OpenUCT :: Browsing by Author "McIntyre, Di"

Browsing by Author "McIntyre, Di"

Now showing 1 - 20 of 48

Open Access
Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism
(1999) Blecher, Mark Stephen; Bachmann, Max; McIntyre, Di
Objective: The objectives of the study were to determine General Practitioners' attitudes to National Health Insurance (NHI) and to capitation as a mechanism of reimbursement. The study also aimed to explore determinants of these attitudes. Design: The methodology utilised a cross-sectional survey using telephone interviews and four focus group discussions. Setting: The study area was the Cape Peninsula area in the Western Cape Province of South Africa. Participants: 174 general practitioners (GPs) were randomly sampled from a total population of 874 GPs in the Cape Peninsula area. Main outcome measures: The main outcome measures were GPs' acceptance of NHI and of capitation as a method of reimbursement. Main results: Sixty three percent of GPs (63,3%) approved of NHI. More than 81 % approved of NHI if GPs were to maintain their independent status, for example their own premises and working hours. Eighty two percent (82,3%) said NHI would be a more equitable system of health care than the system that existed at that time, 88% approved of the fact that NHI would make care by GPs more accessible and 73% said they had the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement. The most common conditions cited by GPs for support of NHI were retention of professional autonomy, fee for service reimbursement and adequate levels of reimbursement. Conclusions: Most GPs in the Cape Peninsula were amenable to some form of NHI. However, approval of NHI is to some extent conditional to details of the NHI system, such as payment mechanisms, workload, income and effects on professional autonomy. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI in South Africa requires serious consideration by policy makers. While this research demonstrates broad ideological and conceptual support for some form of NHI or SHI, further research is required to provide more detailed quantitative information on the trade-offs that GPs would be prepared to make for them to support the introduction of a new socially based insurance system. A national survey of medical practitioners is recommended.
Open Access
Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector
(BioMed Central Ltd, 2012) Abiiro, Gilbert; McIntyre, Di
BACKGROUND: Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP) policy in Ghana.DISCUSSION:Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing), as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems.SUMMARY:The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It is critical that there is more extensive debate on the advantages and disadvantages of alternative funding mechanisms, supported by a solid evidence base, and with the policy objective of universal coverage providing the guiding light.
Open Access
Assessing financial management capacity for district health system development : a case study of the Mount Frere District
(1998) Morar, Reno Lance; McIntyre, Di
The specific objective of this report is the assessment and analysis of the current financial management capacity at the district level in Mount Frere. It will specifically address the assessment and analysis of financial management capacity in the Mount Frere district, Region E in the EC Province, Department of Health.
Open Access
Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana
(BioMed Central, 2017-05-22) Akazili, James; Ataguba, John Ele-Ojo; Kanmiki, Edmund Wedam; Gyapong, John; Sankoh, Osman; Oduro, Abraham; McIntyre, Di
Background: There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods: Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results: There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion: It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.
Open Access
Assessment of user fee system : implementation of exemption and waiver mechanisms in Tanzania : successes and challenges
(2010) Munishi, Victima; Govender, Veloshnee; McIntyre, Di
The aim of this study was to evaluate the implementation of exemptions and waivers and to support efforts to address current challenges and promote use of public sector health services. The study was conducted in Bagamoyo and Mtwara rural districts. A qualitative approach (in-depth interviews and focus group discussions) was used since it was considered appropriate for a study focusing on the perceptions, views, and experiences of users and providers.
Open Access
Benefit incidence analysis of antiretroviral drugs in Uganda : a case study of Kampala and Masaka districts
(2005) Kyomuhangi, Rosette; McIntyre, Di
In the face of rising morbidity and mortality due to HIV / AIDS epidemic in Sub-Saharan Africa, there has been an increasing pressure to provide life sustaining antiretroviral (ARV) drugs to countries in most urgent need of them. Antiretroviral Therapy (ART) has been identified by policy-makers in Uganda as a potential programme aimed at mitigating the pervasive effect of HIV / AIDS on the social and economic life of the country. Since 2000, the country has shifted its focus from primarily HIV prevention to paying equal attention to care and treatment including ART. Provision of the ART programmes have been made possible through concerted efforts of international and national organizations such as the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank, Multi-country AIDS Programme (MAP), Great Lakes Initiative on AIDS (GLIA), the USA President's Emergency Plan for AIDS Relief (PEPFAR), UN agencies, Bi-lateral and Government of Uganda inputs (UAC 2004). New and increased funding notwithstanding, the Ugandan population has continued to grow exponentially at a rate of 3.5% and even though the economy has been growing at a rate of 6 % per annum, there is a widening disparity in incomes attributed largely to high levels of unemployment in the country (Ministry of Finance 2002). These income disparities have also greatly contributed to health inequities in Uganda, thus affecting the equitable allocation of the limited health resources including ART. The main aim of the study was to establish the socioeconomic status of those individuals who benefit most from the provision of free ARV drugs and to explore factors that influence the distribution of such benefits. The study was carried out in Kampala district (Uganda's capital city) and Masaka district. The study employed both qualitative and quantitative methods. Facility-exit interviews with patients accessing free ARVs formed the quantitative method, while Focus Group discussions with community representatives and in-depth interviews with key informants formed the qualitative part of the study. Quantitative data was obtained by use of a questionnaire, which was structured to obtain information on socioeconomic characteristics, including asset possession as a measure of wealth. A principal component analysis was run for both the Uganda Demographic Health Survey (UDHS) and facility-exit asset data to determine utilization of ARV by wealth quintiles. A benefit incidence costing model was also employed to determine monetary benefit of free ARVs in Uganda.
Open Access
Benefit incidence of health services in Ghana and access factors influencing benefit distribution
(2011) Garshong, Bertha; McIntyre, Di
Universal coverage is built around financial protection and access to needed care for all members of the society. The main focus in many countries, including Ghana, has been on financial protection. However removing financial barriers does not necessarily remove other access barriers to the use of health care services. The extent to which a population gains access to health care depends on a multiplicity of factors. The study investigated the distribution of health care benefits across socioeconomic groups, assessed if these benefits are distributed according to need and identified health system and community access factors that influence the distribution of benefits from using health care services in Ghana, in order to identify policy options for promoting equitable access to and use of health services in Ghana.
Open Access
A cost analysis of rural primary health care (PHC) services in KwaZulu-Natal
(2004) Matsheke, Thembakazi; Muheki, C; McIntyre, Di
It has been found that South Africa has very limited costing information of health services at both primary and higher levels of care. Therefore, a study was conducted in Ingwavuma health district, a rural setting in KZN, evaluating costs of primary health care (PHC) services. The primary objective of the study was to evaluate the costs of providing PHC services in a rural setting and to compare costs of providing PHC services at different levels of care. Costs data were collected through interview and record reviews from Manguzi hospital, a district hospital, and nine clinics operating within the hospital's catchment area. Cost comparisons between Manguzi clinics and between the clinic and hospital levels were undertaken. Variations in terms of costs between similar facilities (clinics) were discovered, with some clinics being more costly compared to others. Such variations can be explained by some input costs, e.g. personnel which varied considerably between facilities. Variations in the personnel costs between similar facilities were found to be linked with staff distribution patterns and facility utilisation. In addition, variations in terms of costs were also discovered between services provided within one facility. For instance, expenditure ﬁgures revealed that the largest proportion of resources was spent on curative services. Tuberculosis and mental health services consumed a minimum amount of resources, namely about 1%. Further comparison of Manguzi results with those of the Centre for Health Policy (CHP) was undertaken. Costs analyses of PHC services provided at Manguzi clinics with similar facilities compared to other sites. namely Agincourt (a rural setting), and Alexandra Health Centre (AHC) (an urban setting), were undertaken. Manguzi and Agincourt have similar costs of PHC services. However, AHC has relatively higher costs compared to the other two sites. This is probably because Manguzi and Agincourt are both rural. Finally, analysis on scaling-up PHC services in Manguzi to the essential package target of 3.5 utilisations per person per year shows that there would be no additional staff costs required. The current staffing levels in Manguzi seem to be sufficient to provide a comprehensive PHC package of 3.5 visits per person per year.
Open Access
The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa - a primary data analysis
(BioMed Central Ltd, 2006) Cleary, Susan; McIntyre, Di; Boulle, Andrew
BACKGROUND:Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART) represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY) and quality adjusted life year (QALY) gained of HIV treatment interventions from a provider's perspective. METHODS: Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years) using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line) were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. RESULTS: Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210) per QALY and US$984 (95% CI 913-1,078) per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes were lower, but the ICER was similar. CONCLUSION: Decisions to scale-up ART across sub-Saharan Africa have been made in the absence of incremental lifetime cost and cost-effectiveness data which seriously limits attempts to secure funds at the global level for HIV treatment or to set priorities at the country level. This article presents baseline cost-effectiveness data from one of the longest running public healthcare antiretroviral treatment programmes in Africa that could assist in enhancing efficient resource allocation and equitable access to HIV treatment.
