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World Health Organization : Year 1997 ; World Health Organization, Analysis, Research, And Assessment, Current Concerns, No. 97.6: Public and Private Roles in Health a Review and Analysis of Experience in Sub-Saharan Africa

By Sara Bennett

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Book Id: WPLBN0000142548
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File Size: 3.71 MB
Reproduction Date: 2005

Title: World Health Organization : Year 1997 ; World Health Organization, Analysis, Research, And Assessment, Current Concerns, No. 97.6: Public and Private Roles in Health a Review and Analysis of Experience in Sub-Saharan Africa  
Author: Sara Bennett
Volume:
Language: English
Subject: Health., Public health, Wellness programs
Collections: Medical Library Collection, World Health Collection
Historic
Publication Date:
Publisher: World Health Organization

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Bennett, B. S. (n.d.). World Health Organization : Year 1997 ; World Health Organization, Analysis, Research, And Assessment, Current Concerns, No. 97.6. Retrieved from http://www.self.gutenberg.org/


Description
Medical Reference Publication

Excerpt
SYNOPSIS This paper considers the changing roles of government in sub-Saharan Africa in both the financing of health care and the provision of health care. Four themes are selected for in-depth review and analysis of experience. These themes are user fees for public health care services, insurance, government's relationship with private for-profit providers and government's relationship with the not-for-profit sector. The macro-economic crisis across the continent has created a financing gap in the health sectors of most countries. In response to this problem, and in keeping with broader ideological trends, many African countries have adopted policies changing the relative roles of public and private sectors in health care. All but five countries in sub-Saharan Africa have now implemented some form of user fees for public health care services. Health insurance coverage remains limited but many countries are actively pursuing policies to promote it. Attitudes towards the private for-profit sector have changed remarkably during the past decade; previously viewed in many African countries as a pariah, it is increasingly seen as a partner. Some not-for-profit providers have also benefitted from the policy shift. In countries such as Uganda and Ethiopia there have been marked increases in the level of development aid channelled to not-for-profit organizations.

Table of Contents
TABLE OF CONTENTS SYNOPSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1. 1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 . PRINCIPLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.1 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2 The role of government . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3 . USER FEES FOR PUBLIC HEALTH SERVICES . . . . . . . . . . . . . . . . . . 6 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 3.2 Success in achieving objectives . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.3 Process questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3.4 Equity issues and the impact of fees . . . . . . . . . . . . . . . . . . . . . . . 14 3.5 Conclusions on User fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 4 . HEALTH INSURANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 4.2 Social health insurance schemes . . . . . . . . . . . . . . . . . . . . . . . . . . 20 4.3 Employer based insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 4.4 Community based health insurance . . . . . . . . . . . . . . . . . . . . . . . . 27 4.5 Conclusions on health insurance . . . . . . . . . . . . . . . . . . . . . . . . . . 30 5 . REGULATION AND INCENTIVE SETTING FOR PRIVATE FOR-PROFIT PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 5.2 Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 5.3 Incentives and coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 5.4 Towards internal markets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 5.5 Conclusions on private for-profit providers . . . . . . . . . . . . . . . . . . . 41 6 . REGULATION AND INCENTIVE SETTING FOR PFUVATE NOT-FOR- PROFIT HEALTH CARE PROVIDERS . . . . . . . . . . . . . . . . . . . . . . . . . 43 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 6.2 Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 6.3 Incentives and coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 6.4 MOH contracting with the not-for-profit sector . . . . . . . . . . . . . . . . 48 6.5 Coi~clusionso n the private NFP sector . . . . . . . . . . . . . . . . . . . . . 50 7 . CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 REFEFENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 APPENDIX1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 ANNOTATED BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

 
 



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