Good Practices in Health Financing

Contents......Page 6
Foreword......Page 16
Acknowledgments......Page 18
Executive Summary......Page 20
Acronyms and Abbreviations......Page 24
Part 1 Assessing Good Practice in Health Financing Reform......Page 26
1 Introduction......Page 28
2 Health Financing Functions......Page 34
3 Criteria for Defining “Good Practice” and Choosing Country Cases......Page 40
4 Summaries of Country Cases......Page 52
5 Enabling Factors for Expanding Coverage......Page 82
References for Part I......Page 101
Part 2 Nine Case Studies of Good Practice in Health Financing Reform......Page 112
6 Chile: Good Practice in Expanding Health Care Coverage-Lessons from Reforms......Page 114
7 Colombia: Good Practices in Expanding Health Care Coverage......Page 162
8 Costa Rica: “Good Practice” in Expanding Health Care Coverage-Lessons from Reforms in Low-and Middle-Income Countries......Page 208
9 Estonia: “Good Practice” in Expanding Health Care Coverage......Page 252
10 The Kyrgyz Republic: Good Practices in Expanding Health Care Coverage, 1991–2006......Page 294
11 Sri Lanka: “Good Practice” in Expanding Health Care Coverage......Page 336
12 Thailand: Good Practice in Expanding Health Coverage Lessons from the Thai Health Care Reforms......Page 380
13 Tunisia: “Good Practice” in Expanding Health Care Coverage Lessons from Reforms in a Country in Transition......Page 410
14 Vietnam: “Good Practice” in Expanding Health Care Coverage Lessons from Reform in Low-and Middle-Income Countries......Page 464
Appendix A......Page 504
Index......Page 512
Box 2A Measures of Financial Protection in Tunisia......Page 37
Figure 6.10 Chile: Infant Mortality and Life Expectancy Compared with Other Latin American Countries, 2004......Page 124
Box 8.1 Costa Rica: Cooperatives as Health Care Providers......Page 242
Box 10.1 The Kyrgyz Republic: The Manas National Health Care Reform Program......Page 323
Box 12.1 Thailand: Minimum CUP Requirements......Page 395
Figure 1.1 Determinants of Health, Nutrition, and Population Outcomes......Page 30
Figure 2A.1 Payments as Share of Total and Nonfood Expenditure in Tunisia, 2003......Page 38
Figure 3.1 Population Health Indicators Relative to Income and Spending......Page 45
Figure 3.3 Total Health Spending Relative to Income......Page 46
Figure 3.4 Health Spending as Share of GDP and per Capita vs. Income......Page 47
Figure 3.6 Government Share of Health vs. Income......Page 48
Figure 3.7 Out-of-Pocket Spending Relative to Income......Page 49
Figure 3.9 Literacy vs. Income......Page 50
Figure 5.1 Real GDP Trends per Capita, 1960–2005......Page 85
Figure 5.2 Political Freedom Trends in Case Countries, 1900–2004......Page 89
Figure 6.1 Chile: Economic Growth, 1810–2005......Page 115
Figure 6.3 Chile: GDP per Capita, 2004......Page 116
Table 6.1 Chile: Net Tax Revenue Structure, 1996–2004......Page 117
Table 6.2 Chile: Macroeconomic Performance, 2000–05......Page 118
Figure 6.6 Chile: Population Structure, 1990, 2005, and 2020......Page 120
Figure 6.8 Chile: Life Expectancy, by Historical Period and Gender, 1950–2025......Page 122
Figure 6.9 Chile: Poverty Compared with Other Latin American Countries, 1999......Page 123
Figure 6.11 Chile: The Mandatory Health Insurance System, 2006......Page 126
Table 6.5 Chile: Health Spending as a Percentage of GDP, 2004......Page 128
Figure 6.14 Chile: Coverage of Open ISAPREs, 2006......Page 132
Figure 6.15 Chile: Structure of Financing for Public Health Spending......Page 135
Figure 6.16 Chile: Social Security System Beneficiaries, by Income Decile and Insurance Type, 2000......Page 136
Figure 6.17 Chile: FONASA and ISAPRE Beneficiaries, by Age, 1990 and 2005......Page 138
Figure 6.18 Chile: Available Beds in the SNSS System, 1990–2002......Page 140
Figure 6.19 Chile: Chronology of Health Reforms, 1917–2006......Page 144
Figure 6.20 Chile: Cumulative Cost of the 56 GES-Covered Health Conditions, estimates for 2007......Page 151
Figure 7.2 Colombia: Population Pyramid, 2005......Page 165
Figure 7.3 Colombia: Flow of Funds in the Solidarity and Guarantees Fund......Page 169
Table 7.6 Colombia: Total Population, by SISBEN category, 2003......Page 170
Figure 7.6 Colombia: Reported Sources of Payment for Consultations and Hospitalizations, by Insurance Status, 2000......Page 179
Figure 7.8 Colombia: Population Reporting Use of Preventive Services, by Insurance Status, 1997 and 2003......Page 181
Figure 7.9 Colombia: Population Reporting Hospitalization in Last Year, by Insurance Status, 1997 and 2003......Page 182
Figure 7.10 Colombia: Total Enrollees, by Type of Health Plan and Regime, 2005......Page 183
Figure 7.11 Colombia: Expansion of CR and SR Insurance Coverage, 1992–2006......Page 189
Figure 7.13 Colombia: Employment of SR Contributors, 1993–2006......Page 190
Figure 7.14 Colombia: Insurance Coverage, by Income Quintile, 1992–2003......Page 191
Figure 7.15 Colombia: Growth of Insurance Coverage, by Regime and by Residence, 1993–2003......Page 192
Figure 7.16 Colombia: National Health Spending Distribution and Trends, 1993–2003......Page 193
Figure 7.17 Colombia: Balance of FOSYGA Compensation Fund, 1996–2005......Page 194
Figure 7.18 Colombia: Unemployment, GDP Real Growth, and Percentage of Population in Poverty, 1991–2005......Page 195
Table 7.18 Colombia: Selected Determinants of FOSYGA Balance, 1998–2002......Page 196
Table 7.19 Colombia: SR Funding Sources, 1995–2005......Page 197
Figure 7.21 Colombia: Projections for Universal Health Insurance, 2005–2010......Page 201
Figure 8.1 Costa Rica: Population Pyramids, 1990, 2005, and 2020......Page 210
Table 8.4 Costa Rica: Leading Causes of Morbidity and Mortality, 2002......Page 212
Figure 8.3 Costa Rica: National Distribution of Public Spending on Health, by Income Category, 2001......Page 215
Table 8.8 Costa Rica: Health Insurance Coverage, by Income Group, 2005......Page 220
Figure 8.5 Costa Rica: Income and Social Expense Distribution by Function, 2000......Page 223
Figure 8.7 Costa Rica: Health Expenditures and Contributions to CCSS, by Income Decile......Page 224
Figure 8.8 Costa Rica: Health Insurance Coverage, of Economically Active Population 1990–2004......Page 237
Figure 8.9 Costa Rica: Primary Health Care Program Coverage, 1990–2003......Page 240
Figure 9.1 Estonia: Population Pyramids, 2004 and 2025......Page 255
Figure 9.2 Estonia: Burden of Disease......Page 256
Figure 9.3 Estonia: Average Life Expectancy at Birth Compared with EU Countries, 2003......Page 257
Figure 9.4 Estonia: Distribution of Funding Sources, 1999 and 2004......Page 259
Figure 9.5 Estonia: Out-of-Pocket Payments Compared with European Union, 2004......Page 261
Figure 9.6 Estonia: Overview of the Health Financing System, 2004......Page 262
Figure 9.7 Estonia: The EHIF Contracting Process......Page 263
Figure 9.8 Estonia: Payment Methods for Inpatient and Outpatient Specialist Care, 2005......Page 265
Figure 9.9 Estonia: Payment Methods for Family Physicians, 2005......Page 266
Figure 9.10 Estonia: Number of Family Physicians, 1993–2004......Page 270
Figure 9.11 Estonia: Number of Hospitals and Acute Care Admissions, 1985–2003......Page 273
Figure 9.12 Estonia: Access to Medical Care, by Residence......Page 274
Figure 9.13 Estonia: Number of Doctors and Nurses per 100,000 Inhabitants, 1998–2004......Page 275
Figure 9.14 Estonia: Cumulative Increase in EHIF Pharmaceutical and Health Care Services Expenditures, 1993–2006......Page 276
Figure 9.15 Estonia: Use of Cardiovascular Medicines, by Groups, 1994–2005......Page 277
