Health Financing in the Republic of Gabon

Saleh, Karima; Couttolenc, Bernard F.; Barroy, Helene

doi:10.1596/24580

Cited by 6 publications

(15 citation statements)

References 1 publication

(1 reference statement)

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“…A scheme is truly compulsory if those who are eligible for it ‘do not have the option of not being covered’ 25 because their enrolment is forced or automatic. Of the 16 UHI schemes studied, 9 are de jure compulsory (Algeria, 26 Benin, 27 Burundi, 28 Djibouti, 29 Gabon, 30 Ghana, 31 Kenya, 32 Rwanda 33 and Tunisia 34 ). But, in fact, almost all these systems are voluntary.…”

Section: Resultsmentioning

confidence: 99%

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Universal health insurance in Africa: a narrative review of the literature on institutional models

Bassoum

Faye

2022

BMJ Glob Health

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IntroductionSeveral African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals.MethodThis study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection).ResultsNinety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa.ConclusionPublic health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.

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Section: Resultsmentioning

confidence: 99%

“…The three schemes operate independently of each other; there is neither pooling of resources nor cross-subsidisation. 51 In Kenya, the national health insurance fund also operates three schemes, one for civil servants, one for the indigent and a general scheme for the rest of the population, each offering different benefits. 71…”

Section: Resultsmentioning

confidence: 99%

Universal health insurance in Africa: a narrative review of the literature on institutional models

Bassoum

Faye

2022

BMJ Glob Health

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“…Redistribution is achieved by providing budget transfers and gradually increasing these, with the ultimate aim of achieving equitable access to health services and harmonized benefit packages. Countries that have pursued this pooling reform option include for example Colombia, 31 Gabon, 32 Mexico, 33 Peru 6 and Thailand. 34 In these countries, reforms have substantially reduced the differences in per capita expenditure between different population groups, and thus helped to improve financial protection and equitable access to health services.…”

Section: Cross-subsidizationmentioning

confidence: 99%

Pooling financial resources for universal health coverage: options for reform

Mathauer

Torres

Kutzin

et al. 2019

Bull. World Health Organ.

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Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions-revenue raising, pooling of funds and purchasing health services-are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.

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“…There is some evidence that fee-for-service reimbursements, the system used by Cambodia's social health protection schemes, may contribute to oversupply as it incentivizes service provision [60][61][62][63]. However, provider remuneration is complex and there is also evidence that the risk of overprovision is contextual ( [64,65].…”

Section: Discussionmentioning

confidence: 99%

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

John

Bogetoft

Chea³

et al. 2022

Health Econ Rev

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Background Achieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels. Methods This study assesses Cambodia’s public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories. Results Overall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side ‘service space’ to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient. Conclusions Public health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.

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Health Financing in the Republic of Gabon

Cited by 6 publications

References 1 publication

Universal health insurance in Africa: a narrative review of the literature on institutional models

Universal health insurance in Africa: a narrative review of the literature on institutional models

Pooling financial resources for universal health coverage: options for reform

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia

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