced by general taxation and social insurance, but strongly affected by out-of-pocket payments. Increasing the benefits from social health insurance would help to reduce horizontal inequity.

The Global South nations and their statehoods have presented a driving force of economic and social development through most of the written history of humankind. China and India have been traditionally accounted as the economic powerhouses of the past. In recent decades, we have witnessed reestablishment of the traditional world economic structure as per Agnus Maddison Project data. These profound changes have led to accelerated real GDP growth across many LMICs and emerging countries of the Global South. This evolution had a profound impact on an evolving health financing landscape. This review revealed hidden patterns and explained the driving forces behind the political economy of health spending in these vast world regions. The medical device and pharmaceutical industry play a crucial role in addressing the unmet medical needs of rising middle class citizens across Asia, Latin America, and Africa. Domestic manufacturing has only been partially meeting this ever rising demand for medical services and medicines. The rest was complemented by the participation of multinational pharmaceutical industry, whose focus on investment into East Asia and ASEAN nations remains part of long-term market access strategies. Understanding of the past remains essential for the development of successful health strategies for the present. Political economy has been driving the evolution of health financing landscape since the establishment of early modern health systems in these countries. Fiscal gaps these governments face in diverse ways might be partially overcome with the spreading of cost-effectiveness based decision-making and health technology assessment capacities. The considerable remaining challenges ranging from insufficient reimbursement rates, large out-of-pocket spending, and lengthy lag in the introduction of cutting-edge technologies such as monoclonal antibodies, biosimilars, or targeted oncology agents, might be partially resolved only in the long run.

Since 2017, Population Services International Myanmar (PSI/Myanmar) has been running Strategic Purchasing (SP) clinics in Hlegu and Shwepyithar townships in Yangon, Myanmar. In the project, Population Services International Myanmar simulated the role of a purchaser and contracted SP clinics through a capitation payment scheme. The project aimed to reduce the health-related financial burden of poor populations in the catchment area, by having them registered under respective SP clinics for access to a package of essential health services for a minimal fixed co-payment, as a replacement for usual fee-for-service payments. Four longitudinal surveys of households registered under SP clinics were conducted in 2017, 2018 and 2019. Among 2506 registered households, 867 households sought some health care in all surveys, resulting in 3468 observations. Multivariable linear mixed-effect regression model was used to analyse the changes in out-of-pocket expenditure for health care in relation to household capacity to pay (OOPCTP). The utilization of SP clinics increased over time, and the rates were much higher in Hlegu (20.5% in baseline to 61.9% in round three) compared with those in Shwepyithar (0.2 to 7.9%). Compared with the baseline assessment, household OOPCTP decreased significantly during and after the implementation (0.76 times in round one, 0.80 in round two and 0.82 in round three; P < 0.001). Households in Shwepyithar with less utilization of SP clinics had 1.8 times higher OOPCTP compared with those in Hlegu (1.82, 95% CI 1.58, 2.09; P < 0.001). Household direct expenditures on care-seeking and family planning were up to 50% lower among those who used SP clinics. Our study highlighted that capitation-based health financing schemes could successfully lower out-of-pocket health expenditures among the poor. Optimal utilization of services was paramount in the successful implementation of such programmes. Therefore, for the effective scale-up of new health financing schemes, service utilization rates should be carefully monitored as one of the critical indicators.

Summary Background Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. Methods For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. Findings Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. Interpretation These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. Funding Bill & Melinda Gates Foundation.

Health is one of the major determinants of the overall well-being of a society. The World Health Organization has emphasised the right to health for all, and the universal health coverage is a paradigm of this emphasis with an agenda of nobody to be left behind in the provision of health services without any financial burden by 2030.This article tries to analyse the extent of catastrophic expenditure being incurred by the people despite being sheltered under a financial protection (Health Insurance) in the state of Maharashtra. The impact caused by out-of-pocket (OOP) health expenditure on the economic status of the people in the state is assessed using the National Sample Survey Office’s 71st round conducted by the Ministry of Health and Family Welfare, Government of India. It was found that over 4.18% of the population endured the burden caused by OOP expenditure by falling below the poverty line post health payments. A higher proportion of rural population is observed to have experienced a fall in the economic status from above poverty line (APL) to below poverty line (BPL) due to high OOP expenditure than that of the urban population in Maharashtra.

