Health> Vol.5 No.8, August 2013
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Choices of health care financing schemes for resource poor country: An analysis of Nepal’s experiences

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ABSTRACT

An appropriate health care financing scheme can improve the efficient, equitable, and effective use of health care resources; however, each popular health care financing scheme has some advantages and disadvantages. The designing of health care financing strategy to fit with the country specific features is not straightforward. In resource poor country, allocation of resources for health care services are always critical and frequently unstable due to nuances annual budget process, small fiscal space, uncertainties in contributions of external development partners. Considerable quantities of country specific researches require for the choice of an appropriate health care financing scheme. The paper illustrates possible better options for the government to pursue the goal of ensuring that the poor receive more benefits. The paper compares the benefit incidences and cost of services with different options purposed for primary health care services by utilizing recently collected data from different hospitals in Nepal. The paper offers an alternative policy such as a universal free care below the district level services; but in the district level which is top level of primary care, “extended targeted free health care” may be an efficient, fair, and relatively simple approach.

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Cite this paper

Adhikari, S. (2013) Choices of health care financing schemes for resource poor country: An analysis of Nepal’s experiences. Health, 5, 1295-1302. doi: 10.4236/health.2013.58176.

References

[1] Xu, K., Evans, D.B., Kadama, P., Nabyonga, J., Ogwal, P.O., Nabukhonzo, P. and Aguilar, A.M. (2006) Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Social Science & Medicine, 62, 866-876. doi:10.1016/j.socscimed.2005.07.004
[2] Yates, R. (2009) Universal health care and the removal of user fees. Lancet, 373, 2078-2081. doi:10.1016/S0140-6736(09)60258-0
[3] Andrew, C. (1997) User fees: They don’t reduce costs, and they increase inequity. British Medical Journal, 315, 202-203. doi:10.1136/bmj.315.7102.202
[4] Lagarde, M. and Palmer, N. (2008) The impact of user fees on health service utilization in low-and middle-income countries: How strong is the evidence? Bulletin of the World Health Organization, 86, 839-848. doi:10.2471/BLT.07.049197
[5] Laterveer, L., Munga, M. and Schwerzel, P. (2004) Equity implications of health sector user fees in Tanzania. Do we retain the user fee or do we set the user f(r)ee? Analysis of literature and stakeholder views. Research for Poverty Alleviation (REPOA), ETC Crystal Leusden.
[6] Gilson, L. and McIntyre, D. (2005) Removing user fees for primary care in Africa: The need for careful action British Medical Journal, 331, 762-765. doi:10.1136/bmj.331.7519.762
[7] RTI International (2010) Health care financing in Nepal Research. RTI International, Triangle Park.
[8] O’Donnell, O. (2007) Access to health care in developing countries: Breaking down demand side barrier. Rio de Janeiro, 23, 2820-2834.
[9] Adhikari, S.R. and Maskay N.M. (2004) Health sector policy in the first decade of Nepal’s multiparty democracy: Does clear enunciation of health priorities matter? Health Policy, 68, 103-112. doi:10.1016/j.healthpol.2003.09.008
[10] MOHP (2012) Nepal national health account 2007-2009. Ministry of Health and Population, Kathmandu.
[11] RTI International (2009) Cost and Equity Implications of Public Financing for Health Services at District Hospitals in Nepal. RTI International, Research Triangle Park.
[12] Filmer, D. and Pritchett, L.H. (2001) Estimating wealth effects without expenditure dataor tears: An application to educational enrollments in States of India. Demography, 38, 115-132.
[13] O’Donnell, O., van Doorslaer, E., Wagstaff, A., and Lindelow, M. (2008) Analyzing health equity using household survey data: A guide to techniques and their implementation. World Bank, Washington DC.
[14] Vyas, S. and Kumaranayake, L. (2006) Constructing socioeconomic status indices: How to use principal components analysis. Health Policy and Planning, 21, 459-468. doi:10.1093/heapol/czl029
[15] Pearson, M. (2002) Benefit incidence analysis: How can it contribute to our understanding of health system performance? UK Department for International Development, London.
[16] MOHP (2009) Free care operational guidelines 2008. Ministry of Health and Population, Government of Nepal, Kathmandu.
[17] MOF (2008) Economic survey 2007/08. Ministry of Finance Government of Nepal, Kathmandu.
[18] O’Donnell O., van Doorslaer, E., Rannan-Eliya, R.P., Somanathan, A., Adhikari, S.R., Harbianto, D., Garg, C.C., et al. (2007) The incidence of public spending on healthcare: Comparative evidence from Asia. The World Bank Economic Review, 21, 93-123. doi:10.1093/wber/lhl009
[19] Gertler, P. and van der Gaag, J. (1990) The willingness to pay for medical care: Evidence from two developing countries. Johns Hopkins University Press for the World Bank, Baltimore and London.
[20] Mwabu, G., Ainsworth, M. and Nyamete, A. (1993) Quality of medical care and choice of medical treatment in Kenya: An empirical analysis. Journal of Human Resources, 28, 838-862. doi:10.2307/146295
[21] Meessen, B., Van Damme, W., Tashabya, C.K. and Tiouti, A. (2006) Poverty and user fees for public health care in low income countries: Lesson from Uganda and Cambodia. Lancet, 368, 2253-2257.
[22] WHO (2009) South East Asian region and western pacific region health financing strategies for the Asia Pacific region 2010-2015. South East Asian Region and Western Pacific Region, World Health Organization.

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