Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol

Asante, Augustine; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, João S; Guinness, Lorna; Ataguba, John E.; Limwattananon, Supon; Mills, Anne; Jan, Stephen; Wiseman, Virginia

doi:10.1136/bmjopen-2014-006806

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…For instance, following acute conflict and violence during the late 1990s, Timor-Leste, in concert with the World Bank and other development partners, implemented a series of health sector rehabilitation and development projects in 2000 and 2001 to re-establish the country's health system and improve health service delivery to the poor. 47 , 48 In more recent years, health-care reform and financing have topped policy agendas in Timor-Leste, 49 including the Ministry of Health's roll-out of a Basic Health Services Package and Hospital Services Package in 2007 under the pursuit of achieving UHC. 50 Following almost a decade of civil conflict that severely disrupted health service provision, Tajikistan launched a series of health reforms beginning in the late 1990s 51 and introduced a new benefits package for guaranteed health services in 2007.…”

Section: Discussionmentioning

confidence: 99%

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Lim¹,

Allen²,

Bhutta³

et al. 2016

The Lancet

457

288

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SummaryBackgroundIn September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).MethodsWe applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices.FindingsIn 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8–61·8) and varied widely by country, ranging from 85·5 (84·2–86·5) in Iceland to 20·4 (15·4–24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0–10·4), and gains on the MDG index (a median change of 10·0 [6·7–13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1–8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened.InterpretationGBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.FundingBill & Melinda Gates Foundation.

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Section: Discussionmentioning

confidence: 99%

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Lim¹,

Allen²,

Bhutta³

et al. 2016

The Lancet

457

288

View full text Add to dashboard Cite

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“…Full details of the sampling procedure are published elsewhere (http://bmjopen.bmj.com/).20 We also obtained information on health expenditure for different types of services from the Fiji MoHMS. These data were used to calculate the unit costs of inpatient and outpatient services.…”

Section: Methodsmentioning

confidence: 99%

Financing for universal health coverage in small island states: evidence from the Fiji Islands

et al. 2017

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BackgroundUniversal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to UHC and reforming their health financing systems to better align with UHC goals. This study provides the first comprehensive evidence on equity of the health financing system in Fiji, a small Pacific island state. The health systems of such states are poorly covered in the international literature.MethodsThe study employs benefit and financing incidence analyses to evaluate the distribution of health financing benefits and burden across the public and private sectors. Primary data from a cross-sectional survey of 2000 households were used to assess healthcare benefits and secondary data from the 2008–2009 Fiji Household Income and Expenditure Survey to assess health financing contributions. These were analysed by socioeconomic groups to determine the relative benefit and financing incidence across these groups.FindingsThe distribution of healthcare benefits in Fiji slightly favours the poor—around 61% of public spending for nursing stations and 26% of spending for government hospital inpatient care were directed to services provided to the poorest 20% of the population. The financing system is significantly progressive with wealthier groups bearing a higher share of the health financing burden.ConclusionsThe healthcare system in Fiji achieves a degree of vertical equity in financing, with the poor receiving a higher share of benefits from government health spending and bearing a lower share of the financing burden than wealthier groups.

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“…UHC stipulates that people should be able to access the health services they need without risking financial ruin or impoverishment [ 6 , 7 ]. Effective implementation of this principle requires a robust health financing system which guarantees a fair distribution of the burden of paying for health care according to ability-to-pay (ATP) and benefits from health care spending according to need [ 8 , 9 ]. Health systems in many LMICs are financed through key sources such as taxation, social health insurance contributions, private health insurance premiums, and out-of-pocket payments [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

et al. 2016

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IntroductionHealth financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.Methods and FindingsKey electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.ConclusionStudies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality.

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Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol

Cited by 13 publications

References 25 publications

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015

Financing for universal health coverage in small island states: evidence from the Fiji Islands

Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

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