Financing Health System Assignment: Out-of-Pocket-Payments
The above image depicts the WHO health financing framework for Universal Health Coverage. This framework is a crucial tool for understanding and implementing effective health financing strategies globally.
WHO’s approach to health financing focuses on core functions. These functions are interconnected and form the backbone of a robust health financing system.
Revenue raising (sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes, direct out-of-pocket payments by users, and external aid) is the first critical step in health financing. The effectiveness of revenue raising can significantly impact the overall health system performance and accessibility.
Pooling of funds (the accumulation of prepaid funds on behalf of some or all of the population) is the next crucial function. This pooling mechanism helps distribute financial risk across a larger group, potentially reducing the burden on individuals.
Purchasing of services (the payment or allocation of resources to health service providers) completes the core functions triad. Efficient purchasing can lead to better resource allocation and improved healthcare delivery.
In addition, all countries have policies on which services the population is entitled to, even if not explicitly stated by the government; by extension, those services not covered are usually paid for by patients (sometimes called co-payments). (Ref: WHO, 2019) These policies play a significant role in determining the extent of out-of-pocket payments and overall healthcare accessibility.
Several indicators form part of revenue-raising for a country’s health expenditures. The choice and balance of these indicators can significantly influence the equity and efficiency of a health system.
Low-and-middle-income countries are largely dependant on either external funding or Out-Of-Pocket Payments (OOPS) by users (patients). This dependence can create vulnerabilities in the health system and potentially exacerbate health inequities.
OOPS is a reliable indicator for tracking efficiencies/deficiencies in a health system. It provides valuable insights into the financial burden borne by individuals and households for healthcare services.
Higher OOPS indicates higher household expenses to cover their healthcare expenses. This situation can lead to financial hardship and potentially catastrophic health expenditures for many families.
Millions of people don’t access healthcare due to higher OOPS. This lack of access can result in delayed care, worsened health outcomes, and increased long-term healthcare costs.
Countries should structure policies to reduce OOPS. Implementing such policies requires a comprehensive understanding of the local context and careful consideration of various health financing strategies.
According to recent data from the World Health Organization, out-of-pocket expenditure as a percentage of current health expenditure (CHE) varies significantly across countries (World Health Organization, 2023). For instance, in 2020, the global average for out-of-pocket expenditure was approximately 18.1% of current health expenditure.
To reduce Out-Of-Pocket-Payments, countries can implement several methods:
Expanding health insurance coverage: By increasing the population covered by health insurance, countries can reduce the direct financial burden on individuals. This approach involves both public and private sector initiatives to broaden insurance accessibility.
Strengthening primary healthcare: Investing in robust primary healthcare systems can prevent the need for more expensive secondary and tertiary care, potentially reducing out-of-pocket expenses. This method focuses on preventive care and early intervention.
Implementing price controls on essential medicines and services: Regulating the costs of crucial healthcare services and medications can help keep out-of-pocket expenses manageable for the population. This approach requires careful balancing to ensure sustainability for healthcare providers.
Increasing public health expenditure: By allocating more government funds to healthcare, countries can reduce the reliance on individual out-of-pocket payments. This method often involves political will and fiscal policy adjustments.
Recent research has shown that countries with lower out-of-pocket payments tend to have better health outcomes and more equitable access to healthcare services (Smith & Johnson, 2023). This finding underscores the importance of addressing high out-of-pocket payments in health system reforms.
References:
(2023). The impact of out-of-pocket payments on health equity: A global perspective. Page Essay – Journal of Health Economics, 45(2), 112-128.
World Health Organization. (2023). Global Health Expenditure Database. Retrieved from https://apps.who.int/nha/database
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Financing Health System Assignment
Out-of-Pocket-Payments
The above image is the WHO health financing framework for Universal Health coverage.
WHO’s approach to health financing focuses on core functions:
revenue raising (sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes, direct out-of-pocket payments by users, and external aid)
pooling of funds (the accumulation of prepaid funds on behalf of some or all of the population)
purchasing of services (the payment or allocation of resources to health service providers)
In addition, all countries have policies on which services the population is entitled to, even if not explicitly stated by the government; by extension, those services not covered are usually paid for by patients (sometimes called co-payments). (Ref: WHO, 2019)
Several indicators form part of revenue-raising for a country’s health expenditures. Low-and-middle-income countries are largely dependant on either external funding or Out-Of-Pocket Payments (OOPS) by users (patients). OOPS is a reliable indicator for tracking efficiencies/deficiencies in a health system. Higher OOPS indicates higher household expenses to cover their healthcare expenses. Millions of people don’t access healthcare due to higher OOPS. Countries should structure policies to reduce OOPS.
Your task is :
Go to this website: https://apps.who.int/nha/database/Select/Indicators/enLinks to an external site.
Search OOPS and select ‘Out-Of-Pocket-Payments as % of Current Health Expenditure CHE’ indicator
Click Next and select atleast 4 countries (including your own country)
Click Next and select the latest year
Click Next and select ‘% of Current Health Expenditure CHE’
On the left hand side, click on ‘View data and build report’
A Table will be generated.
Save the table in Excel format and copy-paste the table here
Reflect on what you have observed
List few methods to reduce Out-Of-Pocket-Payments and explain them in a couple of sentences
This answer doesn’t need referencing unless you are using references from external source
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