Browsing by Subject "Financing"

Now showing 1 - 4 of 4
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    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.
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    An evaluation of health systems equity in Indonesia: study protocol
    (BioMed Central, 2018-09-12) Wiseman, Virginia; Thabrany, Hasbullah; Asante, Augustine; Haemmerli, Manon; Kosen, Soewarta; Gilson, Lucy; Mills, Anne; Hayen, Andrew; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn
    Background Many low and middle income countries are implementing reforms to support Universal Health Coverage (UHC). Perhaps one of the most ambitious examples of this is Indonesia’s national health scheme known as the JKN which is designed to make health care available to its entire population of 255 million by end of 2019. If successful, the JKN will be the biggest single payer system in the world. While Indonesia has made steady progress, around a third of its population remains without cover and out of pocket payments for health are widespread even among JKN members. To help close these gaps, especially among the poor, the Indonesian government is currently implementing a set of UHC policy reforms that include the integration of remaining government insurance schemes into the JKN, expansion of provider networks, restructuring of provider payments systems, accreditation of all contracted health facilities and a range of demand side initiatives to increase insurance uptake, especially in the informal sector. This study evaluates the equity impact of this latest set of UHC reforms. Methods Using a before and after design, we will evaluate the combined effects of the national UHC reforms at baseline (early 2018) and target of JKN full implementation (end 2019) on: progressivity of the health care financing system; pro-poorness of the health care delivery system; levels of catastrophic and impoverishing health expenditure; and self-reported health outcomes. In-depth interviews with stakeholders to document the context and the process of implementing these reforms, will also be undertaken. Discussion As countries like Indonesia focus on increasing coverage, it is critically important to ensure that the poor and vulnerable - who are often the most difficult to reach – are not excluded. The results of this study will not only help track Indonesia’s progress to universalism but also reveal what the UHC-reforms mean to the poor.
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    Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response
    (2020-06-01) Shretta, Rima; Silal, Sheetal P; Malm, Keziah; Mohammed, Wahjib; Narh, Joel; Piccinini, Danielle; Bertram, Kathryn; Rockwood, Jessica; Lynch, Matt
    Background Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005 and 2015. These gains have been facilitated in part, due to increased financial commitment from government and donors. Total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million in 2011. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential donor requirements for increased government contributions. The resulting financial gap will need to be met domestically. The purpose of this study was to provide economic evidence of the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization. Methods A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios of common interventions that allowed the attainment of elimination and those that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option. Results Elimination was predicted using the package of interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana is predicted to cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced health system expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Reducing interventions, predicted an additional 38.2 clinical cases, 2500 deaths and additional economic losses of USD 14.1 billion. Conclusions Malaria elimination provides robust epidemiological and economic benefits, however, sustained financing is need to accelerate the gains in Ghana. Although government financing has increased in the past decade, the amount is less than 25% of the total malaria financing. The evidence generated by this study can be used to develop a robust domestic strategy to overcome the financial barriers to achieving malaria elimination in Ghana.
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    Potential strategies for sustainably financing mental health care in Uganda
    (BioMed Central, 2018-12-05) Ssebunnya, J.; Kangere, S.; Mugisha, J.; Docrat, S.; Chisholm, D.; Lund, C.; Kigozi, F.
    Abstract Background In spite of the pronounced adverse economic consequences of mental, neurological, and substance use disorders on households in most low- and middle-income countries, service coverage and financial protection for these families is very limited. The aim of this study was to generate potential strategies for sustainably financing mental health care in Uganda in an effort to move towards increased financial protection and service coverage for these families. Methods The process of identifying potential strategies for sustainably financing mental health care in Uganda was guided by an analytical framework developed by the Emerging Mental health systems in low and middle income countries (EMERALD project). Data were collected through a situational analysis (public health burden assessment, health system assessment, macro fiscal assessment) and eight key informant interviews with selected stakeholders from sectors including health, finance and civil society. The situational analysis provided contextualization for the strategies, and was complimented by views from key informant interviews. Results Findings indicate that the following strategies have the greatest potential for moving towards more equitable and sustainable mental health financing in the Uganda context: implementing National Health Insurance Scheme; shifting to Results Based Financing; decentralizing mental health services that can be provided at community level; and continued advocacy with decision makers with evidence through research. Conclusion Although several options were identified for sustainably financing mental health care in Uganda, the National Health Insurance Scheme seemed the most viable option. However, for the scheme to be effective, there is need for scale up to community health facilities and implementation in a manner that explicitly includes community level facilities.