“Health sector reforms in both developed and developing countries have led to fair financing of healthcare services.”
Executive Summary
Introduction
Health & medical sector in case of developed & developing countries have been experiencing one of the biggest reforms. This has led to an increase in the demand for this particular sector. With the conversion of the health care sector in to a public sector approach, there has been a rise in the overall donations of the funds or finances.
While formulating as well as implementing the health sector, the two parties i.e. the donor along with the various communities would be willing to place a system which could help in order to monitor & evaluate the success of the various reforms in the health sector.
While recognizing the various types of weaknesses attached in order to measure the reforms in health sector. Some of the major concerns which would be recommended in order to measure the financing of the healthcare services would be to take into consideration sustainability, efficiency, quality, etc. While measuring the financial performance of the health sector various relevant & reliable aims. The data available would be easily collected & used from time to time which would help in order to measure the financials of the health care sector.
The various criteria i.e. strengths & weakness would be quite useful in measuring the performance of the health care sector. Various links between the performance indicators have been discussed within the report. In this report the mainly consists of the various financials within the health care sector in both developed & developing countries such as Canada & India respectively. The success in case of the health sector would be done not only by the looking into the various aspects but would be dependent upon the various ways with which the performance has been measured. While measuring the various aspects, the next step would be to see the various systems which could be relied upon. The further steps would be to do a final short listing of the various systems such as sector reforms, scoring systems, availability & quality of the data, etc to allocate the financial of the health sector
Important achievements of health care in developing nations during the preceding years included the movement towards universal childhood immunization; expansion of oral rehydration therapy; and the approaching eradication of polio in the Americas. There was also increased recognition of new challenges in reproductive health, management of the sick child, and HIV/AIDS. Vertical and categorical programs had made a mark.
Nevertheless, it was also increasingly apparent that the health systems necessary to support and sustain these gains were seriously deficient and often deteriorating. As many sector reports and health sector assessments consistently demonstrated, health systems in numerous developing countries suffered from grossly inefficient and inequitable resource allocation, declining quality, and demoralized work forces. Patients were abandoning public systems, “voting with their feet,” by choosing private care, which was often of questionable quality. These deteriorating health systems raised questions of whether the significant health gains would be sustained when intensified donor-supported efforts ended, whether simply injecting more funds would be wise or effective, and whether new gains would be possible in the poorest countries.
“Health sector reform” promised a period of new thinking and innovation in health systems that would address this gap. Concepts such as “new public management” or “public-private partnerships” heralded an exciting potential synthesis of public purpose and entrepreneurial creativity that could launch a new period of rapid health gains. Innovations in health care financing and delivery were seen to be invigorating bureaucratically-run health care systems in more advanced nations.
Health sector in developing country (financing of health care)
The financing of the health sector in case of the developing countries such as India, Bangladesh, Egypt, Maldives, Namibia, etc.
Financing of the health sectors in case of the developing would play one of the most crucial roles while measuring the health system. The main use of the financials would be to define the overall structure, take care of the behavior of the stakeholders as well as maintain high levels of relationship with the same.
There are various sources with which the health financing of a particular sector could be measured. Some of the ways have been discussed as under. They are:
Þ Private sector which would include the nonprofit organizations,
Þ Organize as well as use the various finances with the help of insurance
Þ Health care of the employees, target populations, etc
Þ Include the tax based public sector which would mainly take into consideration the following i.e. state, local government.
Þ Other autonomous public sector bodies would also have been included in the same
Þ Households which would include the different types of fees to be paid to the public
Þ Grants, loans or any other form of external financing, etc
In case of the developing countries such as India, spending on health has been estimated to be approximately 4.5% – 6%. In order to get into an in depth knowledge of the same, a survey was conducted by the National health association. Hence, a detailed survey has been constructed which measures the spending on health. This approach would help in order to provide a better as well as an in depth knowledge regarding the size of the financing done in case of the health sector.
Major findings which have been seen from the national health association have been estimated to be Rs 108, 732 crores in the year 2001-2002 (approximately). This accounts to 4.8% of the total GDP. When measured, the expenditure spent on the health services have been accounted to be a relative measure over the GDP i.e. 5.2%.
It has been seen that, in case of the developing countries such as Maldives, India, etc the Central, State government has spent one fourth of the entire budget fixed upon health expenditure. The major share of the same includes defence, telegraphs, railways; civil ministries, etc have been accounted to be 2.42% approximately as compared to the total spending of the developing country.
The majority of the estimation has been based upon the spending which has been made by the officials taking into consideration the various types of reimbursements, etc. The government reserves with respect to health have been estimated to be 2.2% of the entire spending in case of the health sector. The estimated amount comes from the local government. This estimated does not involve the various types of expenses done by the Panchayats or the people involved in municipal corporations. It should be seen that, people involved in the municipalities refers to one of the main donor who provides such type of shares. The amount contributed by the same would refer to a considerable portion included within the panchayat’s.
