Suchergebnisse

In less than a decade, China transformed its inadequate, unjust health care system in order to provide basic universal health coverage (UHC) for its people. What forces made it possible for China to achieve this? What kind of transformation took place? What are the impacts of these policy changes? What can we learn from China? Moreover, while China has achieved UHC in basic health services, this does not mean that everyone has equal access to the same quality of affordable health care. This paper, which uses a theory of political economy to analyse China´s policy changes and accomplishments, consists of four main sections. Section I reviews the historical development of the Chinese health care system from the 1950s through the 1990s, tracing the serious consequences of the policy shift in the 1980s when the health care system and health care delivery became privately financed and commercialized. Section II analyses the political economy factors that drove and shaped the reform of the Chinese health system, focusing on the politics, institutions and actors that synergistically led to the establishment of UHC in 2009. In this section, we modified slightly John Kingdon´s theory and used it to examine four main streams of forces to explain how China´s reform came about. (1) The problem stream shows how Chinese political leaders recognized a serious, widespread public discontent regarding health and then diagnosed the root causes of these health problems. (2) The policy stream examines how major stakeholders in the health sector proposed, and heatedly debated, different policy options based on their vested interests and ideologies. (3) The financial stream highlights how China´s health policy was driven by fiscal constraints. (4) The politics stream analyses the political factors that influenced the agenda setting and policy formulation of UHC in authoritarian China, albeit with limited political transparency. The paper tracks these streams with historical evidence to conclude that the policy changes for UHC in China were established by the convergence of these four streams. Section III presents the policy outcomes - the current financing structure of the UHC (i.e., the three different insurance schemes, their benefit packages, and key companion programmes to assure the supply of basic services). Based on quantitative evidence, we summarize the impacts of China´s UHC in terms of equitable access to health care, quality and affordability of health care, health outcomes, and financial risk protection from high and/or catastrophic medical expenses. Although China´s UHC was a great achievement, stark disparities remain between urban and rural residents in China, along with high health expenditure inflation rates arising from inefficiency and waste in the health care system. In section IV, we discuss the remaining challenges for China´s health care system and comment on the potential lessons of the Chinese experience for other nations.

Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.

This primer aims to provide IMF macroeconomists with the essential information they need to address issues concerning health sector policy, particularly when they have significant macroeconomic implications. Such issues can also affect equity and growth and are fundamental to any strategy of poverty reduction. The primer highlights the appropriate roles for the state and market in health care financing and provision. It also suggests situations in which macroeconomists should engage health sector specialists in policy formulation exercises. Finally, it reviews the different health policy issue

How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.

The construction of high capacity data sharing networks to support increasing government and commercial data exchange has highlighted a key roadblock: the content of existing Internet-connected information remains siloed due to a multiplicity of local languages and data dictionaries. This lack of a digital lingua franca is obvious in the domain of human food as materials travel from their wild or farm origin, through processing and distribution chains, to consumers. Well defined, hierarchical vocabulary, connected with logical relationships—in other words, an ontology—is urgently needed to help tackle data harmonization problems that span the domains of food security, safety, quality, production, distribution, and consumer health and convenience. FoodOn (http://foodon.org) is a consortium-driven project to build a comprehensive and easily accessible global farm-to-fork ontology about food, that accurately and consistently describes foods commonly known in cultures from around the world. FoodOn addresses food product terminology gaps and supports food traceability. Focusing on human and domesticated animal food description, FoodOn contains animal and plant food sources, food categories and products, and other facets like preservation processes, contact surfaces, and packaging. Much of FoodOn's vocabulary comes from transforming LanguaL, a mature and popular food indexing thesaurus, into a World Wide Web Consortium (W3C) OWL Web Ontology Language-formatted vocabulary that provides system interoperability, quality control, and software-driven intelligence. FoodOn compliments other technologies facilitating food traceability, which is becoming critical in this age of increasing globalization of food networks.

In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.