Open Access
The costs of adult inpatient care for HIV disease at GF Jooste Hospital
(2000) Haile, Brian; McIntyre, Di
The lack of patient care and utilisation data impairs the ability of hospital and clinic administrators to make informed, data-driven policy choices. This concern is particularly acute with HIV/AIDS, given both the striking growth in the local epidemic over the last two years and the high level of HIV-related health expenditures shouldered by the provincial medical system in the Western Cape province of South Africa. A retrospective chart review was conducted to capture clinical and utilisation data of from a sample of 59 inpatients, who were admitted to a township secondary hospital near Cape Town, South Africa during 1997. Three years of data were abstracted and analysed.
Open Access
Critical evaluation of the role of community based health insurance schemes in extending health care coverage to the informal sector in Ghana
(2006) Danso, Collins Akuamoah; McIntyre, Di
One major challenge facing the international development community is how to finance and provide health care for the large informal sector in low and middle income countries. This is as a result of the inability of the traditional tax systems in most of these countries to generate the needed revenue to help meet the health needs of the citizens. In recent times, many countries in developing countries are increasingly depending on Community Based Insurance Schemes (CBHIS) as an alternative health care financing mechanism. In Ghana. the universal tax funded system of health care introduced in 1957 soon alter independence could not be sustained because of economic recession in the 1970's and 1980's forcing the government to introduce user fees in all public health institutions. User fees resulted in a decline in utilization of health services especially the poor and vulnerable group. This situation forced many communities to set up CBHIS meant to cover user fees charged at the health facilities. The success of some of these schemes and the fact that many Ghanaians do not have insurance cover led the government to introduce a National Health Insurance Scheme (NHIS) which is mandatory for all citizens. The law mandates all formal sector workers to contribute part of their social security contribution to the National Health Insurance Fund as premium, thus making it compulsory for them. Those in the informal sector are however required to voluntarily pay directly into their district schemes. Also, even though a proposal has been made to exempt the poor, no mechanism has been determined to identify poor households for subsidy. This study sought to undertake a critical evaluation of the role of CBHIS under the NHIS in extending health care coverage to the large informal sector (who are about 70% of the active labour force) in Ghana. Specifically, the study sought to determine factors that affect enrolment, to determine a practical mechanism to identify the poor and to gain an understanding of how other countries have increased health insurance coverage.
Open Access
A critical evaluation of the sector wide approach (SWAp) in the health sector in Zambia
(2006) Chansa, Collins; McIntyre, Di
International recognition of the health problems being faced by developing countries have resulted in significant increases in external development assistance for health since the late 1980s. However, it has been established that this aid has not been effective due to poor coordination, harmonization and alignment. As part of the aid development architecture, donors and recipient countries have defined approaches, modalities and methods of working aimed at improving harmonization, alignment and management of aid for results. One such approach is the Sector Wide Approach (SWAp) which involves ensuring that "all significant funding for the sector supports a single sector policy and expenditure programme, under government leadership, adopting common approaches across the sector, and progressing towards relying on government procedures to disburse and account for all funds." (Foster et ai, 2000a, p.6).In Zambia, the health SWAp has been in existence since 1993. The adoption of the health SWAp was necessitated by a desire to optimize the use of domestic and externally mobilised financial and in-kind development assistance through the integration of all vertical programmes into a sectoral framework that would meet common national goals and objectives. This was after it was realised that the health system was inefficient in its provision of health services due to the existence of fragmented, multiple donor-assisted projects which the Ministry of Health could not effectively coordinate and manage.This paper explores the contribution of the health SWAp to the provision of effective health care in Zambia since its inception in 1993. The study considered the SWAp as both an aid instrument and as a process and the evaluation is made by looking at both the individual elements of a SWAp and the SWAp mechanism as a whole. The study assesses the contribution of the SWAp to fostering working relationships, accountability for finances and progress, efficient allocation and use of resources, financial sustainability and promotion of geographical equity of access to health care resources.The study was exploratory and a retrospective approach was used to track and associate changes before the introduction of the health SWAp and after the SWAp implementation period 1993 - 2005. In order to take account of certain contextual factors in the broad health reform continuum, a combination of qualitative and quantitative research techniques were used. This includes 21 in-depth key informant interviews, a Focus Group Discussion (FGD), non-participant observation at 4 different SWAp coordination meetings and a comprehensive document review. Study participants were senior members of the Health Sector AdviSOry Committee that were drawn from 6 provinces (including the capital city Lusaka). The actual selection of interviewees was done purposively based on the possession of requisite expertise, diversity and availability.