Figure 9.16 Estonia: Milestones in Health Sector Reform, 1992–2003......Page 278
Figure 10.1 The Kyrgyz Republic: Key Economic Indicators, 1990–2004......Page 296
Table 10.1 The Kyrgyz Republic: Leading Causes of Mortality and Disability, 2002......Page 298
Figure 10.3 The Kyrgyz Republic: Leading Causes of Infant Mortality, 2004......Page 299
Figure 10.4 The Kyrgyz Republic: Health Expenditures as Share of the State Budget, 1995–2003......Page 303
Figure 10.5 The Kyrgyz Republic: Access to Health Services, by Income Level, 2000......Page 312
Figure 10.6 The Kyrgyz Republic: Comparative Indicators of Hospital Efficiency, 1995......Page 313
Figure 10.7 The Kyrgyz Republic: Reallocation of Public Expenditures in the Single-Payer System from Fixed Costs to Variable Costs......Page 318
Figure 10.8 The Kyrgyz Republic: Trends in Out-of-Pocket Payments, 2000–03 (KGS)......Page 324
Figure 10.9 The Kyrgyz Republic: Access to Outpatient Care and Hospital Care, 2000 and 2003......Page 326
Figure 10.10 The Kyrgyz Republic: Mean Payment by a Public Hospital Patient, 2000 and 2003 (KGS)......Page 327
Figure 11.1 Sri Lanka: Population Pyramids 1991, 2006, 2026, and 2051......Page 341
Figure 11.2 Sri Lanka: Government Recurrent Health Spending, 1927–2005......Page 349
Figure 11.4 Sri Lanka: Differentials in Medical Attendance at Childbirth, by Asset Quintile, 1987–2000......Page 352
Figure 11.5 Sri Lanka: Differentials in Use of Modern Methods of Contraception by Currently Married Women, 1987–2000......Page 353
Figure 11.6 Sri Lanka: Trends in Infant Mortality Rates, Country and Nuwara Eliya District, 1920–2003......Page 355
Figure 11.7 Sri Lanka: Government Hospital Provision, 1920–2000......Page 360
Figure 12.1 Thailand: Population Pyramids, 2005, 2010, and 2020......Page 382
Figure 12.2 Thailand: Shift in Budget Allocations, 1982–89......Page 385
Figure 12.3 Thailand: Health Service Delivery Indicators Relative to Income and Spending, 1977–2003......Page 386
Figure 12.4 Thailand: The Health Insurance Model, 2007......Page 390
Table 12.7 Thailand: Utilization by UCS Beneficiaries, 2002–07......Page 396
Figure 12.6 Thailand: Number of Doctor Resignations from MOPH Rural Facilities, 1995–2006......Page 397
Figure 12.7 Thailand: Proposed and Approved Capitation, 2002–08......Page 398
Figure 12.8 Thailand: Number of Financially Constrained Hospitals Receiving Contingency Fund Support, 2002–04......Page 399
Figure 12.9 Thailand: The “Triangle That Moves the Mountain” Strategy......Page 403
Figure 13.1 Tunisia: Population Pyramids, 1990, 2005, and 2020......Page 414
Figure 13.2 Tunisia: Trends in Life Expectancy, Men and Women, 1966–2004......Page 415
Figure 13.3 Tunisia: Coverage Rates by Health Insurance Scheme......Page 420
Figure 13.4 Tunisia: Trends in Health Care Spending, by Financing Agent, 1980–2004......Page 425
Figure 13.5 Tunisia: Shifts in Sources of MSP Financing, 1990–2003......Page 428
Table 13.15 Tunisia: Household Expenditures, by Service Category, 2000......Page 433
Table 13.21 Tunisia: Medical Personnel, 1990–2004......Page 437
Figure 14.1 Vietnam: Population Pyramids, 1990, 2005, and 2020......Page 469
Table 2A.1 Catastrophic Impact of Out-of-Pocket Payments in Threshold Expenditure Shares in Tunisia, 2003......Page 39
Table 3.1 Income and Health Spending, 2004......Page 43
Table 3.2 Health Outcome and Delivery Indicators, 2005......Page 44
Table 3.3 Correlations between Population Health Outcomes and Income, Health Spending, and Literacy Levels......Page 51
Table 6.3 Chile: Disease Burden, 1993 (DALYs lost)......Page 121
Table 6.4 Chile: Key Health Spending Indicators, 1998–2004......Page 127
Table 6.6 Chile: Composition of Spending on Social Welfare Programs, 2000–05......Page 129
Table 6.7 Chile: Health Problems Covered under the GES, 2005–07......Page 130
