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

Abstract

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.

Understanding the effectiveness of government health expenditure in improving health equity: Preliminary evidence from global health expenditure and child mortality rate

“…Experience from West Pacific island countries shows that the financing system for healthcare can be successfully designed to make the wealthier group bear a higher share of the cost, if the limited government health expenditure can be successfully directed toward the poorest 20% of the population. 11 Besides, the well-designed government subsidy schemes to remove user fees are found to have effectively enhanced child health equity in Caribbean area and improved healthcare utilization of poor society in Southeast Asia. [12][13][14] Evidence also shows that health equity in some sub-Saharan areas is in the correct way of improvement since the governmental distribution of health subsidy has been redirected to well target the poor.…”

“…Still, many studies are optimistic and describe a bright picture. Experience from West Pacific island countries shows that the financing system for healthcare can be successfully designed to make the wealthier group bear a higher share of the cost, if the limited government health expenditure can be successfully directed toward the poorest 20% of the population . Besides, the well‐designed government subsidy schemes to remove user fees are found to have effectively enhanced child health equity in Caribbean area and improved healthcare utilization of poor society in Southeast Asia .…”

Governance Functions to Accelerate Progress toward Universal Health Coverage (UHC) in the Asia-Pacific Region

“…Though Pacific island countries have committed to ensuring service delivery is based on UHC principles as part of the "Healthy Islands Vision" and the 2015 Yanuca Island Declaration, different approaches have been used in acting on these commitments. [24][25][26] Fiji has endorsed increased government spending to expand access to health services for the poor. 24,25 Papua New Guinea's Department of Health has worked with provinces to develop annual health service plans, informed by facility audits, covering services in health facilities including aid posts, rural health centers, and hospitals.…”

How to do (or not to do) … a health financing incidence analysis

“…A complementary analysis, BIA, is also used to assess the pro-poorness of the health-care delivery system and the extent to which those that need health services are benefiting according to need ( McIntyre and Ataguba 2011 ; Wagstaff, 2012 ). Together, these analyses (FIA and BIA), which have been combined in recent research ( Akazili et al 2012 ; Ataguba and McIntyre 2012 ; Mtei et al 2012 ; Kwesiga et al 2015 ; Asante et al 2017 ), provide an overall picture of how the health financing system of a country is performing on equity grounds and progressing towards UHC. For a holistic picture of equity, practitioners are encouraged to assess both distributions.…”