Healthcare financing in Egypt: a systematic literature review.

Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

Expectations of individuals regarding the Ijara Forward contract: the case of healthcare financing

The health sector in Morocco is marked by many achievements, but also by large deficits, especially in terms of healthcare expenditures borne by individuals. With the introduction of Islamic banks (called participative banks) in Morocco, the study aims to determine the extent to which Ijara Forward, as an Islamic financial contract, is adapted to the expectations of Moroccans to finance their health expenditures.The study sample consisted of 200 individuals. The univariate and bivariate analyses are used to identify possible relationships between the study variables. In addition, this paper proposes a model that will predict the demand for Ijara Forward based on the logistic regression method. The results reveal that the financial characteristics of the Ijara Forward contract are in line with the financial expectations of Moroccan individuals. Furthermore, the cost of health services is the main factor that makes healthcare inaccessible. This factor influences the demand of Ijara Forward. In addition, this paper reveals that religious beliefs stimulate Ijara Forward’s demand and encourages people to pay a higher price for Ijara Forward.

Healthcare Financing in Low and Middle-Income Countries and Achieving Universal Health Coverage

Using a comparative healthcare system approach, this paper discusses the existing healthcare financing methods in low-and middle-income countries in the move towards achieving universal health coverage (UHC). The article finds that traditional channels of financing the health sector in these countries include government’s budget, donors’ aid, national health insurance, and out-of-pocket model. Moreover, the paper explores other alternative mechanisms for raising resources for the health sector including tax on demerit goods, remittances, and sovereign wealth funds’ revenues. This paper is of particular interest to policymakers in low-and middle-income countries targeting to achieve UHC.

Improving equity in the distribution and financing of health services in Mauritius, a small island state with deeply rooted welfare state standards

BackgroundEnsuring benefits of free healthcare services are accessible to those in need is essential to achieve universal health coverage (UHC). Mauritius has sustained a welfare state over four decades with free health services in all public facilities. However, paradoxically, the national UHC service coverage index stood at only 63 in 2017. An assessment of who benefits from health interventions is, therefore, vital to shape future health financing strategies.MethodsThe study applied benefit incidence analysis (BIA) to understand the distribution of healthcare utilisation and spending in comparison to income distribution. Also, a financial incidence analysis (FIA) was conducted to assess the progressivity of the health financing systems. Data from the national survey on household out-of-pocket (OOP) expenditure for health were used for the purpose of BIA and FIA. Concentration curves and concentration indices (CI) were nationally estimated and disaggregated to rural/urban levels. Kakwani index (KI) was calculated to assess the progressivity of private healthcare financing.ResultsThe CI for outpatient, inpatient and day care within the public health sector is estimated at −0.33, –0.14 and −0.14, respectively. Overall, CI in the public sector is −0.26. Benefit distribution in the private sector is pro-rich with CI of 0.27. Healthcare financing is regressive as demonstrated by a KI of −0.004, with the poorest population groups contributing a large share, in terms of taxes and OOP, to finance the health system.ConclusionThe BIA posits that government spending on public healthcare has resulted in significant pro-poor services distribution. This is largely offset by pro-rich distribution in the private sector. Thus, implying health financing strategies must be reviewed to promote financial protection against catastrophic health payments and bolster efforts to improve UHC service coverage index and achieve UHC Target 3.8 under Sustainable Development Goal 3.

What alternative and innovative domestic methods of healthcare financing can be explored to fix the current claims reimbursement challenges by the National Health Insurance Scheme of Ghana? Perspectives of health managers

Background Low-and-middle -income countries (LMICs), to achieve sustainable universal health coverage (UHC) governments are implementing local and sustainable methods of healthcare financing. However, in Ghana, there is limited evidence on these local methods for healthcare financing to inform policy. This study aimed at exploring health managers views on alternative domestic and sustainable methods of healthcare financing for UHC under the National Health Insurance Scheme (NHIS). Methods A qualitative study using in-depth interviews with 16 health facility managers were held. The health facilities and participants were selected using convenience and purposive sampling methods. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results Health managers across all the health facilities mentioned delayed and erratic claims reimbursement to health facilities as the main challenge. Participants attributed the main reason to lack of funds by the National Health Insurance Authority (NHIA). They said the delayed and irregular payments has been a challenge to efficient delivery of quality healthcare to clients. That in some instances they have been compelled to demand cash or out-of-pocket payment from insured clients or insurance card bearers to be able to render needed healthcare services to them. Participants think that to ensure regular reimbursement of claims to the health facilities by the NHIA, the managers think alternative local sources of funding need to be explored to fill the funding gap. To put in place this, they suggested the need to start levying special taxes on natural resources such as crude oil and gas, gold, bauxite, cocoa, mobile money transfers, airtime and increasing the proportion of levies on the existing Value Added Tax (VAT). Conclusion The study provides important insights into potential innovative alternative domestic sources for raising additional funds to finance healthcare services in Ghana. Despite the potential of these sources, it is important for governments and health policy makers in Ghana and other LMICs who are working towards implementing innovative local methods using special levies on mobile communication services and natural resources to finance their UHC, to implement those that best suit their economies to ensure equity for better health.

