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Evidence on Cost-sharing in Health Care : Applications to Hungary : Executive Summary

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
Relevância na Pesquisa
45.68%
This study, done at the request of the Hungarian government, presents evidence on cost-sharing in the health sector, and its application in Hungary. It presents results on the impact of cost-sharing on revenues in health facilities and insurance, financial sustainability, informal payments, overall service use, and equity in access. Five keyfindings emerge: cost-sharing could lead to a reduction in unnecessary care provided to insured patients who do not have to pay the full price of care; cost-sharing could help reduce informal payments and keep patient payments in the system; cost-sharing with exemption policies are a prerequisite to provide equity in access to care; cost-sharing could support cost containment strategies; experience from OECD countries provides examples of successful cost-sharing policies. Based on these findings. the study recommends that Hungary continues to monitor and evaluate the impact of cost-sharing on access, to identify possible negative effects on equity in service use. In Hungary...

Economics and Ethics of Results-Based Financing for Family Planning : Evidence and Policy Implications

Chowdhury, Sadia; Vergeer, Petra; Schmidt, Harald; Barroy, Helene; Bishai, David; Halpern, Scott
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
45.7%
This paper was developed for World Bank task team leaders (TTLs) and teams designing results-based financing (RBF) programs in family planning (FP). It explores the rationale for introducing such incentives based on insights from classical and behavioral economics, to respond to supply- and demand-side barriers to using FP services. To help the reader understand why incentivizing FP requires specific attention in RBF, the evolution of incentives in vertical FP programs introduced from the 1950s to the early 1990s and the ethical concerns raised in these programs are described. RBF programs after the 1990s were also studied to understand the ways FP is currently incentivized. The paper also touches on the effects of the incentive programs for FP as described in the literature. Finally, it examines ethical concerns related to FP incentives that should be considered during the design, implementation, and evaluation of programs and provides a conceptual framework that can be of use for task teams in the decision making process for FP in RBF programs. It should be noted that the paper is concerned exclusively with developing a framework that can help design ethical programs to address the unmet need for FP.

Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries

Bitran, Ricardo
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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45.68%
The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to quality and timely health care. ISWs are generally reluctant to enroll in insurance schemes...

Moldova : Health Transformation Program

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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45.72%
The proposed Health Transformation Program objective is to reduce key risks for non-communicable diseases, improve financial protection and enhance efficiency of health services in Moldova. The proposed four-year (2014-2018) Health Transformation Program will support a subset of the Strategy s first three sections. The proposed Program-for-Results (PforR) covers a time slice of a portion of the GOM program. It is expected to contribute to the Government program and, therefore, health system as a whole, by disbursing funds against achievement of a subset of its key results.

Verification of Performance in Results-Based Financing : The Case of Community and Demand-Side RBF in Rwanda

Renaud, Adrien; Semasaka, Jean-Paul
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
45.72%
Rwanda, led by its Ministry of Health, was the first African country to implement Performance- Based Financing (PBF) nationwide in its health centers and hospitals. The country then went on to pilot RBF interventions at the community level. Rewarding community members who provide and use Maternal and Child Health (MCH) services is an innovative form of Results-Based Financing (RBF). The supply-side of this community PBF scheme focuses on cooperatives of Community Health Workers (CHWs). It pays them to provide selected MCH services and rewards them for the quality of their reporting as well as for good management. Conversely, the demand-side of this community PBF scheme provides women with in-kind incentives when they utilize three selected MCH services in health centers. Verifying the performance of these interventions is an integral part of RBF program implementation. This case study aims to describe the verification mechanisms used in Rwanda, which include monthly verification of the quantity of services provided by the CHWs...

Verification of Performance in Results-Based Financing Programs

Perazzo, Alfredo; Josephson, Erik
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Trabalho em Andamento
EN_US
Relevância na Pesquisa
45.71%
Verification in results-based financing (RBF) mechanisms is one of the key differentiators between it and related health financing structures such as social health insurance. Verifying that providers have achieved reported performance in RBF mechanisms is considered a crucial part of program implementation and key to maintaining trust through transparency, as well as the viability of the mechanism. Verification is however a process which has thus far been little studied. Information on the methodologies used in different settings (including frequency and sampling methodology), the effectiveness of the verification process, the direct and tangential effects, and the cost is scarce. Plan Nacer employs one of the largest RBF mechanisms in the world and is therefore an excellent case study for the role, methodology and effects of the verification process. This study will give the background to Plan Nacer, detail the major characteristics of the verification process and draw lessons on the process which can inform the design of verification in RBF mechanisms in other countries.

Cost-Effectiveness Analysis of Results-Based Financing Programs; A Toolkit

Shepard, Donald; Zeng, Wu; Nguyen, Ha Thi Hong
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Working Paper; Publications & Research; Publications & Research :: Working Paper
ENGLISH; EN_US
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55.73%
Results-based financing (RBF), which rewards providers, users, or administrators of services upon achieving a set of verified results, has been gaining attraction in global health as a prominent approach to gain value for money. With a large number of countries adopting RBF in the recent years, evidence starts to emerge which points to the effectiveness of RBF in improving coverage and quality of important services, such as maternal and child health and reproductive health. The current toolkit aims to support country programs to assess the cost-effectiveness of RBF interventions and to facilitate cross-country comparisons of RBF programs. The toolkit is specifically tailored to supply-side RBF but its general principles apply to most health systems interventions directed at the health-related millennium development goals (MDGs). The development of the toolkit was based on actual experience of conducting a cost effectiveness analysis of Zambia’s RBF program and an extensive review of RBF programs features across the health results innovation trust fund (HRITF) portfolio. Given that RBF programs in the HRITF portfolio are typically complex health system interventions...

Using Evidence to Scale Up Innovation : Insights from a Results-Based Financing Project for Health in Zambia

Qamruddin, Jumana; Chansa, Collins; Das, Ashis
Fonte: International Finance Corporation, Washington, DC Publicador: International Finance Corporation, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
45.71%
Several developing countries face the challenge of attaining sufficient population level impact to meet health-related Millennium Development Goals (MDGs). This situation is partly attributable to constraints in their health systems, including: severe shortages in human resources for health; inequalities in service provision and utilization; limited financial resources; and inefficiencies in resource allocation and use. Even in countries with adequate financial resources, health indicators are sometimes poor due to inefficiencies and a lack of performance related initiatives. In an attempt to strengthen health systems and improve health-service delivery, several countries in Africa are increasingly using Results-Based Financing (RBF) approaches in their health programs. The premise is that linking financing to results will lead to improvements in health systems and health-outcome indicators. This paper captures emerging lessons from Zambia's drive to improve service delivery in the public-health sector with support from the World Bank's RBF initiative.

Results and Performance of the World Bank Group 2012 : Volume III. Management Action Record

Independent Evaluation Group
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH; EN_US
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45.74%
Management welcomes the Independent Evaluation Group (IEG) report results and performance 2012 of the World Bank group (RAP) and its overall positive assessment of the World Bank group development effectiveness. Management appreciates that the report provides a balanced picture of the World Bank group activities and recognizes that all three institutions have taken important steps to strengthen results, monitoring, and reporting. The report is especially useful to management to prioritize the challenges in the context of the ongoing efforts to strengthen focus on results. Management is concerned that the share of investment lending projects rated moderately satisfactory or better appears to be declining, after a long period of improvements observed since the mid-1990s.This reports includes five chapters: (i) the global development context ;(ii) world bank group operations: findings from evaluation work; (iii) enhancing the bank group's effectiveness;(iv) strengthening institutional results orientation;(v) conclusion: areas for attention

Republic of Uruguay Integrated National Health System : Analysis of the Governability of the SNIS Benefit Plan

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
45.68%
Today the health reform in Uruguay is a mature, ongoing process in which major progress has been consolidated. At the same time, like all systems, it faces challenges in the immediate, medium, and long term, and how they are resolved will not only shape the ultimate outcome of many of the processes currently under way, and but will also impact the sustainability of the accomplishments so far. The purpose of this study is to contribute to development of the integrated national health system (SNIS) by analyzing and identifying policy options aimed at improving its governance, equity, efficiency, and sustainability through the government's use of control variables in order to achieve and maintain conditions of governability and efficiency, which will contribute to the stability and sustainability of the results. The present study analyzes the main variables that Uruguay has at its disposal to manage a central aspect of regulating the sector namely, the plan of benefits that the population receives to cover their health needs. This plan has important consequences for both health and the economy. The specific objectives of the study were to analyze the following three aspects of the SNIS: (i) the conditions of governance and governability of its benefit plan...

The Health Workforce in Ethiopia : Addressing the Remaining Challenges

Feysia, Berhanu; Herbst, Christopher H.; Lemma, Wuleta; Soucat, Agnes
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH
Relevância na Pesquisa
55.68%
Health indicators in Ethiopia, particularly on child health and malaria, have improved significantly in recent years, with the next challenge now focused on improving maternal health indicators. Improvements in child health and malaria in particular can be attributed to strong government commitment towards health results, reflected in a number of notable policies and programs related to Human Resources for Health (HRH), in particular the health extension worker program. However, indicators related to maternal health remain problematic. Ethiopia has one of the lowest levels of assisted deliveries in the region. Although increases in the number of health workers particularly in rural areas may have contributed to improving access to some health services, it is in the government's interest to further improve the stock, distribution, and performance of relevant health workers in Ethiopia, particularly to bring about improvement in access to maternal health services for the poor. This document reviews the current HRH situation in Ethiopia...

