The aim of this study was to understand the trajectory of health expenditure in developing countries. The authors used panel data from 143 countries over 14 years, from 1995 to 2008 to explore the factors associated with the growth of total health expenditure as well as its main components namely, government health expenditure and out-of-pocket payments. The data show great variation across countries in health expenditure as a share of GDP, which ranges from less than 5% to 15%. Apart from income, many factors contribute to this variation, ranging from demographic factors to health system characteristics. The results suggest that health expenditure in general does not grow faster than GDP after taking other factors into consideration. The authors also found no difference in health expenditure between tax-based and insurance-based health financing mechanisms, and noted that external aid for health reduces government health spending from domestic sources.
Resource allocation and health financing
This review examines the role and impact of co-payments in the context of a National Health Insurance system. The application of co-payments, which is a demand-side mechanism, attempts to play a dual role in health care: they primarily serve as a mechanism to avert moral hazard and secondly they add a small amount to the pool of health care funding. Available evidence shows that co-payments are applied in a large variety of health care settings. Across all settings and in different health care and country contexts, co-payments reduce utilisation, disproportionately so for those who are more vulnerable and more disadvantaged. They thereby increase the likelihood of higher health care costs in the long term, as necessary health care is deferred and increasing hospitalisation and more complications arise accordingly. There is, however, no clear evidence to suggest that co-payments address moral hazard and neither is there evidence of any substantial cost savings. A co-payment does, however, shift the burden of cost from health care funders onto users. The review also examines alternate supply-side mechanisms that can contribute to decreased health care costs and address potential over-utilisation, one being gate-keeping. The author concludes that, before co-payments are introduced, other mechanisms should be explored as alternative cost- and utilisation-control interventions.
Without taking social and political realities into account, the Gates Foundation patronage of even the most powerful medications cannot meet the goal of reducing global inequities. Recently Warren Buffett has received near-universal praise for his $31 billion donation to the Bill and Melinda Gates Foundation. The foundation has likewise enjoyed wide acclaim for its global health and educational programs, with Buffett's gift the highest tribute of all. So what could possibly be wrong with Gates-Buffett philanthropy, aimed at improving global well-being? Five such issues are highlighted, warranting pause to the all-around backslapping.
A new study has shown a link between IMF loans to developing countries and increased levels of tuberculosis in the same countries. Researchers claimed a direct relationship could be seen - the start of the increases matched the starting point of IMF programmes, and continued rising as the programme continued. This meant at least a 16.6% increase in deaths across the 21 researched countries, they said. Without the IMF loans, rates would have fallen by up to 10%.
Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries’ education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women’s decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using strategies such as maternal and child health insurance cards it is necessary to ensure beneficiaries and other stakeholders are well informed of the programme, as only giving women insurance cards does not guarantee their access to facility-based delivery.
At this meeting, the Leading Group, an innovative financing advocacy group with 63 member countries, called on the G20 to focus more on innovative financing in its development agenda and pledged to conduct several technical studies in 2011. Participants at the meeting took note of the significant impact of innovative financing in the health sector including the international finance facility for immunisation, advanced market commitment, the air ticket levy and private sector initiatives. New ideas were also introduced, like a tobacco tax and possible new public-private partnerships. The setting up of a dedicated task force was put forward for consideration. In order to meet the Millennium Development Goals and other challenges related to sustainable development, participants agreed to explore innovative financing that is stable, predictable and additional to the existing resources, tapping into various mechanisms, including mandatory contributions, voluntary contributions, loan guarantees, debt swaps, market mechanisms and private sector investments. They also highlighted the need to reduce the cost of migrants’ remittances, and the improvement of their impact on development in recipient countries, including through microcredit institutions.
Around one billion people receive conditional cash transfers today, which have been praised as the magic bullet for poverty eradication. Such programmes are being implemented in Latin America and Africa. But they raise numerous ethical questions Bodies of evidence have shown that Conditional Cash Transfers (CCTs), as a form of social protection, can reduce inequality and poverty. Conditional Cash Transfers are payments made to poor households on the condition that they comply with a set of requirements and invest in their children’s human capital. CCT programmes have led to an uptake in health services, health outcomes and nutritional status of children as well as school enrolment and attendance. This reflexive note discusses development ethics by using Conditional Cash Transfers as a case study. It questions whether CCT prioritise human dignity by giving an overview of the methodology and underlying principles of CCT programmes in alleviating poverty and then analysing them in the light of ethics.
This qualitative study investigated the implementation of Tiba Kwa Kadi scheme in four urban districts of Tanzania using semi-structured interviews, focus group discussions and review of documents. While Tiba Kwa Kadi scheme contributed to access to health services, many challenges which hindered its performance, including frequent stock-out of drugs and medical supplies. This frustrated Tiba Kwa Kadi members and contributed to non-renewal of membership. The scheme was also affected by poor collections and management of the revenue collected from members, limited benefit packages and low awareness of the community. Similar to rural-based Community Health Fund, the Tiba Kwa Kadi scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. The authors recommend that government integrate or merge community-based health insurance schemes into a single national pool with decentralised arms.
In this paper, the authors present a literature review on the costs imposed by non-communicable diseases (NCDs) on households in low- and middle-income countries (LMICs). They examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. These financial costs deter many people suffering from NCDs from seeking the care they need. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. The authors identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.
As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. In the ‘financing gaps framework’, the authors propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customisable to a range of organisational contexts and health aims. The framework brings together expected health spending, potential health spending and spending need, to orient financing decisions around international health targets. As an example of how the framework could be applied, a case study is developed, focused on global goals for child health. The case study harnesses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are tied to progress toward the Sustainable Development Goal’s target for reductions in under-five mortality. The flexibility and comprehensiveness of the framework makes it adaptable for use by a diverse set of governments, donors, policymakers and other stakeholders. The framework can be adapted to short‐ or long‐run time frames, cross‐country or subnational scales, and to a number of specific health focus areas. Depending on donor preferences, the framework can be deployed to incentivise local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals.