The Philosopher in the Health Care Setting: Objections and Replies
Author(s)Melley, Christopher D.
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HEC (HealthCare Ethics Committee) Forum. 1992; 4(4): 237-254.
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Kosovo : Health Financing Reform StudyWorld Bank (Washington, DC, 2012-06-14)The objective of this report is to present information on the different health financing reform options available to Kosovo, which can help the government to make informed policy decisions about financing reforms. The report focuses on the key insurance functions of revenue collection and management, risk pooling, and purchasing of health care, as well as the supportive regulatory and governance framework for health financing. Kosovo aims to reform health financing by moving toward a health insurance system. To implement the proposed single insurer as described in the health law, a draft law for health insurance was discussed in Parliament in 2004. The draft law envisioned the revenue sources for the future health insurance as follows: (i) 60 percent of Health Insurance Fund (HIF) revenue will be paid by the general budget; (ii) 13.5 percent will come from payroll contributions; (iii) 21 percent will come from direct payments by patients in the form of user fees; and (iv) 6.5 percent will come from patients' co-payments. Three years later, in April 2007, the Kosovo Parliament approved a health insurance law to introduce social health insurance (SHI) financed predominantly through payroll taxes, though it did not specify contribution levels. The revenue potential of such payroll funded insurance was estimated to be modest considering Kosovo's relatively small formal sector and employment rate. The Kosovo health system is predominantly tax funded. Government health spending is about 3 percent of gross domestic product (GDP) and 10 percent of general government expenditures. The ministry of economics and finance (MEF) transfer's health funds from the central budget to hospitals (51 percent), to municipalities in the form of an earmarked health grant for the provision of primary health care (PHC) services (26 percent), and to the ministry of health (MOH) for other services (22 percent) (MEF 2007).
Health Care in Sri Lanka : What Can the Private Health Sector Offer?Seshadri, Shreelata Rao; Govindaraj, Ramesh; Navaratne, Kumari; Cavagnero, Eleonora (World Bank, Washington, DC, 2014-06)This review represents an attempt to
bridge the significant knowledge gaps on the private health
sector in Sri Lanka, and foster a dialogue on opportunities
for collaboration between the government and the private
sector. It accomplishes this through a systematic collection
and analysis of primary and secondary data on the provision,
financing, and regulation of health care services. On health
service delivery, the review finds that the private sector:
includes a range of providers; focuses primarily on curative
and outpatient services rather than preventive services; is
heavily dependent on the public sector for its supply of
human resources; and is concentrated in urban areas. The
quality of health care services in Sri Lanka in both the
private and public sectors, while better than in most
developing countries, still lags behind those in more
advanced countries. There is also little systematic dialogue
and collaboration between the public and private sectors. On
financing, the review finds that private health expenditure
is more than half of total health expenditure, mostly in the
form of out-of-pocket payments by households, with clear
implications for Sri Lanka's progression toward
universal health coverage. On stewardship and regulation,
there is a clear and urgent need to bridge the existing gaps
in the legal and regulatory framework, and in the
enforcement of health regulations applicable to the private
sector, as well as to create an enabling environment for
more effective private sector participation in the health
sector. The review demonstrates that the private health
sector in Sri Lanka is a growing force, due both to greater
investment from private players as well as greater demand
from the population. The review highlights areas where a
more effective engagement with the private sector could
ensure that Sri Lanka is able to offer its citizens
universal access to good quality health service while also
stimulating economic growth.
Health Financing Reform in Thailand : Toward Universal Coverage under Fiscal ConstraintsHanvoravongchai, Piya (World Bank,Washington DC, 2013-05-06)Thailand's model of health financing and its ability to rapidly expand health insurance coverage to its entire population presents an interesting case study. Even though it is still a middle-income country with limited fiscal resources, the country managed to reach universal health insurance coverage through three main public schemes: the Universal Coverage Scheme (UCS), the Social Security Scheme (SSS), and the Civil Servant Medical Benefit Scheme (CSMBS). The UCS, which is the largest and most instrumental scheme in the expansion of coverage to the poor and to those in the informal sector, is the focus of this report. It describes the nuts and bolts of the UCS as a key component of the health financing system in Thailand. It analyzes Thailand's experience in health insurance coverage expansion within limited fiscal constraints through various mechanisms to contain costs. It also explores the two commonly discussed approaches for the universal coverage movement: the expansion model (starting from covering the poor and formal sector to universal coverage) and the comprehensive approach (covering the entire population at the same time).