Pub Date : 2020-12-01DOI: 10.1080/23288604.2019.1625498
Joseph Wong, A. Macikunas, Aylin Manduric, Joy Dawkins, Simran Dhunna
ABSTRACT Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health—and specifically addressing the HIV/AIDS crisis—a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand’s success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.
{"title":"Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission","authors":"Joseph Wong, A. Macikunas, Aylin Manduric, Joy Dawkins, Simran Dhunna","doi":"10.1080/23288604.2019.1625498","DOIUrl":"https://doi.org/10.1080/23288604.2019.1625498","url":null,"abstract":"ABSTRACT Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health—and specifically addressing the HIV/AIDS crisis—a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand’s success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"27 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83463527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.1080/23288604.2019.1619065
Nguyen Hoang Giang, T. Oanh, Khuong Anh Tuan, Phan Hong Van, R. Jayasuriya
ABSTRACT The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam. The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD. The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE. This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs. Abbreviations: NCD: Noncommunicable diseases; UHC: Universal Health Coverage; HI: Health insurance; CHE: Catastrophic health expenditure; OOP: Out of Pocket
{"title":"Is Health Insurance Associated with Health Service Utilization and Economic Burden of Non-Communicable Diseases on Households in Vietnam?","authors":"Nguyen Hoang Giang, T. Oanh, Khuong Anh Tuan, Phan Hong Van, R. Jayasuriya","doi":"10.1080/23288604.2019.1619065","DOIUrl":"https://doi.org/10.1080/23288604.2019.1619065","url":null,"abstract":"ABSTRACT The rising burden of Non-Communicable Diseases (NCDs) in developing countries has caused high out-of-pocket (OOP) health spending leading to many households suffering Catastrophic Health Expenditure (CHE). This study examined the association between health insurance (HI) on health-care utilization and the burden of OOP expenditure among people with reported NCDs and on their households in Vietnam. The study draws on a cross-sectional household survey of accessibility and utilization of health services in Vietnam. Data were obtained from three provinces to represent urban, rural and mountainous areas of the country. The study used a sample of 2,038 individuals with reported NCD aged over 18 years from 1,642 households having at least one person with reported NCD. The results show that people with reported NCD who had HI were twice as likely to use outpatient care compared with those without HI. Having more than one member with reported NCD resulted in double the odds of a household suffering CHE. Households in the three lowest wealth quintiles were more likely to encounter CHE and financial distress than economically better-off households. HI did not provide a protective effect to households, as there was no significant association between the HI status of household members with reported NCD and CHE or financial distress. Seeking care at higher-level facilities was significantly associated with CHE. This study highlights the need for evidence to design future HI-based interventions targeting susceptible populations to narrow the gaps in health service utilization among the population and mitigate financial catastrophe associated with NCDs. Abbreviations: NCD: Noncommunicable diseases; UHC: Universal Health Coverage; HI: Health insurance; CHE: Catastrophic health expenditure; OOP: Out of Pocket","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"35 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86275627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01Epub Date: 2019-09-30DOI: 10.1080/23288604.2019.1617026
Faraz Khalid, Maria Petro Brunal, Abdul Sattar, Samia Laokri, Matthew Jowett, Wajeeha Raza, David R Hotchkiss
The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.
{"title":"Assessing the Efficiency of Sub-National Units in Making Progress Towards Universal Health Coverage: Evidence from Pakistan.","authors":"Faraz Khalid, Maria Petro Brunal, Abdul Sattar, Samia Laokri, Matthew Jowett, Wajeeha Raza, David R Hotchkiss","doi":"10.1080/23288604.2019.1617026","DOIUrl":"10.1080/23288604.2019.1617026","url":null,"abstract":"<p><p>The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.</p>","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"106 1","pages":"1-14"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80435151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1655358
P. Abeykoon
Health care is considered a basic human right in Sri Lanka, and, reflecting this priority, the government dedicates government tax revenues to ensure equitable access to all people in the country, regardless of whether they are a citizen. In particular, Sri Lanka has recognized the inherent market failures associated with financing health promotion and prevention related services, and has therefore prioritized investments in those areas. In building off of the conceptual foundation and definition of common goods for health (CGH), this commentary provides an in-depth look at the successes and challenges in the financing and provision of CGH in Sri Lanka. This reflection is particularly timely given the country’s current plans to transform primary health care to meet the growing demands placed on the system by non-communicable diseases (NCDs) and emerging and re-emerging diseases.
{"title":"Financing Common Goods for Health: Sri Lanka","authors":"P. Abeykoon","doi":"10.1080/23288604.2019.1655358","DOIUrl":"https://doi.org/10.1080/23288604.2019.1655358","url":null,"abstract":"Health care is considered a basic human right in Sri Lanka, and, reflecting this priority, the government dedicates government tax revenues to ensure equitable access to all people in the country, regardless of whether they are a citizen. In particular, Sri Lanka has recognized the inherent market failures associated with financing health promotion and prevention related services, and has therefore prioritized investments in those areas. In building off of the conceptual foundation and definition of common goods for health (CGH), this commentary provides an in-depth look at the successes and challenges in the financing and provision of CGH in Sri Lanka. This reflection is particularly timely given the country’s current plans to transform primary health care to meet the growing demands placed on the system by non-communicable diseases (NCDs) and emerging and re-emerging diseases.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"5 1","pages":"397 - 401"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78837100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1655982
W. Savedoff
CONTENTS References The world, and we human beings who live in it, would be better off if we were to invest more resources and attention in producing common goods for health (CGH), such as antipollution and safety regulations, epidemiological surveillance that facilitates rapid response to infectious outbreaks, and taxes levied on harmful products like carbon emissions and tobacco. The logical reasons and the highly favorable benefit-cost ratios that should compel countries to allocate more public resources for such things are laid out clearly in the articles in this special issue of Health Systems & Reform. The papers also explain why logic and evidence are not adequate to convince people and their leaders to dedicate sufficient resources and attention to CGH. As the papers show, before societies will fund CGH, they need to solve a range of collective action problems. The papers argue that societies underinvest in CGH for behavioral reasons, such as underestimating risk and shortterm thinking; as well as economic reasons, such as externalities and free-riding (which create incentives for people to act without regard to the full social costs and benefits of their decisions). With all of these factors conspiring against the production of CGH, it is a wonder that they are produced at all. In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the CGH that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical. Bump and colleagues address the proximate political factors that explain public investments in CGH. In addition to those insights, I contend that historical analysis demonstrates that broader political factors related to collective identity and power are fundamental, with significant implications for the strategies required to realize investments in CGH. In particular, I argue that investing in CGH requires that:
如果我们把更多的资源和注意力投入到生产促进健康的共同产品(common goods for health, CGH)上，例如防治污染和安全法规、便于对传染病爆发作出快速反应的流行病学监测以及对碳排放和烟草等有害产品征税，世界以及生活在其中的我们人类就会变得更好。《卫生系统与改革》这期特刊的文章清楚地阐述了合乎逻辑的原因和高度有利的收益成本比，它们应该迫使各国为这些事情分配更多的公共资源。论文还解释了为什么逻辑和证据不足以说服人们及其领导人投入足够的资源和关注CGH。正如论文所显示的那样，在社会为CGH提供资金之前，他们需要解决一系列集体行动问题。这些论文认为，社会对CGH投资不足是由于行为原因，如低估风险和短视思维;以及经济上的原因，比如外部性和搭便车(这会激励人们不考虑其决定的全部社会成本和利益而采取行动)。所有这些因素都不利于CGH的产生，它们的产生是一个奇迹。在这篇评论中，我认为我们需要清楚地了解导致社会投资于我们今天认为理所当然的CGH的历史和动机。研究过去可以帮助我们确定能够在未来创造、扩大和维持CGH的政治战略。那么，为什么社会会产生CGH呢?答案基本上是历史和政治上的，而不是概念和技术上的。Bump和他的同事探讨了解释公共投资于CGH的直接政治因素。除了这些见解之外，我认为历史分析表明，与集体身份和权力相关的更广泛的政治因素是基本的，对实现CGH投资所需的战略具有重大影响。特别是，我认为投资CGH需要:
{"title":"Why Do Societies Ever Produce Common Goods for Health?","authors":"W. Savedoff","doi":"10.1080/23288604.2019.1655982","DOIUrl":"https://doi.org/10.1080/23288604.2019.1655982","url":null,"abstract":"CONTENTS References The world, and we human beings who live in it, would be better off if we were to invest more resources and attention in producing common goods for health (CGH), such as antipollution and safety regulations, epidemiological surveillance that facilitates rapid response to infectious outbreaks, and taxes levied on harmful products like carbon emissions and tobacco. The logical reasons and the highly favorable benefit-cost ratios that should compel countries to allocate more public resources for such things are laid out clearly in the articles in this special issue of Health Systems & Reform. The papers also explain why logic and evidence are not adequate to convince people and their leaders to dedicate sufficient resources and attention to CGH. As the papers show, before societies will fund CGH, they need to solve a range of collective action problems. The papers argue that societies underinvest in CGH for behavioral reasons, such as underestimating risk and shortterm thinking; as well as economic reasons, such as externalities and free-riding (which create incentives for people to act without regard to the full social costs and benefits of their decisions). With all of these factors conspiring against the production of CGH, it is a wonder that they are produced at all. In this commentary, I argue that we need to be clear-eyed about the history and motivations that led societies to invest in the CGH that we take for granted today. Studying the past may help us identify the political strategies that could create, expand and sustain CGH in the future. So why do societies ever produce CGH? The answer is essentially historical and political, not conceptual and technical. Bump and colleagues address the proximate political factors that explain public investments in CGH. In addition to those insights, I contend that historical analysis demonstrates that broader political factors related to collective identity and power are fundamental, with significant implications for the strategies required to realize investments in CGH. In particular, I argue that investing in CGH requires that:","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"89 1","pages":"402 - 405"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83849783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1663646
M. Schäferhoff, P. Chodavadia, Sebastian Martinez, Kaci Kennedy McDade, Sara Fewer, S. Silva, D. Jamison, G. Yamey
Abstract West Africa’s Ebola epidemic of 2014–2016 exposed, among other problems, the under-funding of transnational global health activities known as global common goods for health (CGH), global functions such as pandemic preparedness and research and development (R&D) for neglected diseases. To mobilize sustainable funding for global CGH, it is critical first to understand existing financing flowing to different types of global CGH. In this study, we estimate trends in international spending for global CGH in 2013, 2015, and 2017, encompassing the era before and after the Ebola epidemic. We use a measure of international funding that combines official development assistance (ODA) for health with additional international spending on R&D for diseases of poverty, a measure called ODA+. We classify ODA+ into funding for three global functions—provision of global public goods, management of cross-border externalities, and fostering of global health leadership and stewardship—and country-specific aid. International funding for global functions increased between 2013 and 2015 by $1.4 billion to a total of $7.3 billion in 2015. It then declined to $7.0 billion in 2017, accounting for 24% of all ODA+ in 2017. These findings provide empirical evidence of the reactive nature of international funders for global CGH. While international funders increased funding for global functions in response to the Ebola outbreak, they failed to sustain that funding. To meet future global health challenges proactively, international funders should allocate more funding for global functions.
{"title":"International Funding for Global Common Goods for Health: An Analysis Using the Creditor Reporting System and G-FINDER Databases","authors":"M. Schäferhoff, P. Chodavadia, Sebastian Martinez, Kaci Kennedy McDade, Sara Fewer, S. Silva, D. Jamison, G. Yamey","doi":"10.1080/23288604.2019.1663646","DOIUrl":"https://doi.org/10.1080/23288604.2019.1663646","url":null,"abstract":"Abstract West Africa’s Ebola epidemic of 2014–2016 exposed, among other problems, the under-funding of transnational global health activities known as global common goods for health (CGH), global functions such as pandemic preparedness and research and development (R&D) for neglected diseases. To mobilize sustainable funding for global CGH, it is critical first to understand existing financing flowing to different types of global CGH. In this study, we estimate trends in international spending for global CGH in 2013, 2015, and 2017, encompassing the era before and after the Ebola epidemic. We use a measure of international funding that combines official development assistance (ODA) for health with additional international spending on R&D for diseases of poverty, a measure called ODA+. We classify ODA+ into funding for three global functions—provision of global public goods, management of cross-border externalities, and fostering of global health leadership and stewardship—and country-specific aid. International funding for global functions increased between 2013 and 2015 by $1.4 billion to a total of $7.3 billion in 2015. It then declined to $7.0 billion in 2017, accounting for 24% of all ODA+ in 2017. These findings provide empirical evidence of the reactive nature of international funders for global CGH. While international funders increased funding for global functions in response to the Ebola outbreak, they failed to sustain that funding. To meet future global health challenges proactively, international funders should allocate more funding for global functions.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"131 1","pages":"350 - 365"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75439923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1648736
O. Gómez-Dantés, J. Frenk
CONTENTS Conceptual Framework of the Mexican Health Reform Financial Architecture of the System for Social Protection inHealth Health-Related Common Goods of the SSPH References A series of studies developed in Mexico in the late 1990s identified disturbing rates of catastrophic health expenditures as a result of the fact that approximately half of the Mexican population, 50 million people, lacked health insurance. This analysis exposed a dreadful paradox: we know that health contributes to the reduction of poverty, yet medical care can itself produce financial stress when a country lacks the social instruments to assure fair financing of personal healthcare services. In 2003, the government of President Vicente Fox secured support from all political parties for legislation aimed at correcting that paradox. A reform to the National Health Law created the System for Social Protection in Health (SSPH). The most prominent component of SSPH is Seguro Popular (SP), a health insurance scheme funded predominantly through federal and state subsidies. Following congressional approval of SP, the government began implementation of the new system in January of 2004. Public expenditure was gradually expanded to finance healthcare coverage for non-salaried workers and their families, who had been excluded from conventional, employment-based social insurance. The mobilization of additional financial resources for health was made possible by the increase of oil prices between 1999 and 2008, a situation that benefited Mexico, an oil-exporter country. This allowed for a major increase of social expenditure. By 2018, over 53 million people were enrolled in the new scheme and had access to a comprehensive package of essential services and a package of high-cost interventions. The country was on track to achieving the goal of universal coverage. A lot has been written about SP, its financial innovations, and its impacts on healthcare coverage, health conditions, and financial protection. However, little is published about the other components of SSPH, more specifically, its common goods components. The purpose of this article is to describe and discuss the common goods for health elements
内容:墨西哥卫生改革概念框架社会保障体系与健康相关的共同利益参考文献20世纪90年代末在墨西哥开展的一系列研究确定了令人不安的灾难性卫生支出率，这是由于大约一半的墨西哥人口(5000万人)缺乏医疗保险。这一分析揭示了一个可怕的悖论:我们知道健康有助于减少贫困，但当一个国家缺乏确保个人医疗保健服务公平融资的社会工具时，医疗保健本身就会产生财政压力。2003年，总统比森特·福克斯(Vicente Fox)领导的政府获得了所有政党的支持，通过了旨在纠正这一悖论的立法。对《国家卫生法》的改革建立了健康社会保护制度。SSPH最突出的组成部分是Seguro Popular (SP)，这是一项主要由联邦和州补贴资助的健康保险计划。国会批准SP后，政府于2004年1月开始实施新制度。公共支出逐步扩大，用于资助被排除在传统的、以就业为基础的社会保险之外的非受薪工人及其家庭的医疗保险。1999年至2008年期间，石油价格上涨，使墨西哥这个石油出口国受益，从而为卫生事业调动了额外的财政资源。这使得社会开支有了很大的增加。到2018年，超过5300万人参加了新计划，并获得了全面的一揽子基本服务和一揽子高成本干预措施。该国正在实现全民覆盖的目标。关于SP、其金融创新及其对医疗保健覆盖范围、健康状况和财务保护的影响，已经有很多文章。然而，关于SSPH的其他成分，更具体地说，它的普通商品成分，很少发表。本文的目的是描述和讨论健康要素的共同商品
{"title":"Financing Common Goods: The Mexican System for Social Protection in Health Agenda","authors":"O. Gómez-Dantés, J. Frenk","doi":"10.1080/23288604.2019.1648736","DOIUrl":"https://doi.org/10.1080/23288604.2019.1648736","url":null,"abstract":"CONTENTS Conceptual Framework of the Mexican Health Reform Financial Architecture of the System for Social Protection inHealth Health-Related Common Goods of the SSPH References A series of studies developed in Mexico in the late 1990s identified disturbing rates of catastrophic health expenditures as a result of the fact that approximately half of the Mexican population, 50 million people, lacked health insurance. This analysis exposed a dreadful paradox: we know that health contributes to the reduction of poverty, yet medical care can itself produce financial stress when a country lacks the social instruments to assure fair financing of personal healthcare services. In 2003, the government of President Vicente Fox secured support from all political parties for legislation aimed at correcting that paradox. A reform to the National Health Law created the System for Social Protection in Health (SSPH). The most prominent component of SSPH is Seguro Popular (SP), a health insurance scheme funded predominantly through federal and state subsidies. Following congressional approval of SP, the government began implementation of the new system in January of 2004. Public expenditure was gradually expanded to finance healthcare coverage for non-salaried workers and their families, who had been excluded from conventional, employment-based social insurance. The mobilization of additional financial resources for health was made possible by the increase of oil prices between 1999 and 2008, a situation that benefited Mexico, an oil-exporter country. This allowed for a major increase of social expenditure. By 2018, over 53 million people were enrolled in the new scheme and had access to a comprehensive package of essential services and a package of high-cost interventions. The country was on track to achieving the goal of universal coverage. A lot has been written about SP, its financial innovations, and its impacts on healthcare coverage, health conditions, and financial protection. However, little is published about the other components of SSPH, more specifically, its common goods components. The purpose of this article is to describe and discuss the common goods for health elements","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"7 1","pages":"382 - 386"},"PeriodicalIF":4.1,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87452105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1633894
J. Shiffman
