Three Essays on Health Financing in Sub-Saharan Africa: Health Shocks, Health Insurance Uptake, and Financial Risk Protection

2019 ◽  
Author(s):  
Adeyemi Okunogbe
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Health Financing ◽  
Sub Saharan Africa ◽  
Health Shocks ◽  
Financial Risk Protection ◽  
Sub Saharan ◽  
Risk Protection

scholarly journals Is the elimination of ‘sleeping sickness’ affordable? Who will pay the price? Assessing the financial burden for the elimination of human African trypanosomiasis Trypanosoma brucei gambiense in sub-Saharan Africa

2019 ◽  
Vol 4 (2) ◽  
pp. e001173 ◽  
Author(s):  
C Simone Sutherland ◽  
Fabrizio Tediosi
Keyword(s):  
Financial Risk ◽  
Human African Trypanosomiasis ◽  
Financial Burden ◽  
Direct Costs ◽  
Sub Saharan Africa ◽  
Financial Risk Protection ◽  
Trypanosoma Brucei Gambiense ◽  
Elimination Programme ◽  
Sub Saharan ◽  
Risk Protection

IntroductionProgramme to eliminate neglected tropical diseases (NTDs) have gained global recognition, and may allow for improvements to universal health coverage and poverty alleviation. It is hoped that elimination of human African trypanosomiasis (HAT) Trypanosoma brucei gambiense (Tbg) would assist in this goal, but the financial costs are still unknown. The objective of this analysis was to forecast the financial burden of direct costs of HAT Tbg to funders and society.MethodsIn order to estimate the total costs to health services and individuals: (1) potential elimination programmes were defined; (2) the direct costs of programmes were calculated; (3) the per case out-of-pocket payments (OOPs) by programme and financial risk protection indicators were estimated. The total estimated costs for control and elimination programme were reported up till 2020 in international dollars. The mean results for both direct programme costs and OOPs were calculated and reported along with 95% CIs.ResultsAcross sub-Saharan Africa, HAT Tbg maintaining ‘Control’ would lead to a decline in cases and cost US$630.6 million. In comparison, the cost of ‘Elimination’ programme ranged from US$410.9 million to US$1.2 billion. Maintaining ‘Control’ would continue to cause impoverishment and financial hardship to households; while all ‘Elimination’ programme would lead to significant reductions in poverty.ConclusionOverall, the total costs of either control or elimination programme would be near US$1 billion in the next decade. However, only elimination programme will reduce the number of cases and improve financial risk protection for households who are impacted by HAT Tbg.

Microinsurance and Rural Health

2019 ◽  
Author(s):  
Syed Abdul Hamid
Keyword(s):  
South Asia ◽  
Low Income ◽  
Informal Economy ◽  
Financial Risk ◽  
Access To Healthcare ◽  
Low Income Countries ◽  
Financial Protection ◽  
Health Shocks ◽  
Financial Risk Protection ◽  
Risk Protection

Health microinsurance (HMI) has been used around the globe since the early 1990s for financial risk protection against health shocks in poverty-stricken rural populations in low-income countries. However, there is much debate in the literature on its impact on financial risk protection. There is also no clear answer to the critical policy question about whether HMI is a viable route to provide healthcare to the people of the informal economy, especially in the rural areas. Findings show that HMI schemes are concentrated widely in the low-income countries, especially in South Asia (about 43%) and East Africa (about 25.4%). India accounts for 30% of HMI schemes. Bangladesh and Kenya also possess a good number of schemes. There is some evidence that HMI increases access to healthcare or utilization of healthcare. One set of the literature shows that HMI provides financial protection against the costs of illness to its enrollees by reducing out-of-pocket payments and/or catastrophic spending. On the contrary, a large body of literature with strong methodological rigor shows that HMI fails to provide financial protection against health shocks to its clients. Some of the studies in the latter group rather find that HMI contributes to the decline of financial risk protection. These findings seem to be logical as there is a high copayment and a lack of continuum of care in most cases. The findings also show that scale and dependence on subsidy are the major concerns. Low enrollment and low renewal are common concerns of the voluntary HMI schemes in South Asian countries. In addition, the declining trend of donor subsidies makes the HMI schemes supported by external donors more vulnerable. These challenges and constraints restrict the scale and profitability of HMI initiatives, especially those that are voluntary. Consequently, the existing organizations may cease HMI activities. Overall, although HMI can increase access to healthcare, it fails to provide financial risk protection against health shocks. The existing HMI practices in South Asia, especially in the HMIs owned by nongovernmental organizations and microfinance institutions, are not a viable route to provide healthcare to the rural population of the informal economy. However, HMI schemes may play some supportive role in implementation of a nationalized scheme, if there is one. There is also concern about the institutional viability of the HMI organizations (e.g., ownership and management efficiency). Future research may address this issue.

Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection

Health Policy ◽  
2011 ◽  
Vol 99 (3) ◽  
pp. 203-209 ◽  
Author(s):  
Priyanka Saksena ◽  
Adélio Fernandes Antunes ◽  
Ke Xu ◽  
Laurent Musango ◽  
Guy Carrin
Keyword(s):  
Health Insurance ◽  
Access To Care ◽  
Financial Risk ◽  
Financial Risk Protection ◽  
Risk Protection

scholarly journals Equity in Health Benefit Utilization and Financial Risk Protection in Outpatient and Inpatient Care: Baseline Survey of Two Socioeconomic Groups of a Pilot Primary Care Benefits Scheme in the Catchment Areas of a University-Based Health Facility

2020 ◽  
Vol 53 (1) ◽  
Author(s):  
Jose Rafael A. Marfori ◽  
Antonio Miguel L. Dans ◽  
Mica Olivine C. Bastillo ◽  
Ramon Pedro P. Paterno ◽  
Mia P. Rey ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Facility ◽  
Financial Risk ◽  
Health Benefit ◽  
Income Group ◽  
The Philippines ◽  
Financial Risk Protection ◽  
Risk Protection

Background. Health inequities in the Philippines are driven by health workforce maldistribution and health system fragmentation. These can be addressed by strengthening primary care through central social health insurance (PhilHealth) coverage. However, high reported PhilHealth population coverage and health provider accreditation have not necessarily increased health benefit utilization or financial risk protection. Objective. This study aims to examine the impact of an enhanced, comprehensive primary care benefits package at a university-based health facility. This paper reports baseline utilization of health services and health benefits, and out-of-pocket health spending in two socioeconomic strata of the catchment population, for outpatient and inpatient services. Methods. A questionnaire-guided survey was done among randomly selected faculty (higher income group) and non-faculty (lower income group) employees to determine the frequencies and costs of using outpatient and inpatient health services, and amounts paid out-of-pocket. Results. Annually, both groups had approximately 1 consultation/patient and about 15 hospitalizations per 100 families annually. For hospitalizations, non-faculty inpatients utilized health insurance more frequently than faculty inpatients (75.7% vs. 66.7%), but paid higher out-of-pocket proportions (73.3% or Php 92,479/hospitalization vs. 57.4% or Php 16,273/hospitalization). For outpatient care, health benefit utilization rates were higher among non-faculty (12.4% vs 2.1% of consultations) although low overall, with similar total (Php 2,319 vs Php 1,741) and out-of-pocket expenses (100%). Conclusion. These findings confirm inequities in accessing outpatient and inpatient health services and utilizing health insurance benefits in the target population.

Healthcare System Challenges in Asia

2019 ◽  
Author(s):  
Winnie Yip
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Financial Risk ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
The Philippines ◽  
Social Health ◽  
Equitable Access ◽  
Financial Risk Protection ◽  
Risk Protection

