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In developing a proposal for the study of the effect of user fees on access to preventive care, a team, comprising researchers and policy-makers, initiated interaction with key policy implementers in the Jamaica's Ministry of Health to ensure that their perspectives were considered at the preliminary stage. There were many pressing events occupying the minds and energies of the implementers, but the team was able to capitalize on existing good relationships to capture attention. In the interviews that followed, agreement was reached on the necessity for the study, its focus and methodology. The process of consultation achieved notable successes and can be regarded as a model for successful research and policy interaction. Diante da proposta de cobrança aos usuários de atendimentos preventivos (defendida pelos implementadores de políticas-chave do Ministério da Saúde da Jamaica), uma equipe de pesquisadores e formuladores de políticas apresentou um projeto de pesquisa visando a estudar os efeitos dessa cobrança de honorários pagos diretamente, e solicitaram ainda que os achados do estudo fossem considerados nesta fase preliminar. Embora a agenda do Ministério da Saúde fosse permeada de muitas questões prementes, a equipe de pesquisa conseguiu potencializar as relações produtivas preexistentes e garantir espaço na agenda do Ministério da Saúde. As negociações levaram a um consenso sobre a necessidade do estudo, seu enfoque e metodologia. O processo de consulta alcançou sucessos notáveis e pode ser considerado um modelo para a interação bem-sucedida entre pesquisa e política.

This study presents findings from\ud evaluating, ex ante, the options, implications and\ud feasibility\ud of a major\ud health financing\ud policy change from a largely tax-based to a\ud principles.\ud system following universal national\ud health insurance (NHI) The case country used is Jamaica a small middle-income country faced with\ud contribution-based\ud fiscal\ud and health financing constraints and prodded into the policy choice of\ud persistent NHI in 1996\ud by recommendations of consultants, international organizations as well as the opportunity provided by its externally funded Health Reform Programme (1997-2005).\ud The\ud approach adopted was to define NHI options by commencing with government's\ud in its 1997 Green Paper on NH! as the baseline; ascertaining from local\ud proposals stakeholderstheir recommendationsfor an NHI plan and eliciting lessonsand\ud design variables from the international experiencewith NHI-type systemsto derive a prototype.\ud This\ud was followed by financial modelling of likely inflows and outflows in each option;\ud assessmentof their merits and viability using criteria such as population coverage,\ud benefits, risk pooling, equity, efficiency, and size of contributions by government; and ranking of scoresto derive a preferred option.\ud workers\ud and\ud As an ex ante analysis (since NHI has not been implemented in Jamaica), the the prototype to be the highest ranked option. It also found that\ud found continuing\ud study macroeconomic difficulties, institutional weaknesses and likely opposition from\ud key\ud stakeholders - factors which affected confidence and derailed the 1997 NHI\ud some proposals\ud for In terms of overall significance, the study highlights international\ud -\ud would\ud still\ud pose major challenges\ud decision\ud makers\ud and planners. ambivalence over\ud design benefit\ud aspects of NHI such as single package and timing of universal coverage. For implementing NHI in Jamaica,it\ud vs. suggestsareas for further research and action such as specifying and phasing benefits;\ud improving aswell asachieving\ud collection systems, quality of health services and targeting stakeholder consensus.