The Social Health Protection Initiative (SHPI) was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage.To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in SHPI.We used secondary data of availed health services from February 2016 to September 2017 under SHPI. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20.Most beneficiaries chose private over public health facilities (90.25%). The adjusted odds of visiting a public sector health facility for surgical and obstetrics/gynaecological services were 0.12 [95% confidence interval (CI): 0.10-0.16] and 0.11 (95% CI: 0.09-0.14) respectively, when compared to medical services.SHPI beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.اختيار المستفيدين للمرفق الصحي في أدنى فئة اجتماعية واقتصادية من السكان في المخطط الحديث للتمويل الصحي على جانب الطلب في باكستان.سدرة مالك، نافيد صادق، سعيد أنور، عمير قاضي.بدأت مبادرة الحماية الصحية الاجتماعية في باكستان في مقاطعة خيبر بختونخوا. وكانت المبادرة تهدف إلى تزويد أدنى فئة اجتماعية واقتصادية من السكان بخدمات الرعاية الصحية للمرضى الداخليين، التي لولا ذلك لواجهوا صعوبة مالية في الحصول عليها. وهي أحد المشاريع الرئيسية لحكومة المقاطعة للمساهمة في تحقيق أهداف الأمم المتحدة للتنمية المستدامة والتغطية الصحية الشاملة.هدفت هذه الدراسة الى تقييم اختيار المستفيدين المُسجَّلين في المبادرة للمرفق الصحي ومُدِّدات اختيارهم لمرافق القطاع العام الصحية مقابل مرافق القطاع الخاص.استخدمنا بيانات ثانوية بشأن الخدمات الصحية التي قُدِّمت من فبراير/ شباط 2016، حتى سبتمبر/ أيلول 2017، في إطار المبادرة. واستُخدم متغير مخرجات بديل، هو زيارة المرفق الصحي، لتحديد اختيار المستفيد بين المرافق الصحية للقطاعين العام والخاص. واتُّذت مجموعة العلاج (الخدمات الصحية التي تلقاها المستفيدون) متغيرًا مستقلًّ مُضبطًا للفئات العمرية وفئات التكلفة والموقع الجغرافي للمرافق الصحية. وأُجريت جميع التحليلات الإحصائية بالنسخة 20 من برنامج SPSS.فضَّل معظم المستفيدين المرافق الصحية الخاصة على المرافق الصحية العامة (90.25٪). ومع ذلك، بلغت نسبة الأرجحية المُصحَّحة لزيارة مرفق صحي في القطاع العام من أجل الخدمات الجراحية وخدمات أمراض النساء 0.12 [فاصل الثقة 95٪: 0.10-0.16] و 0.11 [فاصل الثقة 95٪: 0.09-0.14) على التوالي، عند مقارنتها بالخدمات الطبية.احتمالات زيارة المستفيدين من مبادرة الحماية الصحية الاجتماعية لمستشفى عام أقل من احتمالات زيارتهم لمستشفى خاص. وقد يتأثر الاختيار بعوامل مثل عمر المستفيد، وتكلفة الخدمات الصحية، والموقع الجغرافي للمرافق الصحية.Choix des établissements de santé par les usagers appartenant au groupe socio-économique le plus bas dans le cadre d’un nouveau programme de financement de la santé axé sur la demande mis en œuvre au Pakistan.L’initiative de protection sociale de la santé (Social Health Protection initiative, SHPI) a été initialement mise en place au Pakistan dans la province de Khyber Pakhtunkhwa. Son objectif était de fournir au groupe socio-économique le plus bas de la population des services des soins hospitaliers, dont l’accès serait autrement financièrement difficile. Il s’agit de l’un des projets phares du gouvernement provincial visant à contribuer à la réalisation des objectifs de développement durable des Nations Unies et à la mise en place de la couverture sanitaire universelle.Évaluer le choix des établissements de santé par les personnes inscrites à l’initiative de protection sociale de la santé et les facteurs qui déterminent ce choix entre les établissements du secteur public et ceux du secteur privé.Nous avons utilisé les données secondaires des services de santé dispensés de février 2016 à septembre 2017 dans le cadre de l’initiative de protection sociale de la santé. Une variable de résultat de substitution – la fréquentation d’un établissement de santé – a été utilisée pour déterminer le choix des usagers entre les établissements de santé des secteurs public et privé. Le groupe de traitement (services de santé dispensés aux bénéficiaires) a été utilisé comme variable indépendante qui a été contrôlée pour les groupes d’âge, les groupes de coûts et l’emplacement géographique des établissements de santé. Toutes les analyses statistiques ont été réalisées à l’aide du logiciel SPSS version 20.La plupart des bénéficiaires ont préféré les établissements de santé privés aux établissements publics (90,25 %). Cependant, les probabilités ajustées de se rendre dans un établissement de santé du secteur public pour des services chirurgicaux et gynécologiques étaient de 0,12 [intervalle de confiance (IC) à 95 % : 0,10 à 0,16] et de 0,11 (IC à 95 % : 0,09 à 0,14) respectivement, par rapport aux services médicaux.Les bénéficiaires de l’initiative de protection sociale de la santé sont moins susceptibles de se rendre dans un hôpital public que dans un hôpital privé. Le choix peut être influencé par des facteurs tels que l’âge du bénéficiaire, le coût des services de santé et l’emplacement géographique des établissements de santé.