Analysis of the Effect of Private Healthcare Financing on Poverty in Nigeria: Evidence from Edo State

Poverty is one of the problems that challenge economies in Africa. Though it is a complex phenomenon which requires efforts by different experts to reduce or eliminate, conventional wisdom posits that “health is wealth”. Health status is a component of human capital development which plays a fundamental role in the poverty and well-being of individuals and national economies. Paradoxically the cost of accessing quality healthcare is an important contributor to income poverty among low income households. Thus adequate healthcare financing mechanisms (public and private) are required to attain quality health outcomes. This study therefore investigates the adequacy or otherwise of the current means of private health care financing in Edo state of Nigeria and it employed the survey method and multinomial logistic regression technique. Results revealed that the dominant means of private health care financing in Edo state is “out of pocket” payments which has negative effect on the income of households. It therefore recommends the introduction of a more effective collective healthcare financing mechanism to mitigate the financial burden associated with out-of-pocket spending. Also funding should be provided for research and development of locally manufactured drugs with high local content to enhance the availability and affordability of effective drugs.

Methodological Features of the Formation of the Model of Healthcare Financing

The situation when, in the context of unsystematic risks caused by the influence of unpredictable factors, there is a need to implement reasonable methods of regulating the state of the health sector, manifested itself in practice during the period of threat to public health. In this regard, the theoretical substantiation of the ways of implementing the functions of healthcare management based on the assessment of the state and stages of development is an urgent area of research. Based on the study of threats to the economic security of the socio-economic system from healthcare in the regions of the Russian Federation, the article examines the main provisions of the theory of life cycles and evaluates the legitimacy of the formulated hypothesis about its applicability to the healthcare financing model. In the article, taking into account the substantiation of the legitimacy of the author's hypothesis about the dependence of the economic security of the socio-economic system on the healthcare financing mechanism, the requirements for the methodological approach to the model for assessing the economic security of the region are proposed. It is shown that on the basis of the implementation of the main provisions of the life cycle theory, subject to their meaningful development, it is possible to form such a model of the evolutionary transformation of the healthcare financing mechanism, which ensures a stable state of the socio-economic system of the region. Requirements for the healthcare financing model, which ensure the necessary state of economic security of the regional socio-economic system, are formulated.

Health Insurance as a Healthcare Financing Mechanism in India: Key Strategic Insights and a Business Model Perspective

This study provides strategic insights and a business model perspective on health insurance as a vehicle for financing healthcare. It uses both primary (expert interview) and secondary data to investigate the overall disease burden and healthcare industry trends and track healthcare financing through the health insurance mechanism in India. To identify the critical success factors and to gain a business model perspective within the health insurance industry, telephonic and face-to-face interviews were held with 27 experts in the healthcare, insurance, and strategic management field. The study’s findings suggest that the growth of health insurance as a healthcare financing mechanism in India has been challenged continuously and impacted by multiple changes in the health insurance and healthcare industry over the last decade. One of the critical challenges faced by insurance companies is the high incurred claim ratio. We find the Indian health insurance industry to be very competitive and that the focus on critical success factors can help insurance companies gain a competitive advantage. The health insurance business model is unique, with varying configurations, and broadly comprises strategic choices and consequences. In this article, drawing from the strategic management literature on the resource-based view (RBV) and insights gained from the interviews of healthcare and health insurance experts, we highlight the six critical success factors relevant for competing in the health insurance business. We also list five strategic choices that can help health insurance companies improve their profitability and gain a sustained competitive advantage. We recommend that the insurance companies design and develop an innovative business model centred around lowering the claim ratio and simultaneously increasing the customer willingness to pay. To increase the customer willingness to pay and reduce the claim ratio, the insurance companies should focus on the six critical success factors and invest in the five strategic choices.

Income and healthcare financing system in the United States: an asymmetric analysis

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.