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PubMed1998

Household health expenditures in Nepal: implications for health care financing reform.

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

Developing Countries↗
PubMed2000

A new light on the community health fund--effective political support for a community essential drug project in Vietnam.

This report sheds new light on the development of a community health fund through the implementation of a community essential drug project, and its impact on the improvement of primary health care at the community level. The experience of community drug funds in Vietnam, supported by a strong government commitment, in which full delegation of authority on the management of drugs and finances is given to the community along with a measure for tax exemptions for drug fund revenues, provides a significant example of an autonomous community with active participation of people and effective resource mobilization, that is leading to the improvement of community health.

Community Health Services↗
PubMed1990

Design for the national evaluation of the Robert Wood Johnson Foundation Program on Chronic Mental Illness.

The Robert Wood Johnson Foundation chose the University of Maryland Mental Health Policy Studies Program to conduct an independent national evaluation of its Program on Chronic Mental Illness, a large-scale demonstration in which nine cities across the country are participating. The national evaluation aims at describing the implementation of the program and assessing its impact on clients. The evaluation effort comprises five groups of interrelated studies: a site-level study, a community care study, housing studies, financing studies, and disability and vocational rehabilitation studies. Taken together, the components of the evaluation should provide evidence that will help create new structures and processes in large cities for delivering care to persons with chronic mental illness.

Chronic Disease↗
PubMed1996

The community tracking study: a focus on change in the health care system.

Recognizing that health care delivery is predominantly local, the Center for Studying Health System Change is investigating what is happening in health care financing and delivery at the community level. The Community Tracking Study focuses on changes in the health care system in 60 sites that are representative of the nation. Twelve of these communities are being studied intensively. The 48 additional communities studied less intensively will permit generalization to the nation as a whole and analysis of the relationship between health system characteristics and the effects of change on people. Data collection and analysis for the Community Tracking Study are planned in two-year cycles. The first cycle, which began in spring of 1996, will establish a baseline.

Community Health Services↗
PubMed2004

Community-based health insurance in low-income countries: a systematic review of the evidence.

Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.

Community Networks↗
PubMed1989

A people-centered approach to primary health care implementation in Mvumi, Tanzania.

The Mvumi community-based health care programme in Dodoma Region has been attempting to involve communities in promoting their health. It established a dialogue using communication and adult training skills and assisted communities only in those activities which they themselves planned and which they were ready to finance. Such activities included training of community resource persons such as traditional midwives and village health promoters/workers. Within only 4 years substantial output and outcome results could be demonstrated. Many village communities, for example, have assumed responsibility for the village-based nutrition rehabilitation of their severely malnourished children.

Community Health Services↗
PubMed1993

Case management in social and health care. Lessons from a United Kingdom program.

In the United Kingdom, despite a stated commitment to community care, centralized planning and financing through the Social Security System, rather than the Social Services Department, resulted in a serious distortion in policy. Social Security funded care in residential and nursing homes, and not community care. As in the United States, central government expenditures for expensive institutional care rose dramatically in the 1980s as a result. By the end of the decade, changes were implemented to decentralize the provision and funding of social care. Several projects were undertaken to demonstrate effective means of applying the new policies. In each instance, case managers worked with relatively small caseloads of the frail elderly and were responsible for allocating funds to purchase the services needed within a fixed budget. In all settings, there was a reduction in the use of institutional care facilities; the quality of life of both the clients and their caregivers improved significantly; and these gains were achieved at no greater cost than for individuals receiving the traditional services without case management. Despite the fact that issues such as what happens to costs when the system is expanded to other target clienteles remain to be resolved, the success of the projects highlights the significant gains to be achieved with case managers who have control of both service selection and budgets.

Aged↗
PubMedDate not supplied

Maternal and child health services in the twenty-first century: critical issues, challenges, and opportunities.

Poor women, their children, and families use public-funded maternal and child health (MCH) services worldwide. However, with the decline in public-funded health services and the growing role of private-financed systems, poor women and their children are at risk of falling through the cracks of business-driven health systems. This article is an overview of (a) critical MCH global health and non-health issues, and (b) 10 MCH challenges in the twenty-first century. MCH advocates can turn these challenges into unique opportunities for MCH clients by developing public/private partnerships at local, state, national, and international levels that will assure the provision of basic clinical and public health services in either public- or private-financed health systems.

Child↗
PubMed1993

Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.

Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services.

Centers for Medicare and Medicaid Services, U.S.↗