Health equity funds in Cambodia

Leemput, Luc Van; Ponsar, Frederique; Philips, Mit; Brikci, Nouria

doi:10.1016/s0140-6736(07)60302-x

Cited by 3 publications

(2 citation statements)

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“…Georgia has chosen its own path in reforming the health financing system by allocating general government revenues to purchase relatively comprehensive coverage for the poor identified through the means testing system. The focus on priority groups and specifically on the poor segments of the population is a common feature of health financing reforms in other low- and middle-income countries (LMICs) [ 1 - 7 ]. Nonetheless, the Georgian experience can be unique for two reasons.…”

Section: Introductionmentioning

confidence: 99%

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Zoidze

Rukhazde

Chkhatarashvili

et al. 2013

Health Res Policy Sys

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BackgroundThe present study focuses on the program “Medical Insurance for the Poor (MIP)” in Georgia. Under this program, the government purchased coverage from private insurance companies for vulnerable households identified through a means testing system, targeting up to 23% of the total population. The benefit package included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This paper presents the results of the study on the impact of MIP on access to health services and financial protection of the MIP-targeted and general population.MethodsWith a holistic case study design, the study employed a range of quantitative and qualitative methods. The methods included document review and secondary analysis of the data obtained through the nationwide household health expenditure and utilisation surveys 2007–2010 using the difference-in-differences method.ResultsThe study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient services and total household health care costs, and there was a higher probability of receiving free outpatient benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the households’ expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package and possibly due to improper utilisation management by private insurance companies, were not able to reverse adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure.ConclusionsThe recent governmental decision on major expansion of MIP coverage and inclusion of additional drug benefit will most likely significantly enhance the overall MIP impact and its potential as a viable policy instrument for achieving universal coverage. The Georgian experience presented in this paper may be useful for other low- and middle-income countries that are contemplating ways to ensure universal coverage for their populations.

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Section: Introductionmentioning

confidence: 99%

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Zoidze

Rukhazde

Chkhatarashvili

et al. 2013

Health Res Policy Sys

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“…Consequently, “third-party payer” systems, including health equity funds, have been created in several countries in Asia and Africa as an alternative exemption approach that incorporates a mechanism to ensure sufficient funding is available at health facilities and to compensate facilities for the cost of granting exemptions so that the health provider can achieve both equity and efficiency [ 17 , 21 ]. Some reviews of this type of mechanism suggest that adequate health facility or health administration funding from external sources; an independent agent determining eligibility of beneficiaries based on clear, agreed criteria; and regular updates of the beneficiary list are all key to the success of the mechanism but pre-existing health services must also be operating with sufficient financial and human resources [ 17 , 21 , 22 ]. Nonetheless, there are large gaps in the knowledge relating to the process of implementing fee exemption measures for the poor at the ground-level, particularly about how such schemes are actually implemented and why many schemes have not produced the outcomes intended.…”

Section: Discussionmentioning

confidence: 99%

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar

Honda

2015

BMC Research Notes

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BackgroundThere are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established “equity funds” at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme.MethodsThis study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar’s Boeny region.ResultsPolicy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor.ConclusionThe ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the ‘targeting’ approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.

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An impact evaluation of medical insurance for poor in Georgia: preliminary results and policy implications

Gotsadze¹,

Zoidze²,

Rukhadze³

et al. 2015

Health Policy and Planning

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Marginal changes in access to services and the geographically diverse impact of the MIP on service utilization points to other factors affecting health-seeking behaviour of the insured. These other factors include private insurer behaviour that may have used strategies for reducing claims and managing utilization. Equity impact of the MIP and improved financial protection, especially for the poor, are benefits to be retained by government policies when universal health coverage is rolled out nationwide and all citizens will be covered. The role of private insurance companies as financial intermediaries of the publicly funded programme needs further evaluation before moving forward.

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Health equity funds in Cambodia

Cited by 3 publications

References 1 publication

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar

An impact evaluation of medical insurance for poor in Georgia: preliminary results and policy implications

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