Improving Health Service Delivery in Developing Countries : From Evidence to Action

Peters, David H.; El-Saharty, Sameh; Siadat, Banafsheh; Janovsky, Katja; Vujicic, Marko
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research
EN_US
Relevância na Pesquisa
45.68%
Decision makers and the public are in need of information to guide their decisions about how to strengthen health services. This book pulls together available evidence concerning strategies to improve health services delivery in low- and middle-income countries (LMICs), using current methods to assemble a knowledge base and analyze the findings. It describes the results of reviews of such strategies, and how such strategies can produce gains for the poor. This type of information is intended to help decision makers in LMICs learn from others and from their own experiences, so that they may develop and implement strategies that will improve health services in their own setting. The book provides some suggestions for what works and how to improve implementation, as the evidence does not hold up for 'blueprint' planning. It finds that there are many ways that can succeed in improving health services. But not nearly enough attention has been paid to demonstrating how to improve services for the poor. Approaches that ask difficult questions, use information intelligently, and involve key stakeholders and institutions are critical to 'learning and doing' practices that underlie successful implementation of health services.

Tajikistan - Feasibility Study for Results-Based Financing (RBF) In the Health Sector

World Bank
Fonte: World Bank Publicador: World Bank
Tipo: Economic & Sector Work :: Other Health Study
ENGLISH
Relevância na Pesquisa
55.74%
The purpose of this study is to examine the feasibility of introducing Results-Based Financing (RBF) in Tajikistan's health sector. Several countries have experience with RBF in low-income settings, and lessons learned can be interesting for Tajikistan. Technically, RBF is a retrospective provider payment that can be designed to reimburse providers for contractually defined services and specific compliance targets, including for efficiency and quality targets. In Tajikistan RBF will be linked to ongoing provider payment reforms. Therefore, the chapter also provides a brief overview on provider payment mechanisms and experience with provider payment reforms and treatment patterns from middle- and higher-income countries. The objective of this feasibility study is to propose a sustainable RBF pilot program for two oblasts (Khatlon and Sughd), to cost-effectively improve maternal and child health (MCH) outcomes. The study aims to inform the health sector strategy and help the Government and partners to effectively design and use RBF mechanisms at three potential levels. First...

Extension of Health Services Coverage in El Salvador : The RHESSA Project Experience

Bablumian, Isabella; Fernandez, Danilo; Cortez, Rafael
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
ENGLISH
Relevância na Pesquisa
55.66%
For a variety of reasons, the governments of Central America have struggled to provide basic healthcare services to their rural and impoverished populations. The lack of incentives for healthcare personnel to reside in or even to travel to remote areas, along with the deep rural-urban and rich-poor divides have resulted in poor coverage and poor health indicators. Further, language and cultural barriers and the lack of a budget for transportation in the rural departments have added to the complications in meeting the needs of the poor. In an effort to address the poor health indicators and the clients' complaints, to achieve equitable access to healthcare, and to reach the goals established by the Millennium Development Goals, the Salvadoran Government sought to extend essential healthcare services to disadvantaged populations, especially mothers and children, the poor, and rural and indigenous populations. With the help of a World Bank loan, the Ministry focused on: (1) solidifying the provision of health services to remote and poor areas; (2) expanding coverage; and (3) institutionalizing the program to assure its sustainability and governance for improved health results. Given the emerging financial crisis...

Benin - Health, Nutrition and Population : Health and Poverty Analytical Report; Benin - Santé, nutrition et population : rapport analytique santé pauvreté

World Bank
Fonte: World Bank Publicador: World Bank
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH
Relevância na Pesquisa
45.68%
This study is a continuation of the previous sector review, conducted in 2004. The 2008 review had two main objectives. This review is primarily an update on the situation. In its development strategy, Benin gave considerable importance to the health of its population. This effort is part of the long-term vision of the country. Improving health status, especially for the poor, is one of eight strategic directions for that vision. Similarly, on a more operational level, this objective is reflected in the current Growth Strategy for Poverty Reduction (GPRS 2007-2009). Benin is particularly committed towards the Millennium Development Goals, including 3 on the health sector. This review was also an opportunity to further analyze the constraints in the health system, consistent with the new strategy Health Nutrition and Population World Bank, Strategy adopted in 2007. But this exercise was not intended merely to be analytical. It also aimed to enrich the political dialogue between, on one hand, the actors in health and...

