The primacy of politics in neoliberal universal health coverage policy reform. A commentary on ‘financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?” by William C Hsiao and Winnie Yip

Mladovsky, Philipa; Prince, Ruth J.; Hane, Fatoumata; Ridde, Valéry

doi:10.1016/j.socscimed.2023.115742

Cited by 5 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Why was so much time lost since the proposal for departmentalization in 2014 as a pre-step towards UHC than C-CBHIs? This commentary shows the influence of TFP in the choice of policy instruments (here C-CBHI), but also that the alignment and coordination of TFP, set out in the Paris Declaration, is far from being the rule in practice despite the rhetoric ( Gautier and Ridde, 2017 ; Mladovsky et al. , 2023 ).…”

Section: Discussionmentioning

confidence: 96%

External influences over Senegalese health financing policy: delaying universal health coverage?

Ridde,

Caffin,

Hane

2023

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

Senegal has long sought solutions to achieve universal health coverage (UHC). However, in a context dependent on international aid, the country faces multiple external pressures to choose policy instruments. In this commentary, we propose an analysis of this influence. The empirical material comes from our involvement in analysing health reforms for 20 years and from many interviews and observations. While studies have shown that community-based health insurance (CBHI) was not an appropriate solution for UHC, some international actors have influenced their continued application. Another global partner proposed an alternative (professional and departmental CBHI), which was counteracted and delayed. These issues of powers and influences of international and national consultants, established in a neo-liberal approach to health, have lost at least a decade from UHC in Senegal. The alternative now appears to be acquired and is scaling up at the country level, witnessing a change in the current policy paradigm.

show abstract

Section: Discussionmentioning

confidence: 96%

External influences over Senegalese health financing policy: delaying universal health coverage?

Ridde,

Caffin,

Hane

2023

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

show abstract

“…In Bangladesh, low public funding is prevalent, which leads to high out-of-pocket spending among the population. Adopting structural adjustment programs in Bangladesh could explain this low public financing but also the persistence, as elsewhere in the world, of a neoliberal approach to healthcare systems as proposed by numerous international financial institutions (62,63). There have been several controversies on the negative impact of these programs in the health sector as processes such as the liberalisation of the economy and the privatisation of the private sector cause a reduction in public health financing (23).…”

Section: Discussionmentioning

confidence: 99%

Health Systems Reforms in Bangladesh: An Analysis of the Last Three Decades

Udechukwu,

Fofana,

Carnapete

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Objective: We reviewed the evidence regarding the health sector reforms implemented in Bangladesh within the past 30 years to understand their impact on the health system and healthcare outcomes. Method: We completed a scoping review of the most recent and relevant publications on health system reforms in Bangladesh from 1990 through 2023. Studies were included if they identified health sector reforms implemented in the last 30 years in Bangladesh, if they focused on health sector reforms impacting health system dimensions, if they were published between 1991 and 2023 in English or French and were full-text peer-reviewed articles, literature reviews, book chapters, grey literature, or reports. Results: Twenty-four studies met the inclusion criteria. The primary health sector reform shifted from a project-based approach to financing the health sector to a sector-wide approach. Studies found that implementing reform initiatives such as expanding community clinics and a voucher scheme improved healthcare access, especially for rural districts. Despite government efforts, there is a significant shortage of formally qualified health professionals, especially nurses and technologists, low public financing, a relatively high percentage of out-of-pocket payments, and significant barriers to healthcare access. Conclusion: Evidence suggests that health sector reforms implemented within the last 30 years had a limited impact on health systems. More emphasis should be placed on addressing critical issues such as human resources management and health financing, which may contribute to capacity building to cope with emerging threats, such as climate change.

show abstract

“…The future will tell us whether these reforms increase citizens' confidence in their health and CBHI systems and contribute to rendering membership more systematic. Even if the policy instrument is unchanged (insurance), it may illustrate a return of the State [41] in the field of social protection, as has long been demanded [42]. As with the success of CBHIs in Ethiopia, it is essential to give a 'signal of strong political and government commitment' [43].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Mandatory membership of community-based mutual health insurance in Senegal: A national survey

Ridde,

Gaye,

Ventelou

et al. 2023

PLOS Glob Public Health

Self Cite

View full text Add to dashboard Cite

With the low adherence to voluntary mutual health insurance, Senegal’s policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs—a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.

show abstract

The primacy of politics in neoliberal universal health coverage policy reform. A commentary on ‘financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?” by William C Hsiao and Winnie Yip

Cited by 5 publications

References 21 publications

External influences over Senegalese health financing policy: delaying universal health coverage?

External influences over Senegalese health financing policy: delaying universal health coverage?

Health Systems Reforms in Bangladesh: An Analysis of the Last Three Decades

Mandatory membership of community-based mutual health insurance in Senegal: A national survey

Contact Info

Product

Resources

About