On general terms, while health finance reforms occur in many countries at different levels of economic development, there is evidence to support WHO’s claim that programmes that come closest to meeting the needs of their populations should include some form of prepayment and pooling to ensure stable and sufficient funds for health, but also that national wealth is not a prerequisite for moving closer to universal coverage.
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In order to raise additional funds it is crucial that governments make health a higher priority in their budget and find new or diversified sources of domestic funding.The report points out to Rwanda as a supporting evidence that all countries can potentially extend financial risk protection and equitable access to health services. Per capita national income in Rwanda is about US$400, with a set of basic services covered through a system of health insurances costing US$37 per capita. Rwanda benefits from the financial support of international donors, but the government also spends 19.5% of its annual budget on health. Although 182 WHO Member States have comparable or superior levels of per capita GDP to Rwanda’s, many are still far away from universal health coverage. WHO estimates that if the governments of the world’s 49 poorest countries allocated 15% of state expenditure to health, they would almost double the current available funding by adding US$15 billion per year. Efficient tax collection systems, tobacco or alcohol taxes and currency transactions levies are some of the ways to increase tax revenues to be used for healthcare, according to the different economic situation and trade composition of each country. It is also important to underline that if all higher income countries kept the promise to allocate 0.7% of their GDP to official development assistance, three million lives could be saved in lower income countries by 2015. Proper use of health funding is crucial to improve access to care for the entire population, but it requires removal of financial barriers to obtaining care. Reducing the dependence on direct, out-of-pocket payment is an important step towards this goal, which yet implies finding resources elsewhere to replace the fees charged for services. Faced to the financial risk of paying for health services, many households simply defer or give up seeking treatment.The best way to address inequalities in poorer groups’ ability to access treatment is therefore to pool funds in order to share the risk among a great number of people. Small voluntary health insurance such as local sickness funds or community health insurances may cover primary-level care costs and part of the cost of hospitalization and constitute a stepping stone to bigger regional schemes, gradually consolidated into national risk pools if properly supported by the government. This process was in place in many countries who are now closer to universal coverage, such as Germany and Japan. Most health financing systems are based on hybrid models collecting resources from a mix of public and private sources, which do not necessarily need to determine how funds are pooled or who benefits. For instance, insurance contributions from employers and/or employees can be pooled together with contributions from general government revenues. Moreover, investment in adequate prevention, primary-level care and rural health services is the basis to overcome additional, nonfinancial barriers such as transportation difficulties or costs and social or cultural issues such as gender discrimination. Last but not least, improving efficiency in health spending may release resources to expand coverage and provide better care at minor costs. Medicines are a main field of intervention, as they account for 20–30% of global health spending, slightly more in low- and middle-income countries. France, for instance, has adopted as a strategy to use generic drugs instead of brand names where possible, saving about US$2 billion in 2008. Countries can improve efficiency by deciding which services to purchase based on information on the health needs of the population and link payments to providers on their performance and to information on service costs, quality and impact, and by reducing hospital inefficiency often related to excessive inpatient admissions and length of stay, for instance by expanding prevention programs and supporting the development of home care and outpatient care services.
Source: World Health Organization (www.who.int)
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