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Over the past three decades, many countries of Latin America and the Caribbean have recognized health as a human right. Since the early 2000s, 46 million more people in the countries studied are covered by health programs with explicit guarantees of affordable care. Reforms have been accompanied by a rise in public spending for health, financed largely from general revenues that prioritized or explicitly target the population without capacity to pay. Political commitment has generally translated into larger budgets as well as passage of legislation that ring-fenced funding for health. Most countries have prioritized cost-effective primary care and adopted purchasing methods that incentivize efficiency and accountability for results, and that give stewards of the health sector greater leverage to steer providers to deliver on public health priorities. Evidence from the analysis of 54 household surveys corroborates that investments in extending coverage are yielding results. Though the poor still have worse health outcomes than the rich, disparities have narrowed considerably - particularly in the early stage of the life course. Countries have reached high levels of coverage and equity in utilization of maternal and child health services; coverage of noncommunicable disease interventions is not as high and service utilization is still skewed toward the better off. Catastrophic health expenditures have declined in most countries; the picture regarding equity, however, is mixed. While the rate of impoverishment owing to health-care expenditures is low and generally declining, 2-4 million people in the countries studied still fall below the poverty line after health spending. Efforts to systematically monitor quality of care in the region are still in their infancy. Nonetheless, a review of the literature reveals important shortcomings in quality of care, as well as substantial differences across subsystems. Improving quality of care and ensuring sustainability of investments in health remain an unfinished agenda.
The reform of social security pensions and healthcare is a key issue for the modern world, and in many ways Latin America has acted as a social laboratory for the reform of these systems. From the reforms that took place in Chile in 1981, most pension and health care systems in the region have seen reform, and been fully or partially privatized. Many other countries considering reform of their own systems have been influenced by the policies implemented in Latin America. Yet despite the importance and influence of these reforms, until now there has not been an integrated and comprehensive analysis of the changes and their effects. This book is the result of four years of painstaking work, data collection, field research and international collaboration, and so fills the vacuum in the literature with a systematic comparison of pension and healthcare reforms in the 20 Latin American countries. It identifies reform models, and elaborates taxonomies to facilitate their understanding and comparison. Some key features of the reforms to emerge are: labour force and population coverage, equity and solidarity, sufficiency and quality of benefits, state regulation, competition and degree of privatization, efficiency and administrative costs, social participation in management, financing sources and long-term sustainability. Effects of the reforms on social security principles are measured based on recent standardized statistics and other information. Goals or assumptions of the reforms are contrasted with actual outcomes, and the pros and cons of private versus private provision assessed. Detailed policy recommendations are offered to correct current problems and improve pension and healthcare systems. This is the first book to comprehensively study these influential reforms in Latin America's pension and health care systems, and as such will be of importance to academics and researchers interested in social security and welfare policy, pensions, health care, and public policy; Social security, pension, and health care policy-makers; And social security, pension, and health care consultants and practitioners. Published in association with PAHO
Argentina, Brazil, Chile, and Colombia have reformed the ways health insurance and health care are organized and delivered, have extended formal coverage to previously marginalized groups, and have tried to finance this extension fairly. Each has reformed health insurance differently.
Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.