Background Expenses related to employee’s health benefit packages are rising. Hence, organisations are looking for complementary health financing arrangements to provide more financial protection for employees. This study aims to develop criteria to choose the most appropriate complementary health insurance company based on the experience of a large organisation in Iran. Methods This study was conducted in 2021 in Iran, in the Foundation of Martyrs and Veterans Affairs to find as many applicable criteria as possible. To develop a comprehensive list of criteria, we used triangulation in data sources, including review of relevant national and international documents, in-depth interviews of key informants, focus group discussion, and examining similar but unpublished checklists used by other organisations in Iran. The list of criteria was prioritised during focus group discussions. We used the best-worst method as a multi-criteria decision making method and a qualitative consensus among the key informants to value the importance of each of the finalised criteria. Findings Out of 85 criteria, we selected 28 criteria to choose an insurer for implementing complementary private health insurance. The finalised criteria were fell into six domains: (i) Previous experience of the applicants; (ii) Communication with clients; (iii) Financial status; (iv) Health care providers’ network; (v) Technical infrastructure and workforce; (vi) and Process of reviewing claims and reimbursement. Conclusion We propose a quantitative decision-making checklist to choose the best complimentary private health insurance provider. We invite colleagues to utilise, adapt, modify, or develop these criteria to suit their organisational needs. This checklist can be applied in any low- and middle-income country where the industry of complementary health insurance is blooming.

Private equity (PE) is increasing its role in healthcare financing and may be a source of strategic funding for orthopaedic practice groups. With acquisitions in other medical specialties such as dermatology and ophthalmology, PE works to increase operating efficiency and cut costs. Orthopaedic practices' access to revenue through ancillary services and ambulatory surgery centers, coupled with a growing, aging cohort, make them an attractive candidate for PE acquisition. However, careful consideration is warranted before surgeons enter these partnerships to ensure patient safety, and the quality of care is not compromised because PE works to increase the return on their investment.

PurposeThe purpose of this study is to first assess how the US healthcare financing system is influenced by income variation. Then, it examines whether or not the impact of income variation is asymmetric.Design/methodology/approachFor the analyses of this paper, the autoregressive distributed lag (ARDL) model is implemented to a data set covering the period from 1960 to 2018.FindingsThe results provide evidence that major funding sources of aggregate healthcare expenditure (HCE) respond differently to changes in income. The results also imply that the effect of income is not always symmetric.Originality/valueMany studies have attempted to identify the relationship between income and HCE. A common feature of past studies is that they have only focused on aggregate HCE, while one might be interested in knowing how major funders of aggregate HCE would be affected by changes in income. Another common feature of past studies is that they have assumed that the relationship between income and HCE is symmetric.

Well-functioning purchasing arrangements allocate pooled funds to health providers, and are expected to deliver efficient, effective, quality, equitable and responsive health services and advance progress toward universal health coverage (UHC). This paper explores how improvements in purchasing functions in three Nigerian schemes-the Formal Sector Social Health Insurance Program (FSSHIP), the Saving One Million Lives Program for Results (SOML PforR), and Enugu State's Free Maternal and Child Health Program (FMCHP)-may have contributed to better resource allocation, incentives for performance, greater accountability and improved service delivery. The paper uses a case-study approach, with data analyzed using the Strategic Health Purchasing Progress Tracking Framework. Data were collected through review of program documents and published research articles, and semi-structured interviews of 33 key informant interviews. Findings were triangulated within each case study across the multiple sources of information. Improvements in benefits specification and provider payment contributed to some service delivery improvements in all three schemes: higher satisfaction with the quality of care in FSSHIP; increased use of insecticide-treated nets; greater prevention of mother-to-child HIV transmission; expanded pentavalent-3 coverage in SOML PforR; and greater service utilization in FMCHP. Resource allocation to public health facilities was enhanced and lines of accountability were better defined. These scheme-level improvements have not translated to system change, because of the small amount of funding flowing through these schemes and the high level of health financing fragmentation. The institutionalization of strategic purchasing in Nigeria to advance UHC will require raising awareness among decision makers, strengthening purchasing agencies' capacity, and reducing fragmentation.

Background Financial risk protection and equity are two fundamental components of the global commitment to achieve Universal Health Coverage (UHC), which mandates health system reform based on population needs, disease incidence, and economic burden to ensure that everyone has access to health services without any financial hardship. We estimated disease-specific incidences of catastrophic out-of-pocket health expenditure and distress financing to investigate progress toward UHC financial risk indicators and investigated inequalities in financial risk protection indicators by wealth quintiles. In addition, we explored the determinants of financial hardship indicators as a result of hospitalization costs. Methods In order to conduct this research, data were extracted from the latest Bangladesh Household Income and Expenditure Survey (HIES), conducted by the Bangladesh Bureau of Statistics in 2016–2017. Financial hardship indicators in UHC were measured by catastrophic health expenditure and distress financing (sale/mortgage, borrowing, and family support). Concentration curves (CC) and indices (CI) were estimated to measure the pattern and severity of inequalities across socio-economic classes. Binary logistic regression models were used to assess the determinants of catastrophic health expenditure and distress financing. Results We found that about 26% of households incurred catastrophic health expenditure (CHE) and 58% faced distress financing on hospitalization in Bangladesh. The highest incidence of CHE was for cancer (50%), followed by liver diseases (49.2%), and paralysis (43.6%). The financial hardship indicators in terms of CHE (CI = -0.109) and distress financing (CI = -0.087) were more concentrated among low-income households. Hospital admission to private health facilities, non-communicable diseases, and the presence of chronic patients in households significantly increases the likelihood of higher UHC financial hardship indicators. Conclusions The study findings strongly suggest the need for national-level social health security schemes with a particular focus on low-income households, since we identified greater inequalities between low- and high-income households in UHC financial hardship indicators. Regulating the private sector and implementing subsidized healthcare programmes for diseases with high treatment costs, such as cancer, heart disease, liver disease, and kidney disease are also expected to be effective to protect households from financial hardship. Finally, in order to reduce reliance on OOPE, the government should consider increasing its allocations to the health sector.

