scholarly journals Health Coverage and Financial Protection in Uganda: A Political Economy Perspective

2021 ◽  
Author(s):  
Maria Nannini ◽  
Mario Biggeri ◽  
Giovanni Putoto
Keyword(s):  
Political Economy ◽  
Universal Health Coverage ◽  
National Level ◽  
Health Financing ◽  
Negotiation Process ◽  
Financial Protection ◽  
Health Coverage ◽  
Financing System ◽  
The Government ◽  
Universal Health

Background: As countries health financing policies supporting progress towards Universal Health Coverage (UHC), an analysis of these policies is particularly relevant in Low and Middle-Income Countries (LMICs). In 2001, the government of Uganda abolished user-fees to improve accessibility to health services for the population. However, after almost 20 years, the incidence of catastrophic health expenditures is still very high, and the health financing system does not provide a pooled prepayment scheme at national level such as an integrated health insurance scheme. Objective: This article aims at analysing the Ugandan experience of health financing reforms with a specific focus on financial protection. Financial protection represents a key pillar of UHC and has been central to health systems reforms even before the launch of the UHC definition. Methods: The qualitative study adopts a political economy perspective and it is based on a desk review of relevant documents and a multi-level stakeholder analysis based on 60 Key Informant Interviews in the health sector. Results: We find that the current political situation is not yet conducive for implementing a universal health coverage system with widespread financial protection: dominant interests and ideologies do not create a net incentive to implement a comprehensive scheme for this purpose. The health financing landscape remains extremely fragmented, and community-based initiatives to improve health coverage are not supported by a clear government stewardship. Conclusion: By examining the negotiation process for health financing reforms through a political economy perspective, this article intends to advance the debate about politically-tenable strategies for achieving UHC and widespread financial protection for the population in LMICs.

scholarly journals Gambaran Out of Pocket pada Awal Era JKN di Indonesia

2018 ◽  
pp. 141-146
Author(s):  
Ingan Tarigan ◽  
Taty Suryati
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Financial Protection ◽  
Health Coverage ◽  
Medical Expenses ◽  
The Poor ◽  
The Government ◽  
Universal Health

Abstrak Pogram Jaminan Kesehatan Nasional (JKN) salah satunya bertujuan memberikan perlindungan finansial khususnya biaya katastropik terhadap semua peserta. Penerima manfaat JKN berhak mendapatkan berbagai layanan sebagai bagian dari paket manfaat dasar tanpa mengeluarkan biaya pelayanan, dan diharapkan Out of Pocket (OOP) akan lebih rendah dibandingkan dengan mereka yang tidak memiliki asuransi kesehatan. Tujuan penulisan akan membandingkan total pengeluaran untuk kesehatan dari peserta jaminan kesehatan dengan yang tidak memiliki jaminan kesehatan pada awal era JKN. Dalam analisis ini, pengukuran pengeluaran perawatan kesehatan hanya mencakup biaya pengobatan langsung, seperti biaya konsultasi, pemakaian kamar di rumah sakit dan obat-obatan. Analisis dengan menggunakan data Susenas 2014 terdiri dari 274.673 individu dan 71.051 rumah tangga di 33 provinsi di Indonesia. Hasil penelitian menunjukkan bahwa pada awal era JKN ada sedikit perbedaan OOP pada penduduk miskin dibandingkan dengan penduduk dimana proteksi finansial terhadap penduduk miskin untuk pengeluaran kesehatan masih rendah.Kepemilikan jaminan kesehatan memberikan proteksi finansial akibat pengeluaran biaya kesehatan, khususnya pengeluaran biaya katastropik dibandingkan dengan yang tidak memiliki jaminan kesehatan. Kepesertaan penduduk miskin ditargetkan tahun 2019 sudah terpenuhi sehingga target pemerintah tentang Universal Health Coverage (UHC) perlindungan finansial pada penduduk miskin dan hampir miskin semakin tinggi atau OOP semakin mendekati nol. Kata kunci: OOP, Pembiayaan, Asuransi Kesehatan Abstract One of the main objectives of the JKN program is to provide financial protection, especially catastrophic costs to all members. JKN beneficiaries are entitled to various services as part of the basic benefit package without incurring service costs, and it is expected that Out of Pocket (OOP) will be lower than those who do not have health insurance. The purpose of writing will be to compare the total health expenditures of health insurance participants or beneficiaries and those without health insurance. In this analysis, the measurement of health care expenditures only includes direct medical expenses, such as consultation fees, hospital room usage and medication. Using Susenas data 2014 consists of 274,673 individuals and 71,051 households in 33 provinces in Indonesia. At the beginning of the JKN implementation, there was little difference of out of pocket in the poorest population compared to the richest population. This shows that financial protection to the poor for health expenditures are still low. The ownership of health insurance tends to provide financial protection due to health expenditures, especially catastrophic expenses compared to those without health insurance. In the Year of 2019 where the government targeted to Universal Health Coverage (UHC) expected protection financial on the poor and near poor is getting higher or out of pocket or getting closer up to zero. Keywords: OOP, Financial Protection, Health Insurance

scholarly journals Assessing progress in the national health financing system towards universal health coverage in Iran: a mixed-method study protocol

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mina Anjomshoa ◽  
Ali Akbari Sari ◽  
Amirhossein Takian
Keyword(s):  
Study Protocol ◽  
National Health ◽  
Universal Health Coverage ◽  
Mixed Method ◽  
Health Financing ◽  
Health Coverage ◽  
Financing System ◽  
Second Stage ◽  
Qualitative Phase ◽  
Universal Health

Abstract Introduction Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Methods An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals. Discussion This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC. Ethics and dissemination The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.

scholarly journals Classification and Review of Health Financing Frameworks: What do they Focus on to Assess and Improve the Situation?

2021 ◽  
Author(s):  
Minoo Alipouri Sakha ◽  
Mohammad Bazyar. ◽  
Arash Rashidian
Keyword(s):  
Universal Health Coverage ◽  
Journal Article ◽  
Health Financing ◽  
Lessons Learned ◽  
World Health ◽  
Health Coverage ◽  
Financing System ◽  
Objective Health ◽  
Pubmed Database ◽  
Universal Health

Abstract Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. Different frameworks for assessing of health financing systems have been developed. The purpose of this study is to review the current frameworks for understanding and assessing health financing and draw out the dimensions of conceptual frameworks and how different concepts are used in relation to the concept of health financing assessment. Lessons learned from different frameworks would guide the future use and formulation of such frameworks. Methods We carried out a systematic search strategy, using the PubMed database to find peer reviewed published literature. A search using generic search engines (Google Scholar and the Google) was also performed through a less structured search to find additional documents and reports published. To increase the comprehensiveness of search, Websites of World Health Organization (WHO) and World Bank were also searched. We included any type of report or peer reviewed journal article that reported frameworks to assess, review and map financing functions and sub-functions and highlight different factors that affect it. Results Fifteen frameworks/tools developed during 2001 until 2020 were found. We classified frameworks by grouping them into systems approach- analytical frameworks, indicator-based, and descriptive/ narrative categories. These frameworks vary in the concepts, functions and processes, dimensions, strategies and meet various international or country-specific challenges. Conclusion The process of framework development for health financing review is becoming more comprehensive with pushing universal health coverage to the international agenda. Despite being diverse, various health financing frameworks/ tools offer synergistic views to the health financing system and provide a comprehensive picture of the health financing system. While some frameworks covered the majority of the elements, not any of the frameworks on its own covered all the elements. Health financing review is a laborious endeavor, which usually needs diverse data and an expert team. It is sometimes infeasible to access ready and user-friendly information; therefore, it is important to apply them with some flexibility.

scholarly journals How has sustainable development goals declaration influenced health financing reforms for universal health coverage at the country level? A scoping review of literature

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Walter Denis Odoch ◽  
Flavia Senkubuge ◽  
Charles Hongoro
Keyword(s):  
Sustainable Development ◽  
Universal Health Coverage ◽  
Sustainable Development Goals ◽  
National Level ◽  
Health Financing ◽  
Rapid Review ◽  
Health Coverage ◽  
Review Of Literature ◽  
Development Goals ◽  
Universal Health

Abstract Background Achieving universal health coverage (UHC) requires health financing reforms (HFR) in many of the countries. HFR are inherently political. The sustainable development goals (SDG) declaration provides a global political commitment context that can influence HFR for UHC at national level. However, how the declaration has influenced HFR discourse at the national level and how ministries of health and other stakeholders are using the declaration to influence reforms towards UHC have not been explored. This review was conducted to provide information and lessons on how SDG declaration can influence health financing reforms for UHC based on countries experiences. Methods We conducted a rapid review of literature and followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline. We conducted a comprehensive electronic search on Ovid Medline, PubMed, EBSCO, Scopus, Web of Science. In searching the electronic databases, we combined various conceptual terms for “sustainable development goals” and “health financing” using Boolean operators. In addition, we conducted manual searched using google scholar. Results Twelve articles satisfied our eligibility criteria. The included articles were analyzed thematically, and the results presented narratively. The SDG declaration has provided an enabling environment for putting in place necessary legislations, reforming health financing organization, and revisions of national health polices to align to the country’s commitment on UHC. However, there is limited information on the process; how health ministries and other stakeholders have used SDG declaration to advocate, lobby, and engage various constituencies to support HFR for UHC. Conclusion The SDG declaration can be a catalyst for health financing reform, providing reference for necessary legislations and policies for financing UHC. However, to facilitate better cross-country learning on how SDG declaration catalyzes HFR for UHC there, is need to examine the processes of how stakeholders have used the declaration as window of opportunity to accelerate reforms.

scholarly journals 20.F. Workshop: Dental care – coverage and access across countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Oral Health ◽  
North America ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Dental Care ◽  
Financial Protection ◽  
Health Coverage ◽  
Universal Health

Abstract Oral health is a central element of general health with significant impact in terms of pain, suffering, impairment of function and reduced quality of life. Although most oral disease can be prevented by health promotion strategies and routine access to primary oral health care, the GBD study 2017 estimated that oral diseases affect over 3.5 billion people worldwide (Watt et al, 2019). Given the importance of oral health and its potential contribution to achieving universal health coverage (UHC), it has received increased attention in public health debates in recent years. However, little is known about the large variations across countries in terms of service delivery, coverage and financing of oral health. There is a lack of international comparison and understanding of who delivers oral health services, how much is devoted to oral health care and who funds the costs for which type of treatment (Eaton et al., 2019). Yet, these aspects are central for understanding the scope for improvement regarding financial protection against costs of dental care and equal access to services in each country. This workshop aims to present the comparative research on dental care coverage in Europe, North America and Australia led by the European Observatory on Health Systems and Policies. Three presentations will look at dental care coverage using different methods and approaches. They will compare how well the population is covered for dental care especially within Europe and North America considering the health systems design and expenditure level on dental care, using the WHO coverage cube as analytical framework. The first presentation shows results of a cross-country Health Systems in Transition (HiT) review on dental care. It provides a comparative review and analysis of financing, coverage and access in 31 European countries, describing the main trends also in the provision of dental care. The second presentation compares dental care coverage in eight jurisdictions (Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States) with a particular focus on older adults. The third presentation uses a vignette approach to map the extent of coverage of dental services offered by statutory systems (social insurance, compulsory insurance, NHS) in selected countries in Europe and North America. This workshop provides the opportunity of a focussed discussion on coverage of dental care, which is often neglected in the discussion on access to health services and universal health coverage. The objectives of the workshop are to discuss the oral health systems in an international comparative setting and to draw lessons on best practices and coverage design. The World Conference on Public Health is hence a good opportunity for this workshop that contributes to frame the discussion on oral health systems in a global perspective. Key messages There is large degree of variation in the extent to which the costs of dental care are covered by the statutory systems worldwide with implications for oral health outcomes and financial protection. There is a need for a more systematic collection of oral health indicators to make analysis of reliable and comparable oral health data possible.

scholarly journals Employment based health financing does not support gender equity in universal health coverage

BMJ ◽  
2020 ◽  
pp. m3384 ◽  
Author(s):  
Lavanya Vijayasingham ◽  
Veloshnee Govender ◽  
Sophie Witter ◽  
Michelle Remme
Keyword(s):  
Gender Equity ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Health Coverage ◽  
Universal Health

scholarly journals Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Giulia Loffreda ◽  
Kéfilath Bello ◽  
Joël Arthur Kiendrébéogo ◽  
Isidore Selenou ◽  
Mohamed Ali Ag Ahmed ◽  
...  
Keyword(s):  
Political Economy ◽  
Stakeholder Engagement ◽  
Health Financing ◽  
Research Process ◽  
The Political ◽  
Health Coverage ◽  
Research Uptake ◽  
Political Economy Analysis ◽  
Universal Health

Abstract Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.

scholarly journals Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Taufique Joarder ◽  
Tahrim Z. Chaudhury ◽  
Ishtiaq Mannan
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Service Management ◽  
Service Providers ◽  
Health Financing ◽  
Community Empowerment ◽  
Health Coverage ◽  
Demand Side ◽  
Implementation Barriers ◽  
Universal Health

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

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