During the past three decades, health care systems in the East Asian regions of China, Japan, South Korea, and Taiwan have undergone major changes. Each system has its unique achievements and challenges. Global health care policymakers are increasingly interested in understanding the changes that have taken place in these four systems. This four-volume reference set is designed to help health care professionals, academics, policymakers, and general readers gain a good grasp of the background and latest developments in the health care systems of China, Japan, South Korea, and Taiwan. This reference set provides an in-depth comparative health policy analysis and discussion of health care reform strategies in each of these systems. One unique feature of this set is that each volume has been edited by a leading scholar who has been deeply involved in the development of the health care system in that particular region. Each of these editors also has invited both scholars and practitioners to provide a first-hand description and analysis of key health care reform issues in that system. The many examples provided in each volume demonstrate how findings of evidence-based policy research can be implemented into policy practice.Volume 1 describes and discusses China's ambitious and complex journey of health care reform since 2009. The Chinese government has achieved universal health insurance coverage and has embarked on reforms of the service delivery system and provider payment methods that are aimed at controlling health expenditure growth and improving efficiency. This volume includes pilot and social experiments initiated by the government and researchers and their evaluations that have guided the formulation of health reform policies. It provides information on how to make reforms work at the local and provincial levels. The findings detailed in this volume will contribute to a global knowledge base in health care reforms.Volume 2 provides a comprehensive review and evaluation of the Japanese health care system. Japan has a long history of health care system development and provision of universal health coverage, with a mature and well-developed health care system among East Asian countries. However, due to increases in health care costs, economic stagnation and the country's rapidly aging population, Japan has undergone significant health care reform during the last two decades, both in the delivery as well as financing of health services in its hospital sector, medical technology sector and long-term care insurance. Despite these challenges and reforms, health outcomes among the Japanese population have been progressively among the best in the world. This volume shows how policy research can lead to policy analysis, implementation and assessment. It also provides valuable lessons learnt for mutual learning among other health care systems.Volume 3 offers a comprehensive review of the developments in South Korea's national health insurance system since 1989 in terms of financing, delivery systems, and outcomes. The volume analyzes the efficiency of cost and service delivery by public sectors versus private sectors. It points out areas of challenge to future Korean health care reform. Chapter authors in this volume are leading experts involved in Korean health care policy implementation.Volume 4 reviews the development and achievements of Taiwan Health Insurance since 1995. Because of its continuous reform in payment, services delivery, and pharmaceutical technology, Taiwan has been considered a model example of universal health insurance among global health systems. This volume shows the processes used to translate policy research findings into policy changes. While the health care reform in Taiwan is ongoing, the Taiwan example provides a real-world and practical understanding of health care system changes.In summary, this four-volume set makes an outstanding contribution to health care system reform and policy research, based on solid scholarly work. It also introduces policy researchers and academic communities to current debates about health systems, health financing, and universal health coverage. This reference volume is a must for anyone keen on East Asia's health care system reform dynamics and changing scene.
'Beyond Survival' breaks new ground in the ongoing debate about health finance and financial protection from the costs of health care. The evidence and discussion support the need to consider financial protection, in addition to health status, as a policy objective when setting priorities for health systems. This book reviews the Latin American experience with health reform in the last 20 years and the fundamentals of health system financing, using new evidence to show the magnitude and mechanisms that determine the impoverishing effects of health events (diseases, accidents, and those of the life cycle). It provides options for policy makers on how to protect, and help household to protect themselves,against this impoverishment. The authors use empirical evidence from six case studies commissioned for this report, on Argentina, Chile, Colombia, Ecuador, Honduras, and Mexico. This book provides policy makers with a solid conceptual basis for decisions on the contents of mandatory health insurance benefit packages, choices of financing mechanisms, and the roles of public policy in this field. 'Beyond Survival' provides an in-depth analysis of, and organizational alternatives for, risk pooling and health insurance for financial protection. It analyzes the urgent need to extend risk pooling to the informal sector, the challenges for current social insurance arrangements, and options for policy makers to effectively extend risk pooling to the informal sector.
"The analysis of the distributional impact of policy reforms on the well-being or welfare of different stakeholder groups, particularly on th e poor and vulnerable, has an important role in the elaboration and implementation of poverty reduction strategies in developing countries. In recent years this type of work has been labeled as Poverty and Social Impact Analysis (PSIA) and is increasingly implemented to promote evidence-based policy choices and foster debate on policy reform options. While information is available on the general approach, techniques, and tools for distributional analysis, each sector displays a series of specific characteristics. These have implications for the analysis of distributional impacts, including the types of impacts and transmission channels that warrant particular attention, the tools and techniques most appropriate, the data source typically utilized, and the range of political economy factors most likely to affect the reform process. This volume provides an overview of the specific issues arising in the analysis of the distributional impacts of policy and institutional reforms in selected sectors. Each chapter offers guidance on the selection of tools and techniques most adapted to the reforms under scrutiny, and offers examples of applications of these approaches. This is a companion to the first volume, which offers guidance on trade, monetary and exchange rate policy, utility provision, agricultural markets, land policy, and education."
Using cross-country analysis and case studies, this book provides new insights and potential policy responses for the key fiscal policy challenges that both advanced and emerging economies will be facing.
The report focuses on a review of the implementation experience of case-based and DRG mechanisms in the Asia and Pacific region, drawing particularly on research in Australia, Japan, New Zealand, the Republic of Korea, Singapore and Thailand.