Important health system challenges in the east and southeast Asian countries/territories of Japan, South Korea, Taiwan, Hong Kong, Malaysia, China, Thailand, Vietnam, Indonesia, the Philippines, Laos, Myanmar, and Cambodia exist. The most commonly adopted health system among these areas is social health insurance. The high-income, aging societies of Japan, South Korea, and Taiwan have adopted single-payer/single-pipe systems with a single uniform benefit package and a single fee schedule for paying providers for services included in the benefit package. All three have achieved universal coverage with relatively equitable access to affordable care. All grapple with overutilization, aging populations, and hospital-centric and curative-focused care that is ill-suited for addressing an increasing chronic disease burden. Rising patient expectations and demand for expensive technologies contribute to rising costs. Korea also faces comparatively poorer financial risk protection. China, Thailand, Vietnam, Indonesia, and the Philippines have also adopted social health insurance, though not single-payer systems. China and Thailand have established noncontributory schemes, whereby the government heavily subsidizes poor and non-poor populations. General tax revenue is used to extend coverage to those outside formal-sector employment. Both countries use multiple, unintegrated schemes to cover their populations. Thailand has improved access to care and financial risk protection. While China has improved insurance coverage, financial risk protection gains have been limited due to low levels of service coverage, fee-for-service payment systems, poor gatekeeping, and the fee schedule that incentivizes overprescription of tests and medicine. Indonesia, Vietnam, and the Philippines use contributory schemes. Government revenue provides insurance coverage for the poor, near-poor, and selected vulnerable populations; the rest of the population must contribute to enroll. Therefore, expanding insurance coverage to the informal sector has been a significant challenge. Instead of social health insurance, Hong Kong and Malaysia have two-tiered health systems where the public sector is financed by general tax revenue and the private sector is financed primarily by out-of-pocket payments and limited private insurance. There is universal access to care; free or subsidized, good-quality public-sector services provide financial risk protection. However, Hong Kong and Malaysia have fragmented delivery systems, weak primary care, budgetary strains, and inequitable access to private care (which may offer shorter wait times and better perceived quality). Laos, Cambodia, and Myanmar’s health systems feature high out-of-pocket spending, low government investment in health, and reliance on external aid. User fees, low insurance coverage, unequal distribution of health services, and fragmented financing pose pressing challenges to achieving equitable access and adequate financial risk protection. These countries/territories are diverse in terms of demographics, epidemiological profiles, and stages of economic development, and thus they face different health system challenges and opportunities. This diversity also suggests that these nations/territories will utilize different types of health systems to achieve universal health coverage, whereby all people have equitable access to affordable, good-quality care with adequate financial risk protection.

scholarly journals Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon

2021 ◽  
Vol 8 ◽  
Author(s):  
Kevin Paul Ferraris ◽  
Maria Eufemia C. Yap ◽  
Maria Cristina G. Bautista ◽  
Dewa Putu Wisnu Wardhana ◽  
Sri Maliawan ◽  
...  
Keyword(s):  
Public Health ◽  
Financial Incentives ◽  
Financial Risk ◽  
Health Financing ◽  
Economic Incentives ◽  
The Philippines ◽  
Financial Risk Protection ◽  
Implementation Framework ◽  
Provider Perspectives ◽  
Risk Protection

Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

scholarly journals Financial Risk Protection from Social Health Insurance

2016 ◽  
Author(s):  
Kayleigh Barnes ◽  
Arnab Mukherji ◽  
Patrick Mullen ◽  
Neeraj Sood
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Social Health Insurance ◽  
Social Health ◽  
Financial Risk Protection ◽  
Risk Protection

scholarly journals Financial risk protection for neurosurgical care in Indonesia and the Philippines: a primer on health financing for the global neurosurgeon

2021 ◽  
Author(s):  
Ferraris ◽  
Yap ◽  
Maria Cristina G. Bautista ◽  
Dewa Putu Wisnu Wardhana ◽  
Maliawan ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Financial Risk ◽  
Supply And Demand ◽  
Health Financing ◽  
Economic Incentives ◽  
The Philippines ◽  
Healthcare Provision ◽  
Financial Risk Protection ◽  
Implementation Framework ◽  
Risk Protection

Abstract Which conditions treated by neurosurgeons cause the worst economic hardship among patients in low- and middle-income countries? Might a responsive health financing be the solution to the inequities in the delivery of neurosurgical care? In this review article, we attempt to answer these questions that are relevant to global neurosurgery. Based on the results of a survey of neurosurgeons from Indonesia and the Philippines, socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. The surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, the scheme of conditional cash transfers similarly leverages on financial incentives to reward certain health-seeking behaviors of patients that significantly influence their clinical outcomes. We formulate these health financing strategies in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

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