Croatia Program-for-Results : Improving Quality and Efficiency of Health Services

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study
ENGLISH; EN_US
Relevância na Pesquisa
45.71%
This technical assessment has been carried out as part of the preparation of the Health Program-for-Results (PforR) operation in Croatia. The primary focus of the assessment is on the Government's Program, and the National Health Care Strategy 2012-2020, and serves as the policy framework for this operation. The needs that Croatia's health system must address have changed as a consequence of the demographic and epidemiological transition in the country. The disease burden in Croatia has shifted from being dominated by maternal and child health and communicable diseases to being dominated by chronic and non-communicable conditions. The Government of Croatia's National Health Care Strategy sets out development directions for the health sector and is the framework for making policy and operational decisions, including the distribution of budgetary resources. The development of emergency medical services and investment planning project supported technical assistance to develop a hospital rationalization master plan...

Fiduciary Systems Assessment : Ethiopia Health MDG Support - Program for Results

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Integrated Fiduciary Assessment
ENGLISH; EN_US
Relevância na Pesquisa
45.71%
This health millennium development goals (MDGs) program for results (PforR) operation contributes to Ethiopia's fourth health sector development program (HSDP-IV) objectives by disbursing against achievement of a subset of its key results. MDG performance fund (PF) supports a sub set of key priorities for HSDP-IV. The three areas that the MDG PF supports are: (i) maternal health, (ii) child health, and (iii) strengthening health systems. The presented P4R operation will provide 100 million dollars International Development Association (IDA) funding for the MDG PF provided agreed results have been achieved and have been verified. The IDA credit will be complemented by a United States (U.S.) 20 million dollars grant under the health results innovation trust fund (HRITF). The assessment examined program expenditure framework to determine whether it is comprehensive, clearly defined, and determination whether it is part of the borrower's budget and financial management processes. It also focused on key elements of program procurement arrangements. The key risks identified by the integrated fiduciary systems assessment arise from the performance of the pharmaceutical fund and supply agency (PFSA)...

Sexual orientation and mental health: results from a community survey of young and middle-aged adults

Jorm, Anthony F; Korten, Ailsa; Rodgers, Bryan; Jacomb, Trish; Christensen, Helen
Fonte: Royal College of Psychiatrists Publicador: Royal College of Psychiatrists
Tipo: Artigo de Revista Científica
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55.6%
Background: Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups. Aims: To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals. Method: A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health. Results: The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family. Conclusions: The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Investing in children's health: what are the economic benefits?

Belli,Paolo C.; Bustreo,Flavia; Preker,Alexander
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2005 EN
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55.6%
This paper argues that investing in children's health is a sound economic decision for governments to take, even if the moral justifications for such programmes are not considered. The paper also outlines dimensions that are often neglected when public investment decisions are taken. The conclusion that can be drawn from the literature studying the relationship between children's health and the economy is that children's health is a potentially valuable economic investment. The literature shows that making greater investments in children's health results in better educated and more productive adults, sets in motion favourable demographic changes, and shows that safeguarding health during childhood is more important than at any other age because poor health during children's early years is likely to permanently impair them over the course of their life. In addition, the literature confirms that more attention should be paid to poor health as a mechanism for the intergenerational transmission of poverty. Children born into poor families have poorer health as children, receive lower investments in human capital, and have poorer health as adults. As a result, they will earn lower wages as adults, which will affect the next generation of children who will thus be born into poorer families.

Globalization and health: results and options

Cornia,Giovanni Andrea
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 EN
Relevância na Pesquisa
55.57%
The last two decades have witnessed the emergence and consolidation of an economic paradigm which emphasizes domestic deregulation and the removal of barriers to international trade and finance. If properly managed, such an approach can lead to perceptible gains in health status. Where markets are non-exclusionary, regulatory institutions strong and safety nets in place, globalization enhances the performance of countries with a good human and physical infrastructure but narrow domestic markets. Health gains in China, Costa Rica, the East Asian "tiger economies" and Viet Nam can be attributed in part to their growing access to global markets, savings and technology. However, for most of the remaining countries, many of them in Africa, Latin America and Eastern Europe, globalization has not lived up to its promises due to a combination of poor domestic conditions, an unequal distribution of foreign investments and the imposition of new conditions further limiting the access of their exports to the OECD markets. In these developing countries, the last twenty years have brought about a slow, unstable and unequal pattern of growth and stagnation in health indicators. Autarky is not the answer to this situation, but neither is premature...