Suchergebnisse

Front -- Contents -- Foreword -- Acknowledgments -- Overview and perspectives -- Part I Empirical facts on health expenditure -- Chapter 1 Basic patterns in national health expenditure -- Chapter 2 An overview of health financing patterns and the way forward in the WHO African Region -- Part II Reaching universal coverage -- Chapter 3 Universal coverage of health services: tailoring its implementation -- Chapter 4 Determinants of achieving universal coverage of health care: an empirical analysis -- Chapter 5 Impact of risk sharing on the attainment of health system goals -- Chapter 6 The impact of social health protection on access to health care, health expenditure and impoverishment A comparative analysis of three African countries -- Part III Insurance-based approaches -- Chapter 7 Social health insurance development in low-income developing countries: new roles for government and nonprofit health insurance organizations in Africa and Asia -- Chapter 8 Effectiveness of community health financing in meeting the cost of illness -- Chapter 9 Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems -- Chapter 10 Risk-pooling - necessary but not sufficient? -- Chapter 11 Scaling up community health insurance: Japan's experience with the 19th century Jyorei scheme -- Chapter 12 The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties -- Chapter 13 A framework for the analysis of best practices in the Rural Co-operative Medical System of the P.R. China -- Chapter 14 Social health insurance in developing countries: A continuing challenge -- Chapter 15 Social health insurance: Key factors affecting the transition towards universal coverage.

PART 1 TOWARDS BETTER HEALTH THROUGH COMMUNITY FINANCING IN POOR COUNTRIES -- The Current State of Health in the Third World -- Linkage Between Health, Health Financing and the Economy -- Lessening the Constraints on Health Development -- Economic Analysis of Community -- Financing Schemes -- PART 2 CASE STUDIES OF COMMUNITY FINANCING -- Direct Payment for Drugs at the Public Pharmacy in Fianga (Chad) -- The Role of User Fees in Financing Health Care at Government Health Centres in Rwanda Financing of Health Care at the Health Centre in Kita (Mali) -- The Pikine Project in Senegal: 15 Years of Experience in Financing Urban Primary Health Care -- Prepayment of Hospital Services in Bwamanda (Zaire) -- Main Lessons from the Practice of Community Financing -- Appendix: Exchange Rates -- Index.

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes ( 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.