Background Zambia has invested in several healthcare financing reforms aimed at achieving universal access to health services. Several evaluations have investigated the effects of these reforms on the utilization of health services. However, only one study has assessed the distributional incidence of health spending across different socioeconomic groups, but without differentiating between public and overall health spending and between curative and maternal health services. Our study aims to fill this gap by undertaking a quasi-longitudinal benefit incidence analysis of public and overall health spending between 2006 and 2014. Methods We conducted a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies at three time points. We combined data from household surveys and National Health Accounts. Results Results showed that public (concentration index of − 0.003; SE 0.027 in 2006 and − 0.207; SE 0.011 in 2014) and overall (0.050; SE 0.033 in 2006 and − 0.169; SE 0.011 in 2014) health spending on curative services tended to benefit the poorer segments of the population while public (0.241; SE 0.018 in 2007 and 0.120; SE 0.007 in 2014) and overall health spending (0.051; SE 0.022 in 2007 and 0.116; SE 0.007 in 2014) on institutional delivery tended to benefit the least-poor. Higher inequalities were observed at higher care levels for both curative and institutional delivery services. Conclusion Our findings suggest that the implementation of UHC policies in Zambia led to a reduction in socioeconomic inequality in health spending, particularly at health centres and for curative care. Further action is needed to address existing barriers for the poor to benefit from health spending on curative services and at higher levels of care.

This article assesses the impact of the HIV and COVID-19 pandemics and debt dynamics on health, HIV and pandemic preparedness and response-related financing in developing countries. Using a novel dataset, we did a cross-national systematic analysis of all data sources available for government expenditures on health, HIV, COVID-19 and debt servicing in selected developing countries. We found an inadequate multilateral response with the ensuing gaps allowing both pandemics to thrive. The G20 Debt Service Suspension Initiative and the Common Framework only covered countries with a third of the global population of people living with HIV. Rising and unsustainable debt levels are limiting the capacity of governments to protect the health of their populations. Government spending is already falling in response to high debt payments. Specifically, debt servicing is crowding out lifesaving investments. In 2020, for every USD 5 available, USD 4 was spent on debt servicing. Only USD 1 was invested in health. This is a binding constraint on countries’ efforts to control COVID-19. Even with a gargantuan effort to increase health expenditure, the outlook for health financing remains negative. Fiscal consolidation, with a heavy emphasis on expenditure cuts, is expected to take place across 139 countries in the coming years. These findings suggest that fiscal policymakers should be concerned about the crowding-out and constraining effects of public debt. To this end, pragmatic recommendations are made to treat and cancel debt as a critical policy lever to accelerate the end of the HIV and COVID-19 pandemics in developing countries as a key condition to addressing the growing inequalities and to ensure debt can be a benefit, not a burden.

With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are (early) signs of a shift towards more preventive therapies and policies of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care. Current health information systems only collect very few indicators on oral health and oral health care. An improved evidence base would allow more meaningful assessments and comparisons of oral health systems performance. This in turn would allow better informed policy decisions and enable better targeted and more effective oral health interventions.

The widening gap between improving healthcare coverage rates and stagnating health outcomes across low-income and middle-income countries highlights the need for investments in quality of care, in addition to access. New research, presented in a World Bank report, examines one type of relevant policy reform: performance-based financing (PBF), which is a package reform that always includes performance pay to front-line health workers and often also provides facility autonomy, transparency and community engagement. A large body of rigorous studies and new analysis show that in under-resourced, centralised health systems, PBF can result in gains to service utilisation, but only has limited impacts on quality. Even the relative benefits of PBF on service utilisation are less clear when compared with (1) direct facility financing which provides front-line facilities with operating budgets and provider autonomy, but not performance pay and (2) demand-side financial support for health services (ie, conditional cash transfers and vouchers). Thus, the central component of PBF—the performance pay—appears to add little value over flexible payment systems and provider autonomy. The analysis shows that this lack of impact is unsurprising because most of the constraints to improving quality do not lie with the health worker in these settings. While PBF was conceived as a complex package ‘blueprint’, we review the evidence to conclude that only some elements seem to make sense. To improve quality of care, health financing should pivot from performance pay while retaining the elements of direct facility financing, autonomy, transparency and community engagement.

