Financing Health Care in East Asia and the Pacific

John C. Langenbrunner

Description

The East Asia and Pacific region is characterized by wide variations in sources of healthcare
financing, pooling of funds, purchasing of care services, and the extent to which these
policy instruments and programs provide social protection. Existing healthcare financing
systems in the region are under increasing pressure from a continued prevalence of
communicable diseases, an emergence of non communicable diseases, and a rapidly
aging population.
Large inequalities between the poor and the prosperous in their access to healthcare
financing mechanisms can be reformed and strengthened to improve outcomes-
especially for the poor. Financing Health Care in East Asia and the Pacific emphasizes the
need for high-quality, well-funded health systems that generate sustainable financing to
ensure optimal health outcomes and guaranteed financial protection. Adequate funding,
however, will not be enough. Systems will need to manage and spend funds wisely.
It reviews best practices and remaining challenges related to every function of health
financing both within countries and across East Asia and Pacific countries. The book will
be of particular interest to government leaders, policy makers, health economists, donors,
and health service researchers.

Sujets

• Infectious disease
• Health
• Health policy
• Hospital
• Life expectancy
• Mortality
• Nutrition
• Prévention
• Public health

Informations

• Publié par: world-bank-publications
• Publié le: 16 juin 2011
• Nombre de lectures: 22
• EAN13: 9780821387368
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

DIRECTIONS IN DEVELOPMENT
Human Development
Financing Health Care in
East Asia and the Pacific
Best Practices and Remaining Challenges
John C. Langenbrunner and Aparnaa SomanathanFinancing Health Care in
East Asia and the PacificFinancing Health Care in
East Asia and the Pacific
Best Practices and Remaining Challenges
John C. Langenbrunner
Aparnaa Somanathan© 2011 The International Bank for Reconstruction and Development / The World Bank
1818 H Street NW
Washington DC 20433
Telephone: [phone]
Internet: www.worldbank.org
All rights reserved
1 2 3 4 14 13 12 11
This volume is a product of the staff of the International Bank for Reconstruction and
Development / The World Bank. The findings, interpretations, and conclusions expressed in
this volume do not necessarily reflect the views of the Executive Directors of The World Bank
or the governments they represent.
The World Bank does not guarantee the accuracy of the data included in this work. The
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do not imply any judgment on the part of The World Bank concerning the legal status of any
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ISBN: 978-0-8213-8682-8
eISBN: 978-0-8213-8736-8
DOI: 10.1596/978-0-8213-8682-8
Library of Congress Cataloging-in-Publication Data
Financing health care in East Asia and the Pacific: best practices and remaining challenges.
p.; cm. — (Directions in development)
ISBN 978-0-8213-8682-8 — ISBN 978-0-8213-8736-8
1. Medical economics—East Asia. 2. Medical care, Cost of—East Asia. I. World Bank.
II. Series: Directions in development (Washington, D.C.)
[DNLM: 1. Delivery of Health Care—economics—Far East. 2. Economics, Medical—Far
East. 3. Health Care Costs—Far East. 4. Population Dynamics—Far East. W 84 JA14]
RA410.55.E18F56 2011
338.4′73621095—dc22
2010022089
Cover design: Quantum ThinkContents
Acknowledgments xv
About the Book xvii
Abbreviations xxi
Chapter 1 Overview 1
Key Messages 2Establishing the Baseline: Understanding
the Current Situation 5Preparing for What Comes Next: The Changing
Population and Emergent Disease Profile 10Improving the Performance of Health
Care Financing 11
Reforming Service Delivery and
Organization of Care 21Notes 25Reference 25
Chapter 2 Understanding the Macroeconomic Context and
the Health Sectors in East Asia and the Pacific 27
Macroeconomic Context 27Effects on the Poor 29
v vi Contents
Health Status and Health Outcomes 34Demographic and Epidemiologic Trends 37Millennium Development Goals 44Health Financing Levels and Trends 44Linking Health Expenditures and
Delivery of Services 52
Notes 64References 64
Chapter 3 Importance of Investing in Health and a
Framework for Managing and Using Funds 67Health and Its Effects on Economic Growth 67
Health Care Financing Function and Goals 69References 71
Chapter 4 Mobilization of Revenues for Health 73Assessment of the Mix of Health
Financing Revenues 73
Analysis and Discussion 97Note 114References114
Chapter 5 Pooling and Management of Funds 117Pooling: Is It Important? 117
Pooling and Management of Funds in East Asia and the Pacific 119Notes 134References 134
Chapter 6 Resource Allocation and Purchasing 137
A Resource Allocation and Purchasing Framework 137For Whom to Purchase Services: Reaching All in
the Health Sector 138Resource Allocation, Targeting, and
Decentralization 140What to Buy: Refining and Standardizing
the Benefits Package 146
From Whom to Buy: Contracting for
Improved Cost and Quality 163Contents vii
How to Pay: Implementing New Incentive
Payment Systems 170Demand-S ide Financing (Purchasing) 188Notes 193References94
Chapter 7 Connecting Financing and Delivery of Services:
Institutional and Organizational Characteristics
in East Asian and Pacific Countries 199
Overview and Links to Health Care Financing 199Decentralization and Organizational Issues in
the Delivery Systems 200Dimensions of Governance and Stewardship 219Medical Tourism 231Analysis and Discussion 235
Note 238References38
Chapter 8 Assessing Performance in East Asia and
the Pacific: Efficiency and Equity of
Health Financing 243
Efficiency43Equity 246Distribution of Public Subsidies for Health Care 256Note 259References 260
Appendix A National Health Account Activity in
East Asia and the Pacific 265
Appendix B Medical Tourism in East Asia and the Pacific 287
Appendix C Health Financing in East Asia and the Pacific:
Review of Project Appraisal Documents 305
Index 309viii Contents
Boxes
2.1 China’s Experience with Rising Levels of
Noncommunicable Diseases 45
4.1 Types of Voluntary Health Insurance 78
4.2 Effect of China’s New Cooperative Medical
Scheme on Out-of-Pocket Spending 92
4.3 Donor Financing in Cambodia 94
4.4Health Shocks and Impoverishment in China 112
5.1 The Czech Republic Risk Adjustment Reforms 130
5.2 Public Financing Reforms in Chile 132
6.1Core Policy Levers Related to the Uses of Financing 138
6.2 Provider Payment Pilots in Urban and Rural China 179
6.3Steps for Implementing a Global Budget for Hospitals 188
7.1 Demand-Side Governance: The Affiliated
Network for Social Accountability 223
8.1 The Mixed Public-Private Health System in
Hong Kong SAR, China 259
A.1 Country-Level Criteria for Institutionalization of
NHAs in Low- and Middle-Income Settings 285
B.1 Selected Available Treatments for Medical Tourists in
the Philippines 299
Figures
1.1 Annual Economic Growth Rates in EAP countries:
2004–2015 6
2.1 Population Diversity in the Larger Countries in
East Asia and the Pacific, 2007 28
2.2 Population Diversity in the Smaller Countries in
East Asia and the Pacific, 2007 28
2.3 Gross Domestic Product Growth Per Capita, 2007 28
2.4 Proportion of Poor People in East Asia and
the Pacific, 1990–2007 32
2.5 Rural Population as a Share of Total Population 32
2.6 Trends in Fertility Rates in East Asia and
the Pacific, 1980–2005 33
2.7 Infant Mortality by Income Per Capita, 2005 34
2.8 Infant Mortality Rate Relative to Health Spending, 2005 34
2.9 Infant Mortality Relative to Income and
Health Spending, 2005 35
2.10 Child Mortality by Income Per Capita, 2005 35