Table 6.8 Chile: Health Coverage Provided by Social Security System, 2005......Page 131
Table 6.10 Chile: Average Number of Health Services Provided by ISAPRES per Beneficiary, 1996–2004......Page 133
Table 6.11 Chile: Number of Hospital Admissions, 2001–03......Page 134
Table 6.12 Chile: Contributions, Benefits, and Subsidies within the FONASA, 1995......Page 137
Table 6.13 Chile: Global Health Indicators: 1960 and 1995......Page 149
Table 7.1 Colombia: Selected Economic Indicators......Page 163
Table 7.2 Colombia: Demographic Profile......Page 164
Table 7.5 Colombia: Burden of Disease, by Disease Category and Cause, 2002 (DALYs)......Page 166
Table 7.7 Colombia: UPC Premium Value, 2006......Page 171
Table 7.8 Colombia: Summary of NSHI Schemes, December 2005......Page 173
Table 7.9 Colombia: Classification of Medical Care Types, by Complexity......Page 174
Table 7.10 Colombia: Comparison of Breadth of CR, SR, and PS Benefits Packages......Page 175
Table 7.11 Colombia: CR and SR Enrollment Rules, Copayments, and Choice, 2006......Page 176
Table 7.12 Colombia: Coverage of Services to Supplement the Benefits Packages......Page 177
Table 7.14 Colombia: Selected Health Expenditure Indicators, 2003......Page 178
Table 7.15 Colombia: Households Experiencing Catastrophic Payments or Impoverishment due to Ambulatory or Hospital Health Shock, by Insurance Status, 2003......Page 180
Table 7.16 Colombia: Services Offered by Health Care Facilities, by Type, 2004......Page 185
Table 7.17 Colombia: Milestones toward Achievement of Universal Health Insurance Coverage......Page 186
Table 8.1 Costa Rica: Economic Indicators, 1990–2004......Page 209
Table 8.2 Costa Rica: Population Growth Rates and Projections, 1990–2020......Page 211
Table 8.5 Costa Rica: Health Expenditure Indicators 1998, 2000, and 2003......Page 214
Table 8.6 Costa Rica: Payroll Fees, by Insurance Scheme......Page 216
Table 8.7 Costa Rica: Health Indicators, 1990–2004......Page 218
Table 8.9 Costa Rica: Child and Infant Mortality, by Health Region......Page 221
Table 8.11 Costa Rica: Sources of Health Financing......Page 222
Table 8.12 Costa Rica: Estimated Health Insurance Financial Balance in 2050 under Different Scenarios......Page 226
Table 8.13 Costa Rica: Health System Inputs, 1995–2002......Page 230
Table 8.14 Costa Rica: Major Strengths and Weaknesses of the Health Sector......Page 233
Table 9.1 Estonia: Total Health Expenditure, by Source, 2004......Page 258
Table 10.2 The Kyrgyz Republic: IMR from Respiratory Infections, 1997–2004......Page 300
Table 10.3 The Kyrgyz Republic: Key Health Financing Indicators, 2000–03......Page 302
Table 10.4 The Kyrgyz Republic: Coverage in Phase-1 (1997–2001): Population Groups, Sources of Financing, and Benefits......Page 305
Table 10.6 The Kyrgyz Republic: Copayments for Treatment without Surgery, Diagnosis, Minor Surgery, 2004 (KGS)......Page 307
Table 11.2 Sri Lanka: Social Indicators 1930–2005......Page 338
Table 11.3 Sri Lanka :Demographic and Health Indicators, 1930–2003......Page 340
Table 11.5 Sri Lanka: Patient Morbidity, Inpatients and Outpatients......Page 342
Table 11.6 Sri Lanka: Trends in Health Care Spending, 1953–2005......Page 344
Table 11.7 Sri Lanka: Incidence of Public Health Expenditures, 1979–2004......Page 345
Table 11.8 Sri Lanka: Progressivity in Health Financing Compared with Selected Asian Countries......Page 346
Table 11.9 Sri Lanka: Proportion of Population Pushed below the PPP$1.08 Poverty Line by Household Health Spending, Compared with Selected Asian Countries......Page 347
Table 11.10 Sri Lanka: Infant Mortality Rates in Different Social Groups, 1920–22......Page 350
Table 11.11 Sri Lanka: Infant Mortality Rate, Selected Districts, 1921–2000......Page 351
Table 11.12 Sri Lanka: Health Services Use and Spending, Compared with Selected Comparable Countries......Page 356
