Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case Studies

Harris, Joseph; Ikegami, Naoki; Maeda, Akiko; Cashin, Cheryl; Reich, Michael R.

doi:10.1596/978-1-4648-0297-3

Cited by 110 publications

(157 citation statements)

References 12 publications

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“…14 Some countries such as Turkey, [15][16][17] South Korea, 18,19 Brazil, Thailand, Ghana, Peru, 20 Estonia, Lithuania, 21 and Indonesia [22][23][24] have adopted this policy to expand the size of the risk pool, and to improve the equity, efficiency, and redistribution of cross-subsidization throughout the entire health insurance system.…”

Section: Policy Contextmentioning

confidence: 99%

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

Bazyar¹,

Rashidian²,

Kane³

et al. 2016

Int J Health Policy Manag

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There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI) schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper.

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Section: Policy Contextmentioning

confidence: 99%

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

Bazyar¹,

Rashidian²,

Kane³

et al. 2016

Int J Health Policy Manag

View full text Add to dashboard Cite

show abstract

“…Their focus had been on the financing and human resource arrangements needed to achieve UHC [2] and to understand which disease programmes were the most cost-effective [3]. More recently, WHO has shifted emphasis to ensuring high quality, integrated service delivery as "critical" such that "UHC and people centered integrated health services should be regarded as interdependent and mutually reinforcing if the goals of UHC are to be realized" (WHO 2015 insert page number).…”

Section: Introductionmentioning

confidence: 99%

Can service integration work for universal health coverage? Evidence from around the globe

et al. 2016

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Yours sincerely 2 MANUSCRIPT Highlights: Empirical impacts of past integration experiments were explored through a global review  Positive outcomes for patients and clinicians without incurring additional financial costs were found  Improvements were incremental hence integration should not be considered a fundamental 'game-changer'. AbstractUniversal Health Coverage (UHC) is at the heart of the new 2030 Agenda for Sustainable Development. Health service integration is seen by World Health Organization as an essential requirement to achieve UHC. However, to date the debate on service integration has focused on perceived benefits rather than empirical impact. We conducted a global review in a systematic manner searching for empirical outcomes of service integration experiments in UHC countries and those on the path to UHC. Sixty-seven articles and reports were found. We grouped results into a unique integration typology with six categories -Medical staff from different disciplines; Patients and Medical Staff; Care Package for One Medical Condition; Care Package for Two or More Medical Conditions; Specialist standalone services with GP services; Community locations. We showed that it is possible to integrate services in different human development contexts delivering positive outcomes for patients and clinicians without incurring additional costs. However, the improved outcomes shown were incremental rather than radical and suggest that integration is likely to enhance already well established systems rather than fundamentally changing the outcomes of care.

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“…This narrow understanding is echoed in major recent reviews of 65 empirical studies on UHC progress. [7][8][9] The proposed SDGs also separate population-level public health measures from UHC, addressing the former as distinct targets, not under UHC. 2 Yet, a broader understanding encompassing nonclinical measures can also be found in relevant WHO documents.…”

mentioning

confidence: 99%

“…13 Although there are some exceptions, UHC progress analyses from 11 countries at diff erent levels of development suggest poorer people often lose out initially. UHC expansion generally begins with civil servants or urban formal sector workers; 9 wealthier, well connected urban populations demand and receive clinical services, while poorer and rural populations do not. Some public health interventions-such as nutrition labelling, or information campaigns on behavioural NCD risks-also tend to disproportionately benefi t wealthier groups, raising similar concerns.…”

mentioning

confidence: 99%

“…9 And even if employment opportunities under UHC were scaled up equally in clinical and non-clinical sectors, clinical services are more attractive: compensation is typically higher, and clinical training generally makes physicians and nurses more marketable in high-income countries, further threatening workforce retention. 3 Finally, many of the targets under SDG 3 need population-level health interventions.…”

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confidence: 99%

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Public health, universal health coverage, and Sustainable Development Goals: can they coexist?

2015

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Universal Health Coverage for Inclusive and Sustainable Development: A Synthesis of 11 Country Case Studies

Abstract: D i r e c t i o n s i n D e v e l o p m e n t Human Development

Cited by 110 publications

References 12 publications

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

Can service integration work for universal health coverage? Evidence from around the globe

Public health, universal health coverage, and Sustainable Development Goals: can they coexist?

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