Open Access
Demand for ante-natal care in Nairobi's slum areas
(1998) Wamukuo, Joseph Thairu; Kirigia, Joses; McIntyre, Di
This paper studies the factors influencing the demand for ante-natal care in two of Nairobi's slum areas, namely, Kibera and Mathare. Antenatal care is important as its absence I underprovision means higher incidences of both maternal and infant mortalities. On the other hand proper ante-natal care means improved well-being of both mother and child. These two groups constitute over 70% of Kenya's population. For any economic and social development programmes to succeed, there is need to give mother and child special attention. The factors influencing the demand for ante-natal care could be grouped into three major categories; socio-economic (age, marital status, income etc.), facility (quality of care) as well as policy (user-fee) variables. The data for the analysis was obtained by means of a household survey conducted in Kibera and Mathare. A two stage sampling procedure was used for the data collection. This involved first, listing of all clusters from which a random selection of clusters to be studied was done and secondly, the households were drawn by a random sample within each of the selected clusters.
Open Access
Distributional impact of health care finance in South Africa
(2012) Ataguba, John E; Woolard, Ingrid; McIntyre, Di
In South Africa, health care is financed through different mechanisms - allocations from general taxes, private health insurance contributions and direct out-of-pocket payments. These mechanisms impact differently on different households. While there are empirical evidence in developed countries, the distributional impact of such payments and methodological challenges in such assessments in the context of Africa are scarce. Borrowing from the tax literature, the thesis aims to assess the relative impact of health care financing on households' welfare and standards of living. Methodological issues around the assessment of income redistributive impact of health care payments in the context of South Africa are also explored.
Open Access
The economic burden of 'malaria' morbidity on households in Mtoko district of North-Eastern Zimbabwe
(2006) Chandiwana, Shingirai David; McIntyre, Di
This thesis presents the findings of a research on the economic burden of malaria morbidity to rural households in Mtoko district of North-East Zimbabwe. The main objective of this study was to ascertain the household level impacts of direct costs (medical costs, consultation costs, transport costs and other related costs) and indirect costs (lost productive time by malaria sufferers whilst sick, lost time by caretakers whilst caring for the sick) due to malaria sickness. A cross sectional study with both descriptive and analytical features was carried out and the main finding from the research was that the economic costs of seeking malaria care were regressive. In other words the poor were using a higher percentage of their income whilst seeking malaria care. In addition, access to care was very limited for the poor as they either could not afford to access the care because of prohibitive costs or they were geographically too far away from sources of care to easily access it. Furthermore, indirect costs were far higher than direct costs as they constituted a greater percentage of total malaria costs. It was concluded that measures meant to exempt the poor from paying for malaria treatment and care were needed to limit the economic burden of malaria morbidity on poor households. The need to ensure that cheap affordable malaria drugs were available to the affected rural people is imperative.
Open Access
An economic evaluation of task-shifting approaches to the dispensing of anti-retroviral treatment in the Western Cape, South Africa
(2011) Foster, Nicola; McIntyre, Di
This study aims to critically evaluate the ISPA [indirectly supervised pharmacists assistants] and nurse-based pharmaceutical care models against the standard of care that involves a pharmacist dispensing ART, on the basis of cost, and patient preference.
Open Access
Equity and efficiency in health and health care for HIV-positive adults in South Africa
(2007) Cleary, Susan; McIntyre, Di; Mooney, Gavin
This dissertation presents a framework for assessing equity and efficiency in health and health care for HIV-positive adults in South Africa, which is tested in the extensive analysis of empirical data on the costs and consequences of alternative HIV-treatment strategies in the public health care system. The framework is built through asking three key questions. The ﬁrst question -- what is the good (value or beneﬁt) of health care -- considers what ought to be in the evaluative space of distributive justice in relation to this dissertation and in health economics more generally. The second question considers the factors that might constitute claims on this good, including personal responsibility, need, the social context as well as the impact of allocations of the good on the health of society and the social fabric. The ﬁnal question -- how should the good be distributed -- examines alternative social choice rules for distributing the good and develops an approach grounded in procedural justice that legitimizes the choice of one rule over another. To apply this framework, patient and population-level costs and consequences associated with alternative HIV-treatment interventions are analysed in Markov models. These are extensively validated and uncertainty is assessed through probabilistic and multi-way sensitivity analyses. Results of these analyses are key inputs into mathematical programming algorithms that allow an assessment of the implications of choosing one social choice rule over another in terms of gains in the good and the proportion of need that can be met through one or more treatment strategy across a range of budgets. In discussing and concluding, these empirical results are reintegrated into the conceptual framework where the notion of claims on the good and a decision-making approach grounded in procedural justice is further developed. It is argued that the proper implementation of this framework will result in allocations of the good that are fair even if this is at a level of less than universal access to the most effective treatment strategy.
