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Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income CountriesThis volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks. In doing so, this report seeks to expand the evidence base on good performance in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. With health at the center of global development policy on humanitarian as well as economic and health security grounds, the international community and developing countries are closely focused on scaling up health systems to meet the Millennium Development Goals (MDGs), improving financial protection, and ensuring long-term financing to sustain these gains. With the scaling up of aid, both donors and countries have come to realize that money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills. This realization has sent policy makers looking for reliable evidence about what works and what does not, but they have found little to guide their search.
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Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)Beginning in 2003, Turkey initiated a
 series of reforms under the Health Transformation Program
 (HTP) that over the past decade have led to the achievement
 of universal health coverage (UHC). The progress of Turkey s
 health system has few if any parallels in scope and
 speed. Before the reforms, Turkey s aggregate health
 indicators lagged behind those of OECD member states and
 other middle-income countries. The health financing system
 was fragmented, with four separate insurance schemes and a
 Green Card program for the poor, each with distinct
 benefits packages and access rules. Both the Ministry of
 Labor and Social Security and Ministry of Health (MoH) were
 providers and financiers of the health system, and four
 different ministries were directly involved in public health
 care delivery. Turkey s reform efforts have impacted
 virtually all aspects of the country s health system and
 have resulted in the rapid expansion of the proportion of
 the population covered and of the services to which they are
 entitled. At the same time, financial protection has
 improved. For example, (i) insurance coverage increased from
 64 to 98 percent between 2002 and 2012; (ii) the share of
 pregnant women having four antenatal care visits increased
 from 54 to 82 percent between 2003 and 2010; and (iii)
 citizen satisfaction with health services increased from
 39.5 to 75.9 percent between 2003 and 2011. Despite dramatic
 improvements there is still space for Turkey to continue to
 improve its citizens health outcomes, and challenges lie
 ahead for improving services beyond primary care. The main
 criticism to reform has so far come from health sector
 workers; the future sustainability of reform will rely not
 only on continued fiscal support to the health sector but
 also the maintenence of service provider satisfaction.
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Review of World Bank's Experience with Country-Level Health System AnalysisThe World Bank often carries out
 in-depth analysis of the conditions and challenges facing
 different sectors in our client countries as a contribution
 to developing the analytical and information base for
 lending, policy dialogue, and more in-depth analytical work.
 In the health sector, we have identified a substantial body
 of this type of work focusing on analyzing the performance
 of health systems, its causes, and potential strategies for
 performance improvement. The Bank's 2007 Health,
 Nutrition and Population (HNP) strategy emphasizes the
 importance of our work on health system strengthening. HSA
 is often the analytical foundation of this work in
 countries. This paper reviews a sample of HSAs, 12 major
 studies carried out since 2000 across all Bank regions.
 Using the health systems framework of the flagship program
 on health sector reform and sustainable financing, a
 comparable synopsis of each study has been prepared in a
 simple two page chart which traces the analysis from
 measures of health system performance to its causes and then
 from policy 'control knobs' to proposals for
 reform which are intended to improve that performance.
 Several key questions about the conceptual basis, content,
 process, and results of the Bank's work on HSA are
 investigated. The review finds that most of our HSAs make
 use of sound analytical frameworks that link performance to
 a causal analysis and derive policy recommendations and
 reform strategies from that analysis.