The articles in this special issue make two particularly valuable contributions to understanding health financing reform. First, through historical case studies, they provide rich empirical evidence showing that reform is more than a technical matter: it is also a heavily political undertaking. Second, they provide guidance to reformers on political management, illustrating the utility of a framework that identifies groups of actors who facilitate and obstruct change, including interest groups and political leaders. A focus on political management highlights the role of human agency in health financing reform. Reform is shaped not only by agency but also by political context—enduring political and social arrangements not easily altered by the actions of individuals. For instance, the adoption and smooth implementation of reform may be more likely in a country with a government that has a unitary political structure that limits the ability of anti-reform groups to block change. Several scholars warn against excessive analytical focus on the actions of individuals, as doing so may mask the role of structural forces and long-term social processes in explaining political and social outcomes, including social welfare policy adoption and implementation. The articles in this special issue attend to political context but highlight individual agency. In this commentary, I do the reverse. I do so with a view to calling attention to some of the larger and more enduring factors—pertaining to nature of the political system and party rule, features of civil society, and the global political environment—that alongside human agency may explain why major health financing reforms advance in some national settings but not others.
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Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1630595
V. Tangcharoensathien, W. Patcharanarumol, Anond Kulthanmanusorn, N. Saengruang, Hathairat Kosiyaporn
Abstract Thailand achieved full population coverage of financial protection for health care in 2002 with successful implementation of the Universal Coverage Scheme (UCS). The three public health insurance schemes covered 98.5% of the population by 2015. Current evidence shows a high level of service coverage and financial risk protection and low level of unmet healthcare need, but the path toward UHC was not straightforward. Applying the Political Economy of UHC Reform Framework and the concept of path dependency, this study reviews how these factors influenced the evolution of the UHC reform in Thailand. We highlight how path dependency both set the groundwork for future insurance expansion and contributed to the persistence of a fragmented insurance pool even as the reform team was able to overcome certain path inefficient institutions and adopt more evidence-based payment schemes in the UCS. We then highlight two critical political economy challenges that can hamper reform, if not managed well, regarding the budgeting processes, which minimized the discretionary power previously exerted by Bureau of Budget, and the purchaser–provider split that created long-term tensions between the Ministry of Public Health and the National Health Security Office. Though resisted, these two changes were key to generating adequate resources to, and good governance of, the UCS. We conclude that although path dependence played a significant role in exerting pressure to resist change, the reform team’s capacity to generate and effectively utilize evidence to guide policy decision-making process enabled the reform to be placed on a “good path” that overcame opposition.
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Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1625251
P. Campos, M. Reich
ABSTRACT Any effort to improve health system performance must address the challenges of policy implementation. This article examines one aspect of implementation—the politics of policy implementation for the health sector, particularly the management of stakeholders in order to help change teams improve the chances of achieving policy objectives. Based on a literature scan of political analyses and descriptions of health policy implementation in low- and middle-income countries, we propose six major categories of stakeholder groups that are likely to influence implementation: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The categories of stakeholders can be overlapping. We examine the politics of these different stakeholder categories, and then present selected examples of published case studies that show the types of implementation challenges that arise for each category and how implementers can use political strategies to manage specific stakeholder groups and related political processes. Understanding the political dimensions of implementation can help those responsible for implementation drive policy into practice more effectively. Understanding and addressing conflict, resistance and cooperation among stakeholders are key to managing the implementation process. Systematic and continuous political analysis can help decision makers and change teams improve the chances for successful implementation.
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