Open Access
Equity in Health Care Financing in Ghana
(2010) Akazili, James; McIntyre, Di
Financial risk protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". The study (the first of kind in Ghana) measured the relative progressivity of health care financing mechanisms, the catastrophic and impoverishment effect of direct health care payments, as well as evaluating the factors affecting enrolment in the national health insurance scheme (NHIS), which is the intended means for achieving equitable health financing and universal coverage in Ghana. To achieve the purpose of the study, secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other ministries and departments, and further complemented with primary household data collected in six districts. In addition 44 focus group discussions with different groups of people and communities were conducted. In-depth interviews were also conducted with six managers of District NHI schemes as well as the NHIS headquarters. The study found that generally Ghana's health care financing system is progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes which account for over 50% of health care funding. The national health insurance levy is mildly progressive as indicated by a Kakwani index of 0.045. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are associated with significant catastrophic and impoverishment effects on households. The results also indicate that high premiums, ineffective exemptions, fragmented funding pools and perceived poor quality of care affect the expansion of the NHIS. For Ghana to attain adequate financial protection and ultimately achieve universal coverage, it needs to extend cover to the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the NHI. Furthermore, the funding pool for health care needs to grow and this can be achieved by improving the efficiency of tax collection and increasing the budgetary allocation to the health sector.
Open Access
Equity in Health Financing: Review of Health Care financing in Four organizations for economic cooperation development (OECD) countries, Canada, The republic of Korea, Mexico and the United Kingdom
(2010) Kinyua, Caroline Gacheri; McIntyre, Di
Background: The World Health Assembly Resolution in 2005 urges Member States to introduce and/or strengthen universal coverage policy in order to offer financial risk protection (FRP) to households in order to avoid catastrophic health expenditures and impoverishment from seeking care. The other goal of universal coverage is to ensure equitable access to healthcare based on relative need, irrespective of ability to make health care payments, social status or geographical location. The two prepaid financing mechanisms that guarantee universal coverage are social health insurance and general tax revenue. Aim: To undertake a comparative analysis of selected OECD countries with universal coverage to derive lessons that could inform the development of universal coverage policy in low-to-middle income (LMICs) countries. Methods: Empirical evidence from the OECD was sourced through an extensive review of published literature from print and electronic sources. Selection sought to include a range of countries in different continents and health systems with a long history as universal systems. Most universal systems are in OECD countries. OECD countries were selected because of availability of quality and credible data. The data for the analysis is drawn from the OECD Health Data 2008 dataset. Kutzin's conceptual framework is the analytical tool for the critical analysis of evidence, including OECD data, to evaluate the functionality of each health system based on the concepts of equity, sustainability, efficiency and feasibility. Results: Findings from the analysis show that publicly funded (primarily tax-funded) systems have lower out-of-pocket expenditures and offer greater financial risk protection. Systems with a single risk pool and a single payer tend to be more administratively efficient than multiple pools and payers. Allocating health resources based on a needs-based allocation formula is more equitable than historical budgeting. Capitation provider payment promotes greater efficiency than fee-for-service. A purchaser-provider split can improve efficiency.
Open Access
Evaluating the cost-effectiveness of artemisinin-based combination antimalarial drugs and malaria rapid diagnostic tests within the context of effective vector control : case study of Southern Africa
(2006) Zikusooka, Charlotte Muheki; McIntyre, Di; Barnes, Karen
This study seeks to use the techniques of cost-effectiveness analysis to evaluate, within the context of effective vector control, the change to artemisinin-based combination therapies (ACTs) as first line malaria treatment and to evaluate the relevance of using definitive diagnosis (as opposed to clinical diagnosis) as the basis for initiating malaria treatment, especially when using ACTs for treatment. The cost-effectiveness of ACTs was evaluated in two study sites (i.e. In Kwazulu Natal which switched from SP monotherapy to AL in 2001 and in Mpumalanga which changed from SP monotherapy to AS+SP in 2003) in South Africa. The economic evaluation of use of routine definitive diagnosis as part of malaria case management, using rapid diagnostic tests (ROTs), was undertaken at two districts (Namaacha and Matutuine), in southern Mozambique, where routine use of ROTs and treating malaria patients with an ACT (using artesunate + SP) were implemented at pilot level in 2003.