Author(s)Post, Stephen G.
Health Services Research
Research Ethics Committees
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IRB: A Review of Human Subjects Research. 1995 Sep-Dec; 17(5-6): 8-11.
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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).
The Nuts & Bolts of Jamkesmas, Indonesia’s Government-Financed Health Coverage Program for the Poor and Near-PoorTandon, Ajay; Pigazzini, Anna; Harimurti, Pandu; Pambudi, Eko (World Bank, Washington DC, 2013-05-06)This case study describes and assesses Jamkesmas, Indonesia's government-financed health coverage program for the poor and near-poor. It provides a detailed description of the scope, depth, and breadth of coverage provided under Jamkesmas, and highlights ways in which the program interacts with the rest of Indonesia's health system. It also summarizes and discusses evidence on whether Jamkesmas is attaining its stated objectives of removing financial barriers and improving access to health care by the poor and near-poor, what could be improved, and what lessons can be learned from the experience of Jamkesmas that could help inform Indonesia's quest for universal coverage. The primary theme underlying the study is that supply-side constraints and supply-side subsidies have not been leveraged to increase the effectiveness of the Jamkesmas program. There are significant geographic deficiencies in the availability and quality of the basic benefits package, especially for those living in relatively remote and rural locations of the country, and this limits the effective availability of benefits for many Jamkesmas beneficiaries. The remainder of the case study is organized as follows. Section two provides general background and information on health system outcomes in Indonesia. Section three is an overview of health care financing and delivery. Section four describes the institutional architecture of Jamkesmas. Section five highlights the process of targeting, identification, and enrolment of beneficiaries under the program. Section six focuses on the role of public financing. Section seven outlines the basic benefits package. Section eight provides an overview of the information environment of Jamkesmas. Section nine discusses the special theme of supply-side constraints and supply-side subsidies that dilute the effectiveness of the Jamkesmas program. Section ten discusses the pending agenda around some of the architectural and operational features of Jamkesmas in the context of universal coverage.