For Nigeria to make progress on its commitment to universal health coverage, additional public funding will be required. But more resources alone will not be enough. Government health spending must be more efficient and effective, through more strategic purchasing-a critical policy tool. Studies on health purchasing in Nigeria's health financing schemes are limited, however. This study examines the purchasing arrangements in schemes funded by the federal budget and in the Formal Sector Social Health Insurance Programme (FSSHIP) within the National Health Insurance Scheme. We adopted a qualitative, descriptive case-study approach and collected data through document reviews and key informant interviews based on the Strategic Health Purchasing Progress Tracking Framework. Our analysis used a thematic framework approach. Our findings reveal that legal frameworks and governance structures for strategic purchasing are in place for both schemes. Steps toward strategic purchasing are more advanced in FSSHIP, particularly in the design of benefit packages, accreditation and monitoring of health maintenance organizations (HMOs) and providers, and provider payment mechanisms. The limited share of health funding flowing through these mechanisms, and further fragmentation of that funding, impede strategic purchasing. Strategic purchasing is also hampered by weak regulation and monitoring of providers and purchasers, delays in provider payment, and corrupt practices by HMOs. Improving strategic purchasing in Nigeria will require a concerted effort to reduce fragmentation of health spending, significant investment in human resources, technical know-how, and information systems of purchasing institutions, and actions to improve the accountability of all actors in the system.

Many countries in sub-Saharan Africa have implemented performance-based financing (PBF) to improve health system performance. Much of the debate and analysis relating to PBF has focused on whether PBF "works"-that is, whether it leads to improvements in indicators tied to incentive-based payments. Because PBF schemes embody key elements of strategic health purchasing, this study examines the question of whether and how PBF programs in sub-Saharan Africa influence strategic purchasing more broadly within country health financing arrangements. We searched PubMed, Scopus, EconLit, Cochrane Database of Systematic Reviews, Google Scholar, Google, and the World Health Organization and World Bank's repositories for studies that focused on the implementation experience or effects of PBF in sub-Saharan African and published in English from 2000 to 2020. We identified 44 papers and used framework analysis to analyze the data and generate key findings. The evidence we reviewed shows that PBF has the potential to raise awareness about strategic purchasing, improve governance and institutional arrangements, and strengthen strategic purchasing functions. However, these effects are minimal in practice because PBF has been introduced as narrow, often pilot, projects that run parallel to and have little integration with the mainstream health financing system. We concluded that PBF has not systematically transformed health purchasing in countries in sub-Saharan Africa but that the experience with PBF can provide valuable lessons for how system-wide strategic purchasing can be implemented most effectively in that region-either in countries that currently have PBF schemes and aim to integrate them into broader purchasing systems, or in countries that are not currently implementing PBF. We also concluded that for countries to pursue more holistic approaches to strategic health purchasing and achieve better health outcomes, they need to implement health financing reforms within or aligned with existing financing systems.

A major theoretical issue about health system reform involving decentralization has been whether it promotes equity of health system funding. An article by the principal author and others in 2003 showed that, under certain conditions and policies, decentralization improved the equity of allocation of financial resources to different income levels of municipalities in Colombia and Chile. Another recurring issue has been whether reforms can be sustained over time. In a follow-up study in 2015, we found that the equity of national allocations was sustained even though the allocation rules for intergovernmental transfers and insurance funding sources had changed, as long as

Economist Peter Heller, writing a seminal paper published in Health, Policy and Planning in 2006, identified five opportunities for expanding fiscal space for health: raising revenue, reprioritizing expenditure, borrowing, using seigniorage and mobilizing external grants. The development of the initial framework marked a significant conceptual advancement in health financing, by situating health reforms within a broader macro-fiscal context. Fifteen years later, fiscal space for health is not viewed simply as a question of finding additional revenues but also as a matter of improving public financial management (PFM) in the health sector, specifically for publicly funded health systems. This paper advances the concept of budgetary space for health, which explores available resources generated through greater overall public expenditure, prioritized budget allocations, and improved PFM. The paper adds a critical component, unpacking the ways through which PFM improvements can maximize budgetary space for health. The approach fits the realities of public finances in the era of the Sustainable Development Goals. The key implication is that PFM aspects should be systematically included in assessments of budgetary space to inform more effective country dialogues between the finance and health sectors.

In India, most healthcare expenses are patients' out-of-pocket payments to private sector providers. Catastrophic health expenditures drive millions of families deeper into poverty. To save poorer households, hundreds of government-funded health insurance schemes have been introduced since the 2000s. These "demand side" schemes suggest that treatments in the private sector will be fully reimbursed. Fieldwork in one of India's largest hospitals shows that GFHIs overpromise. GFHIs are designed to turn patients into co-creators of healthcare value, but instead they deepen individuals' lack of market transparency. Poor patients pay the price for the state's lack of trust in them.

