Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress

Simple item page
dc.contributor.authorMcIntyre, Dien_ZA
dc.contributor.authorRanson, Michaelen_ZA
dc.contributor.authorAulakh, Bhupinderen_ZA
dc.contributor.authorHonda, Ayakoen_ZA
dc.date.accessioned2015-11-23T12:10:22Z
dc.date.available2015-11-23T12:10:22Z
dc.date.issued2013en_ZA
dc.description.abstractAlthough universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC.These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds.The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies.This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC.en_ZA
dc.identifier.apacitationMcIntyre, D., Ranson, M., Aulakh, B., & Honda, A. (2013). Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. <i>Health Research Policy and Systems</i>, http://hdl.handle.net/11427/15265en_ZA
dc.identifier.chicagocitationMcIntyre, Di, Michael Ranson, Bhupinder Aulakh, and Ayako Honda "Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress." <i>Health Research Policy and Systems</i> (2013) http://hdl.handle.net/11427/15265en_ZA
dc.identifier.citationMcIntyre, D., Ranson, M. K., Aulakh, B. K., & Honda, A. (2013). Promoting universal financial protection: evidence from seven low-and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst, 11(1), 36.en_ZA
dc.identifier.ris TY - Journal Article AU - McIntyre, Di AU - Ranson, Michael AU - Aulakh, Bhupinder AU - Honda, Ayako AB - Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC.These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds.The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies.This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC. DA - 2013 DB - OpenUCT DO - 10.1186/1478-4505-11-36 DP - University of Cape Town J1 - Health Research Policy and Systems LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress TI - Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress UR - http://hdl.handle.net/11427/15265 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15265
dc.identifier.urihttp://dx.doi.org/10.1186/1478-4505-11-36
dc.identifier.vancouvercitationMcIntyre D, Ranson M, Aulakh B, Honda A. Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. Health Research Policy and Systems. 2013; http://hdl.handle.net/11427/15265.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2013 World Health Organization; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceHealth Research Policy and Systemsen_ZA
dc.source.urihttp://www.health-policy-systems.com/en_ZA
dc.subject.otherFinancial protectionen_ZA
dc.subject.otherLow- and middle-income countriesen_ZA
dc.subject.otherPolicy analysisen_ZA
dc.subject.otherPoolingen_ZA
dc.subject.otherPurchasingen_ZA
dc.subject.otherRevenue collectionen_ZA
dc.subject.otherUniversal health coverageen_ZA
dc.titlePromoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progressen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
McIntyre_Promoting_universal_financial_protection_2013.pdf
Size:
237.19 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles