Suchergebnisse

This study reviews literature on financing catastrophic health expenditures in selected countries to describe and synthesize the strategies of relatively successful health financing schemes. It begins with a review of basic concepts and definitions to set the stage for later discussions. This is followed by a country selection process, where countries were selected based on their income level, health outcomes, coverage outcomes, cost effectiveness, and the availability of information on their health financing strategies. Low-income, lower middle-income, and upper middle-income countries were selected, each one having above average outcomes and cost effectiveness relative to other countries within the same income level. The availability of information further limited the selection to three countries - Kyrgyz Republic, Sri Lanka, and Thailand - on which a desk review was conducted. The study presents the stories of each country and the common themes that emerged.The stories reveal that the causes behind catastrophic payments, specifically high out-of-pocket payments, vary, thus the strategies for addressing them also do. Health financing schemes were either set for the whole population or formulated to fit specific segments. All three countries increased the amount of funding available for health care, and did so mostly through taxation. Benefits are comprehensive, covering preventive, inpatient, and outpatient care with drugs and medicines. Payment methods were generally designed to use the available funds in a cost-effective manner by strengthening preventive primary care, and incentivizing efficiency in tertiary care facilities.Beyond that, change management factors that were common to most or all of the countries were: crises that created an impetus for change; strong public demand and participation; a political system that empowers the populace and creates political incentives for reform; commitment to a comprehensive, cohesive, and appropriate strategy; grit and responsiveness throughout the implementation period; monitoring and evaluation; and rapid but phased implementation.

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013-2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.