Összefoglaló. Bevezetés: A csípőtáji törések jelentősen terhelik az egészségügyi ellátórendszereket. Magyarországon 13 000–15 000 beteg szenved évente csípőtáji törést, jelentős részük műtéten is átesik. A betegek túlélését vizsgálták a EuroHOPE és BRIDGE kutatások, amelyek a Nemzeti Egészségbiztosítási Alapkezelőnek a finanszírozási célból gyűjtött, esetszintű adataira támaszkodtak. Az ilyen jellegű adatok megbízhatóságát több kutatás vizsgálta eltérő eredményekkel, ezért a további vizsgálatok előtt szükségesnek tartottuk a csípőtáji törésekre vonatkozóan is ellenőrizni őket. Célkitűzés: Egy magyarországi kórház reprezentatívan kiválasztott eseteinek vizsgálatán keresztül annak megállapítása, hogy a finanszírozási adatbázis adatai megfelelnek-e a betegdokumentációban rögzített adatoknak. Módszer: Egy magyarországi kórházba 2015-ben csípőtáji töréssel felvett betegek kórlapjainak anonim, reprezentatív mintáját összevetettük a EuroHOPE és BRIDGE kutatások adatbázisával tíz különböző adatelemre vonatkozóan. Az adatbázisokat rekordszinten párosítottuk, az egyezést adatelemre és rekordra vonatkozóan néztük. Eredmények: A reprezentatív minta 259 esetet tartalmazott. Az adatbázisok összevetése során nem találtunk eltérést a beteg neme, életkora, ápolást indokló fődiagnózisa és az osztályról történő távozás dátuma esetén. Egy eltérést találtunk az osztályos felvétel dátumában, a műtét dátumában öt darabot. A beteg további sorsa esetén tíz eltérést találtunk. A műtéttípusok esetén is alacsony mértékű (2–4 eset) eltérést tapasztaltunk. Jelentős mértékű eltérést a társbetegségek és a szövődmények esetén találtunk. Következtetés: Eredményeink alapján további vizsgálatokhoz felhasználhatók az alfanumerikus kódokat, számokat vagy dátumokat tartalmazó mezők (például fődiagnózis, felvételi és távozási dátumok), a társbetegségekre és a szövődményekre vonatkozó adatok azonban nem alkalmazhatók mélyebb elemzések során. Orv Hetil. 2021; 162(18): 712–719. Summary. Introduction: Hip fractures pose a heavy burden on healthcare systems. In Hungary, 13 000–15 000 patients experience hip fractures, most of them undergo surgery. Their survival was examined by the EuroHOPE and BRIDGE studies, using patient level data from the National Health Insurance Fund. Data from healthcare financing reports have been examined worldwide, with contradicting results, so we considered it necessary to observe data validity for hip fractures before further analysis. Objective: The aim of our study was to observe a representative sample of patient records in a Hungarian hospital in order to validate the finance reports. Method: We matched a representative sample of hip fracture patient records in a Hungarian hospital with hip fractures in 2015 with the database of the EuroHOPE and BRIDGE studies. The databases were matched on record level, the analysis included ten data fields and was conducted for data fields and records. Results: The sample included 259 cases. No differences were observed in the patients’ gender, age and main diagnosis, or dates of discharge. One difference was observed in the dates of admission, and 5 in the dates of surgery. Minor differences were found in the types of surgery (2–4 cases), but the differences between the databases in comorbidities and complications were large. Conclusion: Based on our results, we can conclude that data fields containing alphanumeric codes, numbers or dates (e.g., main diagnosis, admission, discharge and surgery dates) can be used for further analysis, but comorbidity and complication data are not recommended for research purposes. Orv Hetil. 2021; 162(18): 712–719.

Background Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households. Methods We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment. Results The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment. Conclusion The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.

Objectives. To understand whether and how crowdfunding campaigns are a source of COVID-19–related misinformation. Methods. We searched the GoFundMe crowdfunding platform using 172 terms associated with medical misinformation about COVID-19 prophylaxes and treatments. We screened resulting campaigns for those making statements about the ability of these searched-for or related terms to prevent or treat COVID-19. Results. There were 208 campaigns worldwide that requested $21 475 568, raised $324 305 from 4367 donors, and were shared 24 158 times. The most discussed interventions were dietary supplements and purported immune system boosters (n = 231), followed by other forms of complementary and alternative medicine (n = 24), and unproven medical interventions (n = 15). Most (82.2%) of the campaigns made definitive efficacy claims. Conclusions. Campaigners focused their efforts on dietary supplements and immune system boosters. Campaigns for purported COVID-19 treatments are particularly concerning, but purported prophylaxes could also distract from known effective preventative approaches. GoFundMe should join other online and social media platforms to actively restrict campaigns that spread misinformation about COVID-19 or seek to better inform campaigners about evidence-based prophylaxes and treatments.

OBJECTIVES To explore contextual factors associated with overall dental service use, and investigate whether these factors influenced choice of the type of service according to the healthcare financing alternatives (public services; out-of-pocket services; and private health insurance), by adults and older individuals, based on the most recent Andersen's behavioural model. METHODS Cross-sectional study with individual data on 17,305 adults from 177 Brazilian municipalities in the National Oral Health Survey (SBBrasil 2010). Municipal-level information was obtained from health information systems and census data. Multilevel multinomial logistic regression was carried out for multivariable analysis. RESULTS In the previous year, 38.2% of the individuals visited the dentist; of which 21.4% used out-of-pocket spending, 11.6% used public services and 5.2% private dental insurance. Municipalities with population coverage of public primary dental care >80% had higher chances of using public services (OR = 1.28, 95%CI:1.00-1.64) than those with ≤60%, but lower chances of using private insurance (OR = 0.56, 95%CI:0.38-0.83). Municipalities with population coverage of private dental insurance > 5% had lower chances of using public services (OR = 0.62, 95%CI:0.47-0.81) than those with

