Implementing Health Financing Reform

Analyses the experience with the financing reforms implemented by the countries of Central Europe, Eastern Europe, the Cauxasus and Central Asia.

Since 1990 the social and economic policies of the transition countries of central and eastern Europe the Caucasus and central Asia have diverged including the way they have reformed the financing of their health systems. This book analyses this rich experience in a systematic way. It reviews the background to health financing systems and reform in these countries starting with the legacy of the systems in the USSR and central and eastern Europe before 1990 and the consequences (particularly fiscal) of the transition for their organization and performance. Using in-depth country case experienc.

In 2015, the government of Ukraine initiated transformative reforms of its health system with the goals of improving the health outcomes of the population and providing financial protection from excessive out-of-pocket health care payments. This was to be implemented through modernizing and integrating the service delivery system, introducing changes to provider payment arrangements that incentivize efficiency, and improving the quality of care. It culminated in the passage of a new health financing law--the Law on Financial Guarantees for Health Care Services 2017--which established a health benefit package called the Program of Medical Guarantees (PMG), and also created the National Health Services of Ukraine (NHSU) to serve as strategic purchaser for this program. A joint World Health Organization--World Bank review of the early reforms was published in 2019 that took stock of reform progress since 2017. Two years later, implementation of the health financing reforms has progressed substantially, and it is time to again review where things stand and what the future directions should be. There have been many important accomplishments over the past two years, both in terms of institutional reform and expansion in access to care. The COVID-19 pandemic precipitated adjustments to existing health financing levels and arrangements. At the same time, the pandemic delayed implementation of some aspects of the health financing reforms, such as the anticipated transition to case-based payments. This report provides a comprehensive description and assessment of the development and implementation of policies associated with the PMG reform from the start of the reform in 2017 through mid-2021. It examines (1) how the PMG is financed, (2) strategic purchasing of the different components of PMG benefit package, and (3) the governance arrangements of the PMG. This includes changes in the packages, their contracting arrangements, how they are paid, their complementary enabling reforms, and the extent to which the population is benefiting from them. The report also positions these developments within broader contextual discussions of the financing and organization of health care in Ukraine in order to make the key features of the financing reforms and their importance accessible to domestic and international audiences. Adjustment by the health sector to cope with the COVID-19 pandemic is a common thread. Each section concludes with a set of key recommendations.

This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks (e.g., following the collapse ofthe Soviet Union). In doing so, this report seeks to expand the evidence base on "good performance" in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam.

This book empirically examines health care financing reforms and popular responses in three major cities in East Asia: Shanghai, Singapore, and Hong Kong. It adopts a new revised version of the theory of historical institutionalism to compare and explain the divergent reform paths in these three places over the past three decades. It also examines forces that propel institutional change. The book provides three detailed case studies on the development of health care financing reforms and the politics of implementing them. It shows that health care systems in Shanghai, Singapore, and Hong Kong were the products of Western presence in the nineteenth century. It illustrates how greater attention is paid to the roles played by ideas, actors, and environmental triggers without abandoning the core assumptions that political institutions and policy feedback remain central to impact health care financing reforms. It shows that health care financing reform is shaped by a complex interplay of forces over time. It also provides the most updated material about health care financing reforms in Shanghai, Singapore, and Hong Kong. The central argument of this book is that health care financing reform is both an evolving process responding to changing circumstances and a political process revealing an intricate interplay of power relationships and diverse interests. It shows that institutional changes in health care financing system can be incremental but transformative in nature. It argues that social policies will continue to develop and welfare states will continue to adapt and evolve in order to cope with new risks and needs. This book sheds new lights on understanding the politics of health care financing reform and sources and modes of institutional change.

This book presents the health reform experiences over the past three decades of twelve small and medium-sized nations that are not often included in international comparative studies in this field. The major conclusion of the study is that despite many similarities in policy goals, policy challenges and in the menu of policy options for countries that seek to offer universal coverage to their population, the health reforms of the nations in this book did not converge into one direction or model. However, we found several widespread policy experiences that are relevant for others, too.For example, user fees are unpopular everywhere. Governments often try to soften the consequences by exempting large groups of users, thus largely defeating the very purpose of those fees.As a second example, the introduction of new payment modes for medical care — like the shift from fee for service to case-based payment — took much longer than originally expected everywhere, and also failed to deliver their promises of improved transparency or efficiency gains A third example is that proposals are for universal coverage often ignore the challenges of implementing new financing models that elsewhere took decades if not centuries to develop.The conclusions contain both empirical findings and theoretical conclusions of interest to policy-makers and scholars of international comparison. It is accessible for academics, healthcare managers and students as well as a wider audience of readers interested in the changes in healthcare across the world.

This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.

This “Political Economy of Health Financing: How-to Guide” lays out a structured way to organize and analyze key political economy factors that can impact a health financing reform. This Guide, along with WHO’s broader programme of work on Political Economy of Health Financing Reform, explicitly recognizes the importance of political economy factors in influencing health financing reform trajectories. This Guide is not intended as a toolbox or comprehensive mapping of all the potential political economy factors and strategies related to health financing reform. Rather, it provides a stepwise process for analysis and structured thinking about issues related to health financing and political economy. By understanding the various stakeholders involved in health financing reform, their relative power, interests and position, along with the institutions that shape the bargaining process and the related contextual and economic factors, strategies can be developed to overcome or take into account stakeholders’ resistance or support. The objective of incorporating political economy analysis in this way is to support a more strategic approach to reform as a way to increase the likelihood of effective design, adoption and implementation and ultimately progress towards UHC.

This book provides a multi-disciplinary framework for developing and analyzing health sector reforms, based on the authors' extensive international experience. It offers practical guidance - useful to policymakers, consultants, academics, and students alike - and stresses the need to take account of each country's economic, administrative, and political circumstances. The authors explain how to design effective government interventions in five areas - financing, payment, organization, regulation, and behavior - to improve the performance and equity of health systems around the world.

The objective of this report is to present information on the different health financing reform options available to Kosovo, which can help the government to make informed policy decisions about financing reforms. The report focuses on the key insurance functions of revenue collection and management, risk pooling, and purchasing of health care, as well as the supportive regulatory and governance framework for health financing. Kosovo aims to reform health financing by moving toward a health insurance system. To implement the proposed single insurer as described in the health law, a draft law for health insurance was discussed in Parliament in 2004. The draft law envisioned the revenue sources for the future health insurance as follows: (i) 60 percent of Health Insurance Fund (HIF) revenue will be paid by the general budget; (ii) 13.5 percent will come from payroll contributions; (iii) 21 percent will come from direct payments by patients in the form of user fees; and (iv) 6.5 percent will come from patients' co-payments. Three years later, in April 2007, the Kosovo Parliament approved a health insurance law to introduce social health insurance (SHI) financed predominantly through payroll taxes, though it did not specify contribution levels. The revenue potential of such payroll funded insurance was estimated to be modest considering Kosovo's relatively small formal sector and employment rate. The Kosovo health system is predominantly tax funded. Government health spending is about 3 percent of gross domestic product (GDP) and 10 percent of general government expenditures. The ministry of economics and finance (MEF) transfer's health funds from the central budget to hospitals (51 percent), to municipalities in the form of an earmarked health grant for the provision of primary health care (PHC) services (26 percent), and to the ministry of health (MOH) for other services (22 percent) (MEF 2007).