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The Constitution of Kenya provides that most functions of the state are decentralized in a devolution process. The devolved health system is four tiered: community health services, primary care services, county referral services, and national referral services. However, even though roles and responsibilities are elaborately outlined, in practice the transition from national to county governments has been marred by inconsistency, poor understanding of the system, management challenges, and lack of coordination between the national and county governments. This policy note provides observations from a pilot that tested integration of social accountability mechanisms in healthcare delivery in Kenya between 2011 and 2013.

This article examines rationales for public intervention in health insurance markets from the perspective of public economics. It draws on the literature of organizational design to examine alternative public intervention strategies, including issues of contracting, purchaser provider splits, and regulation of competition. Health insurance reforms in four Latin American countries are then considered in light of the insights provided by the theoretical literature. Health care expenses and lost labor earnings due to illness—not to mention the direct effects of feeling lousy and dying young—represent a major source of risk for individuals and families. Exposure to such risks is costly in itself (if individuals are risk averse), but can also have long-term effects, especially on the poor. Selling assets, withdrawing children from school to care for ill parents, and exiting the labor market can leave low-income families trapped in poverty. This article addresses the role of government in spreading and reducing health risks with particular emphasis on the design and organization of the relevant institutions in Latin America. Faced with wide disparities in both health needs and access to medical care across regions and income groups, and with continuing pressures on public finances arising from the macroeconomic crises of the 1980s and 1990s, a number of countries in the region have adopted wide-ranging health sector reforms that continue today (Greene, Zevallos, and Suarez 1999). Generally, among the higher-income countries, there has been a move toward extending explicit insurance coverage to those outside the formal labor market. At the same time, these countries have examined the ways in which insurance and health care have been delivered and have instituted reforms that are meant to improve allocative and production efficiency in the sector. Lower-income countries in the region have not proceeded as far in terms of explicit health insurance reform, which requires a certain administrative capacity, and have tended to concentrate on running public hospitals and clinics better.

The plan nacer program was designed by the Argentine ministry of health to provide health coverage to uninsured women during their pregnancies and for an additional 45 days after giving birth, as well as to children under the age of six. In doing so, it focuses on the most vulnerable populations, addressing a basic inequity in health care. In addition, the program includes three main distinctive features: an explicit menu of health benefits, disbursements linked to achieving agreed-upon targets of enrollment and health results, and audits conducted by an independent external firm to corroborate service delivery and quality. The plan is an innovative way to strengthen health systems. Rather than simply funding more facilities and inputs or adjusting existing insurance mechanisms neither of which have been successful in dealing with the health problems of the poor, the Argentine ministry of health realized that improvements to quality and coverage of health services for the uninsured would require drastic operational changes. To do so, it decided to introduce performance incentives at all levels and to focus on results.

Jamaica is a Caribbean country that has initiated comprehensive programs to address Non-Communicable Diseases (NCDs). The government created the National Health Fund (NHF) to reduce the cost of treatment of NCDs and finance some prevention programs. The main objective of this study is to learn from Jamaica's experience in tackling major NCDs and related risk factors, to provide policy options for Jamaica to improve its NCD programs and to share with other countries the lessons learned from its experience. The study attempts to answer three questions: a) whether the NHF and its drug subsidy program have reduced out-of-pocket spending on NCDs; b) whether access to treatment of NCDs has improved; and c) what the economic burden on NCD patients and their families is. The report presents an overall picture of the epidemiological and demographic transitions in Jamaica, its current burden of NCDs, and the change in the trend of NCDs in the past decade, using publicly available data, particularly data from the Jamaica living condition household surveys. It assesses the risk factors and analyzes Jamaica's response to NCDs with emphasis on the impact of the NHF on people's lives. Estimates of the economic burden of NCDs are provided and policy options to improve Jamaica's NCD programs are suggested. This study focuses on Jamaica's experience in addressing major NCDs and their related risk factors with the objective of learning from Jamaica and providing policy options to Jamaica to improve its programs.

As gains in basic health care increase life expectancy, more people live past the age of 65, a time when the risk of dementia and other degenerative diseases is higher and people are more likely to require long-term care (LTC) services. Whether at home or in an institution, such care is an important way to protect the lives and dignity of a country's elderly citizens. Unfortunately, the cost of LTC, especially in institutions, can be catastrophic for families. Without public social protection systems many people cannot afford the care they need or the high cost of care sends them and their families into poverty. Thus, LTC is not only a health issue, but also a fiscal issue and as the European population ages, it is crucial for states to develop comprehensive LTC systems that address this interrelated issue. The next section explores the demographic background of the Bulgarian population, which is one of the fastest aging in Europe. This is followed by s short-description of the macro-economic and fiscal framework in post-crisis Bulgaria. Next, an overview of LTC service provisions is given, followed by a section on financing of LTC services. The last section concludes by introducing some guiding principles for future policy reforms.