In this paper we adopt a growth accounting projection model to estimate and characterize health-financing needs in Brazil as well as to assess the extent to which financing needs may diverge from spending capacity in the future. We estimate an annual increase of 0.71% in the share of projected financing needs relative to GDP, with excess growth rates being 0.74% and 0.69% for the public and private health sectors, respectively. Institutional reforms and public spending restrictions may leverage public-private segmentation in health financing throughout the next decades, thus potentially leading to losses of equity in the system. Our projections contribute to a scant empirical literature on health financing sustainability in low- and middle-income countries and shed light on the role of spending capacity and institutional constraints over the path towards universal health coverage.

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that significantly impairs quality of life. There are high direct and indirect financial burdens associated with HS, which may compel patients to turn to online crowdfunding for assistance covering HS-related costs. Crowdfunding is the financing of a specific initiative by pooling many smaller donations from numerous individuals, and has previously been used to fund dermatologic care.

The aim:to conduct a comparative analysis of the dynamics of health expenditures from GDP, cash expenditures of families and public expenditures on health in Ukraine, Poland and the countries of the WHO European Region. Materials and methods. The object of the research was the data of the WHO European Office. Historical, analytical-comparative, systemic, logical, graphic, mathematical-statistical and other research methods were used. Research results. It was found that all indicators of the analysis in Ukraine had an unstable character of changes in the years dynamics. Since 1995, Poland and European countries have seen a systematic increase in total health spending (%) of the country's GDP. The indicator of out-of-pocket expenses of families on medical and pharmaceutical support in Ukraine was significantly higher than in Poland and European countries, and its average values in Ukraine were 1.5 times higher than in Poland. In 2014, this indicator reached its maximum (46.2 %) against the background of an increase in government spending (%) of total health spending (from 11.9 % to 12.7 %). In 2014, this indicator exceeded similar values in Poland by 2.0 times and 1.7 times in European countries. In contrast, in Poland, the out-of-pocket expenses of families on medical and pharmaceutical support have been steadily decreasing from 30.0 % to 22.1 %, and since 2010 they have been lower than in European countries. According to government spending as a percentage of total health spending in Europe and Poland, there was a trend towards a gradual increase from 11.0 % to 13.2 % (European countries) and from 8.2 % to 10.7 % (Poland). The corresponding Ukrainian data were higher than in Poland and lower than in European countries (from 10.8 % to 11.4 %). Against the background of the unstable nature of the dynamics of changes in indicators characterizing the participation of the state in financing health care in Ukraine, since 2005, there has been an increase in the cash expenditures of Ukrainian families for relevant needs. As a result of systemic transformations in Poland, on the threshold of its accession to the EU (May 1, 2004), since 2005, there has been a decrease in the out-of-pocket expenditures of families against the background of a slight increase in % of public spending on health care. Conclusions.The unstable nature of the dynamics of changes in domestic indicators, in comparison with similar data that was observed in Poland and the countries of the WHO European Region, suggests the need to introduce more decisive actions, which should lead to a reformatting of the role of the state in financing the health system

Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare – universality and accessibility – as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.

Objective The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report "For the Public's Health: Investing in a Healthier Future." Design Qualitative study involving key informant interviews. Setting and participants Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report. Main outcome measures Qualitative feedback about changes to public health finance since the report. Results Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow. Conclusions Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level. Implications for policy and practice Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.

