Suchergebnisse

The Timor-Leste health resource tracking study was undertaken in order to improve the flow of critical cash and in-kind resources to districts and health centers by identifying, and proposing how to relieve, the most critical impediments in the public financial management (PFM) cycle. The study follows these three inputs backwards through every stage of the PFM cycle in order to unearth the pertinent issues that impede the timely and sufficient delivery of inputs to frontline providers. It required the collection of data from a wide variety of sources and the use of diverse methodological approaches, including semi-structured district- and facility level surveys, one-to-one interviews, transaction analysis, document review, and analysis of the government's financial management information system (FMIS). The study findings are presented in detail, together with the supporting evidence and key related recommendations, in chapter one, operating cash, chapter two, fuel budget, and chapter three, vehicle repairs and maintenance. Chapter four presents a set of cross-cutting findings that affect all areas of the goods and service budget.

Providing protection against the financial risk of high out-of-pocket health spending is one of the main goals of the Philippines' health strategy. Yet, as this paper shows using eight household surveys, health spending increased by 150 percent (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has trebled since 2000, from 2.5 to 7.7 percent. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate. In light of these findings, recent policies to enhance financial risk protection—such as the expansion of government-subsidized health insurance for the poor, a deepening of the benefit package, and provider payment reform aimed at cost-containment—are to be applauded. Between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, possible quick wins could include issuing health insurance cards for the poor to increase awareness of coverage and introducing a fixed copayment for non-poor members. Over the medium term, complementary investments in supply-side readiness are essential. Finally, an in-depth analysis of the pharmaceutical sector would help to shed light on why medicines continue to place such a large financial burden on households.

This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.

Excise taxes on tobacco and alcohol products can be an effective instrument for promoting public health through curbing smoking and excessive drinking, while raising significant revenues for development priorities. In 2012, the Philippines successfully passed a landmark tobacco and alcohol tax reform—dubbed the "Sin Tax Law." This book describes the design of the Philippines sin tax reform, documents the technical and political processes by which it came about, and assesses the impact that the reform has had after three years of implementation.

Objectives. We sought to provide data-based estimates of sexual violence in the Democratic Republic of Congo (DRC) and describe risk factors for such violence.

Social security, designed to provide protection against various contingencies, is not well suited to the elimination or redress of large-scale, endemic poverty, nor is it effective against the deep poverty caused by events such as the Great Depression. Social security on its own cannot overcome poverty of this magnitude, particularly in developing countries. For reasons of fiscal and administrative capacity, inter alia, social security usually expands through piecemeal reforms rather than through grand schemes. The basic income grant was, in its conception, just such a grand scheme and its proponents' untempered enthusiasm has unfortunately done harm to the cause of social security's realistic expansion. Now even the Taylor Committee, after initial enthusiasm, has accepted that a basic income grant is not viable. And so the time has come to return to the job at hand for social security: to painstaking and piecemeal analysis, to the careful weighing of alternatives, and to informed debate. This article attempts to contribute to this end. We show that the South African social security system, though very advanced for a country at this level of per capita income, still has pervasive gaps in its coverage and is close to the limits of its capacities. Yet the Constitution obliges government to work towards the progressive expansion of social security and in this article we support incremental and targeted social security interventions as the strategy most likely to contribute to poverty reduction. We use an analysis of 1995 income distribution data to assist us in identifying where such social security interventions are most likely to have a significant poverty alleviating effect.

This book describes the nature of public-private partnerships (PPPs) in the health sector in Vietnam. It defines health-related PPPs, describes their key characteristics, and develops a taxonomy of the different types of PPPs that exist in practice, illustrated by international examples. It also assesses the regulatory and institutional framework for the health PPP program in Vietnam, as well as financing and accountability mechanisms for PPPs at its national and subnational levels. It provides an overview of the PPP project pipeline in Vietnam and analyzes important issues in the health PPPs' design, preparation, and implementation, using eight case studies involving projects in different phases of the project cycle. This book also examines barriers that have hampered the successful design and implementation of health care PPPs in Vietnam. These barriers may be broadly categorized as barriers in the PPP policy and regulatory framework, in the public sector, in the private sector, and in the financial sector. It proposes feasible and actionable recommendations so that the government can consider tackling the identified barriers and advance the successful design and implementation of health PPPs.