Table 11.13 Sri Lanka: Technical Efficiency in Public Hospitals, Compared with Selected Countries......Page 357
Table 11.14 Sri Lanka: Proportion of MOH Expenditures Devoted to Hospitals......Page 358
Table 11.16 Sri Lanka: Trends in Treatment Sources Used by Sick Persons, 1978–2004......Page 359
Table 11.17 Sri Lanka: The Chronology of Scaling-Up Health Reforms......Page 363
Table 11.18 Sri Lanka: Expansion of Health Service Coverage, 1931–51......Page 370
Table 12.1 Thailand: Top 10 Causes of Disease Burden, by Gender, 2004......Page 383
Table 12.2 Thailand: Evolution of Health Insurance Coverage......Page 387
Table 12.3 Thailand: Health Expenditure, by Source, 1995–2005......Page 388
Table 12.4 Thailand: Characteristics of Health Insurance Schemes, 2007......Page 389
Table 12.5 Thailand: UCS Inclusion and Exclusion List of Expensive Health Care Interventions, 2001......Page 392
Table 12.6 Thailand: The 13 Elements for UCS Budget Allocation, 2002–08......Page 394
Table 12.9 Thailand: Catastrophic Health Care Expenditure by Households, 2000–06......Page 400
Table 12.10 Thailand: Consumer Satisfaction......Page 401
Table 13.1 Tunisia: Economic Indicators......Page 411
Table 13.2 Tunisia: Government-Sponsored Benefits......Page 412
Table 13.3 Tunisia: Poverty Trends, by Area, 1975–2000......Page 413
Table 13.4 Tunisia: Selected Demographic Indicators......Page 416
Table 13.5 Tunisia: Global Burden of Disease, 2002 Estimates......Page 417
Table 13.6 Tunisia: Top Five Burden of Disease Causes, 2002 Estimates......Page 418
Table 13.7 Tunisia: CSS Insurance Coverage Rates......Page 421
Table 13.8 Tunisia: Health Expenditure, as a Share of GDP and Per Capita, 1980–2004......Page 423
Table 13.9 Tunisia: Health Expenditure Indicators, 1995–2004......Page 424
Table 13.10 Tunisia: Health Care Coverage and Financing......Page 427
Table 13.11 Tunisia: Health Care Provider Payment Methods, by Type of Coverage......Page 429
Table 13.12 Tunisia: Provision for NFSPS Affiliates......Page 431
Table 13.14 Tunisia: Household Consumption, 1975–2000......Page 432
Table 13.16 Tunisia: Health Care Provision, by Facility Type, 2004......Page 434
Table 13.17 Tunisia: Number of Beds in MSP Facilities......Page 435
Table 13.20 Tunisia: The Physician Workforce, 1981–2004......Page 436
Table 13.22 Tunisia: Large-Scale Medical Equipment, 1995–2004......Page 439
Table 13.23 Tunisia: Life Expectancy and Infant Mortality Compared with MENA Region, 1960–2004......Page 442
Table 13.24 Tunisia: Coverage with Primary Health Care Services, 2005......Page 443
Table 13.25 Tunisia: Health Outcomes Compared with Similar Countries......Page 444
Table 13.26 Tunisia: Inequity of Financial Contribution Indicators Compared with Similar Countries......Page 445
Table 13.27 Tunisia: Health Inequalities Compared with Similar Countries......Page 446
Table 13.28 Tunisia: Stakeholder Analysis for Health Insurance Reform......Page 453
Table 13.29 Tunisia: Contribution Rates for Health Insurance Scheme......Page 456
Table 14.1 Vietnam: Economic Indicators, 1990–2004......Page 466
Table 14.2 Vietnam: Selected Population and Social Indicators, 1990–2004......Page 468
Table 14.3 Vietnam: Estimated Burden of Disease, 2002......Page 470
Table 14.4 Vietnam: Per Capita Total Expenditure on Health, 1999–2003......Page 473
Table 14.6 Vietnam: Sources of Funding, by Type of Service, 2003......Page 474
Table 14.7 Vietnam: Health Insurance Coverage, by Program Type, 1998–2004......Page 475
Table 14.8 Vietnam: Human Resources for Health, Selected Indicators......Page 484
Table 14.9 Vietnam: Selected Health Care Coverage and Health Outcome Indicators, 1990–2004......Page 485
Table 14.10 Vietnam: Chronology of Health Reforms, 1989–2006......Page 489