Health prepayment, a key indicator under the Sustainable Development Goals monitoring framework, is strongly associated with household financial protection; however, the impact of government health budget on the level of prepayment has rarely been discussed.To address the following research questions. (1) Does a higher government health budget translate into higher prepayment rates in the healthcare financing system? (2) What are the effects of government health budget on public prepayment and private prepaid plans? (3) What are the heterogeneities between groups of countries with different income levels and public health prepayment systems?Analysis of panel co-integration, impulse response function, and variance decomposition were conducted in 34 Organisation for Economic Co-operation and Development (OECD) members for the period 1995-2016.Government health budget has a long-running equilibrium relationship with the level of public and total prepayment. However, a stable relationship could not be confirmed with private prepaid plans. Moreover, government health budget played a significant positive role in explaining the fluctuations in the total and public prepayments over a long time, that is, 51 and 37 periods, respectively. Considering differences between groups of countries, the impacts are greater for those with higher income levels and more public-dominated health-financing systems.Government health budget has a long-time relationship with the levels of both total prepaid expenditure and public prepayment. By contrast, it does not systematically crowd out private prepaid plans.أثر الميزانية الحكومية على مستويات الدفع المسبق في مجال الصحة: دلائل مستمدة من بلدان منظمة التعاون والتنمية في الميدان الاقتصادي.ينج تشانج، جاك فانيست، وينكينج بان، ليوي تشانج.يرتبط الدفع المسبق للحصول على الخدمات الصحية، وهو مؤشر رئيسي في إطار رصد أهداف التنمية المستدامة، بصورة وثيقة بالحماية المالية للأسر؛ غير أنه من النادر أن تجري مناقشة تأثير الميزانية الحكومية للصحة على مستويات الدفع المسبق.هدفت هذه الدراسة إلى الرد على الأسئلة البحثية التالية: (1) هل يُترجَم ارتفاع مخصصات الميزانية الحكومية للصحة إلى ارتفاع معدلات الدفع المسبق في نظام تمويل الرعاية الصحية؟ (2) ما هي آثار الميزانية الحكومية للصحة على خطط الدفع المسبق العامة وخطط الدفع المسبق الخاصة؟ (3) ما هي أوجه التفاوت بين مجموعات البلدان المختلفة من حيث مستويات الدخل ونُظُم الدفع المسبق في مجال الصحة العامة؟.أجري تحليل تآلف المجموعة، ووظيفة الاستجابة الاندفاعية، وتحليل التفكك التبايني في 34 عضواً في منظمة التعاون والتنمية في الميدان الاقتصادي خلال الفترة من 1995 وحتى 2016.هناك علاقة طويلة الأمد ومتوازنة بين الميزانية الحكومية للصحة ومستوى الدفع المسبق العام وإجمالي الدفع المسبق. ومع ذلك، لم يتسن تأكيد وجود علاقة مستقرة مع خطط الدفع المسبق الخاصة. وعلاوة على ذلك، فقد أدت الميزانية الحكومية للصحة دوراً إيجابياً هاماً في تفسير التقلبات في إجمالي الدفع المسبق والدفع المسبق العام على مدى فترة طويلة بلغت 51 و 37 دورة على التوالي. وبالنظر إلى الاختلافات بين مجموعات البلدان، فإن الآثار المترتبة تكتسي أهمية أكبر بالنسبة للبلدان التي لديها مستويات دخل أعلى ونُظُم تمويل صحي يهيمن عليها القطاع العام أكثر من أي قطاع آخر.هناك علاقة ممتدة بين الميزانية الحكومية للصحة ومستويات إجمالي الإنفاق المدفوع مقدماً والدفع المسبق العام على حد سواء. وعلى العكس من ذلك، فإن الميزانية الحكومية لا تتنافس مع خطط الدفع المسبق الخاصة.Impact du budget de l’État sur les niveaux de prépaiement pour les soins de santé : données probantes des pays membres de l’OCDE.Le prépaiement pour les soins de santé, un indicateur clé du cadre de suivi des objectifs de développement durable, est fortement associé à la protection financière des ménages ; toutefois, l’impact du budget public de la santé sur le niveau de prépaiement a rarement été examiné.Répondre aux questions de recherche suivantes. 1) Une augmentation du budget public de la santé se traduitelle par des taux de prépaiement plus élevés dans le système de financement des soins de santé ? 2) Quels sont les effets du budget public de la santé sur le prépaiement public et les systèmes privés de prépaiement ? 3) Quelles sont les hétérogénéités entre les groupes de pays ayant des niveaux de revenu et des systèmes de prépaiement de santé différents ?Pour la période 1995-2016, 34 membres de l'Organisation de coopération et de développement économiques (OCDE) ont procédé à une analyse de la co-intégration des panels, de la fonction de réponse impulsive et de la décomposition des variances.Le budget public de la santé est depuis longtemps en équilibre avec le niveau des prépaiements publics et totaux. Cependant, une relation stable n'a pas pu être confirmée avec les systèmes privés de prépaiement. En outre, le budget de la santé a joué un rôle positif important en expliquant les fluctuations de l’ensemble des prépaiements et des prépaiements publics sur une longue période, c'est-à-dire 51 et 37 périodes, respectivement. Compte tenu des différences entre groupes de pays, les impacts sont plus importants pour ceux dont les niveaux de revenu sont plus élevés et dont les systèmes de financement de la santé sont plus à dominante publique.Le budget public de la santé est lié depuis longtemps aux niveaux du total des dépenses prépayées et des prépaiements publics. En revanche, il ne permet pas de supplanter systématiquement les systèmes privés de prépaiement.

This article explores longitudinal trends of healthcare financing and mortality levels among the children under 5 (U5) years of age in the BRICS nations between 2000 and 2015. This analysis is based on the relevant secondary data obtained from the WHO data repository and various other publicly available sources. Inferential statistical tools like linear regression analysis was carried out to test the relationship between dependent and independent variables. The results indicate an inverse relationship between current health expenditure and U5 child deaths, revealing a decline of 29,000 U5 child deaths and 19,000 infant deaths for every US$1increase in per capita healthcare expenditure. Further, neonatal deaths declined by 1.74% and infant deaths 2.8%, while U5 child deaths declined by 4.6% per annum. India spends lowest among the BRICS nations—about US$63 per capita, while out-of-pocket expenditure (OOPE) is highest at 69.3%. Countries with higher per capita government health expenditure have better health indicators. This article, therefore, calls for strengthening public investment in healthcare to improve health outcomes.