sábado, 4 de septiembre de 2010

Implementing health financing reform



Implementing health financing reform

World Health Organization WHO 2010, on behalf of the European Observatory on Health Systems and Policies

The editors:

Joseph Kutzin - Regional Advisor for Health Systems Financing and Head of the Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe.

Cheryl Cashin - Research Fellow at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, School of Public Health, University of California, Berkeley,USA.

Melitta Jakab - Senior Health Financing Policy Analyst at the Barcelona Office for Health Systems Strengthening, WHO Regional Office for Europe.

Available online PDF [425p.] at: http://bit.ly/bEFpqk

"…….the conceptual approach used for this study is guided by the assumption that lessons from experiences relating to implementation of health financing reforms can be derived by using
(1) a common set of explicit policy objectives as assessment criteria;
(2) a function-based framework as a basis for describing health financing systems and reforms; and
(3) identification and analysis of key contextual factors with implications for particular reform options and their effects.

This standardized approach to assessment and description will enable lessons to be generated, particularly from those countries that have carried out "deep" reforms of their financing systems. Such lessons will be of interest not just to the countries in transition, but for countries in other parts of the world as well.


A. Framework for analysis - The conceptual approach is built on three pillars (Fig. 1.1).

·          The first is a standard set of objectives for health financing policy derived from The world health report 2000 framework (WHO 2000). These serve as the criteria against which health financing reform experience is assessed.

·          Second is a standard approach to describing the functions and policies associated with all health financing systems (adapted from Kutzin 2001). The world health report 2000 identified health financing as one of the four functions of the health system3 and the health financing system consists of specific sub-functions and policies – revenue collection, pooling of funds, purchasing of services, and policies to define and ration benefit entitlements (most commonly through patient cost-sharing obligations).

·          The third pillar consists of a recognition and analysis of how key contextual factors limit the extent to which a country can sustain achievement of the policy objectives, and may affect the feasibility of implementing certain reform options. The most important of these is the fiscal context. This refers to the ability of government to mobilize tax and other public revenues…."




Part one: Background to health financing systems and reforms in countries in transition

Chapter 1 Conceptual framework for analysing health financing systems and the effects of reforms

Chapter 2 Understanding the legacy: health financing systems in the USSR and central and eastern Europe prior to transition

Chapter 3 Fiscal context and health expenditure patterns

Part two: Reforms in health financing functions

Chapter 4 Sources of funds and revenue collection: reforms and challenges

Chapter 5 Reforms in the pooling of funds
Chapter 6 Purchasing of health care services

Chapter 7 Coverage decisions: benefit entitlements and patient cost sharing

Part three: Improving the performance in health financing systems

Chapter 8 Financing capital costs and reducing the fixed costs of health systems

Chapter 9 Financing of public health services and programmes: time to look into the black box

Chapter 10 Aligning public expenditure and financial management with health financing reforms

Chapter 11 What role for voluntary health insurance?

Chapter 12 Strategies to address informal payments for health care

Chapter 13 Promoting accountability in health care financing institutions

William D. Savedoff, Hernan L. Fuenzalida-Puelma

Part four: Synthesis – lessons for policy from the experience of CE/EECCA countries on the implementation of health financing reforms

Chapter 14 Implementing health financing reform in CE/EECCA countries: synthesis and lessons learned



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