Þ Public Financing of Health
The public financing of health plays one of the major roles while financing of the health services. It has been noticed that, the contribution done by the same is estimated to be less as compared as compared to the total spending made in one of the developing countries such as India. Public health plays one of the biggest roles in planning, shaping as well as release the different types of services. This type of provision in case of the public health services would be quite essential to achieve. Therefore, it could be seen that the public health care services have been wide spread in the different parts of the country. This health system has increased its importance. This could be seen with the help of the figures noted in the year 2001- 02 i.e. 137311 sub centers, 4048 hospitals, 22842 PHC & an approximate work force of 345514. The way with which the financing in the health sector has been taken into place would detect the level of efficiency of a particular service which involves high levels of mechanisms to be taken place within the sector.
Health has been referred to as one of the aspects as well as subject matter f critical interest. Therefore, high levels of financing have been done by the state & central government in the developed & developing countries. The per capita spending upon this sector ahs been approximately estimated to be US$23 (1997-2003). It has been noticed that in India the levels of spending in the health sector has been relatively low as compared to the other developing nations such as Thailand & Sri Lanka. The estimated levels of spending in the two developing countries mentioned are US$71 & US$31 respectively. It has been noticed that, in India there has been breakdown in case of this sector. It has been reportedly said that, there has been a significant levels of health outcomes in case of Sri Lanka & Thailand. This denotes that, there has been a remarkable increase or there is a strong base which has led to a rise in the overall spending on the health sector. This has been stated by two of the autonomous bodies such as National Health Policy & National Common Minimum Program.
One of the main ways with which public financing could be practiced would be with the help of tax & non tax revenues. The two primary sources mainly include loans, grants, fees, etc from the various internal as well as external; sources. This would majorly face high levels of competition in terms of demand. The levels of competition could be seen from the various departments, different ministries attached to it etc.
The handful amounts of resources have been contributed by the Central & the State government which would own & control the program. The Central government plays one of the most important roles which would help in order to club the various types of the programs designed for the health sector. This would help in order to meet the various types of goals by abiding to the various health policies or guidelines. In order to take up the various types of goals in the health sector, certain critical components would be kept in mind which would be supported by the various programs in the same field.
One of the main ways with which finances could be raised by the public would be with the help of the taxes. Apart from tax, an amount could be raised by the public along with the amount of fees, fines, etc attached to it. This amount could be supported with the various types of grants, fees, loans, etc from the different external sources. The local government along with the state government would be depending upon the big health programs. The regional government would mainly raise different types of resources which would vary from one state to another. The variation would be noticed in high or large numbers. Hence, it could be stated that health sector has been rendered to as one of the sectors which is underfunded.
Health Expenditure by the Central Government
Some of the ways with which the central governments have financed the health sector within the various developing countries such as India, Maldives, etc. Some of the initiatives made by the government are in forms of reforms which would help in order to originate from the Ministry of Health & Welfare. This plays one of the crucial roles in case of financing the health sectors.
The ministry of the Health & Family majorly comprises of three main departments. The breakup within the department could be seen with respect to the budget which has been spent by the same. It has been estimated that, approximately one-third of the entire budget has been spent by the Health department & the rest i.e. two-third of the budget has been spent over the of family welfare. In case of Indian Context, approximately 2-3% of the entire budget has been spent by the Indian Government. The five main points which have been taken into consideration in the recent years are as follows:
Þ A steady drop in the levels of funds has been done in US during the time of fiscal stress.
Þ A high levels of dip within the investment in case of public hospitals during the innovations within the technology, shift in the needs of the health as well as epidemiology would lead to an increase or a rise in the burden to increase the levels of disease
Þ High levels of subsidy to its employees
Þ Assign as well as apportion different types of inefficiencies which have been covered within the various Health programs
Þ To use various preventive measures related to the health sector
Health sector in developed country (financing of health care)
The health sector in case of the developed countries such as Canada, US, UK, etc, an elaborative government system has been framed which would involve discussions in relation to policy issues being practiced in Canada. It has been noticed that, in the year 1906, people of the government along with the various officials had apprehended many meetings focusing upon the health care system which has been formulated by the Health Act of Canada.
The various roles which have been played by the federal as well as the provincial government in case of this sector would include the following. They are as follows:
Þ Formulate various plans & programs focusing upon the health care sector
Þ Major regulations in the field of health would help in order to promote, protect, security of health, etc
Þ To take into consideration that, vaccines, dugs & various medical products would be sold in the developed country
Þ The medical products sold in the country would be of the optimum quality, safe to use & therapeutically effective
Þ To provide medical as well as scientific research with the help of various means of funding, etc
Þ To make sure that, the health services provided by the government officials of Canada should be provided to the various specific groups such as aboriginal people, people in the federal prisons, etc.
Þ To provide transfer payments this would help in order to assist the government in order to provide various consistent services in case of health sector under the Health Act of Canada.
The government
The provincial governments exercise their constitutional power to formulate policies for the administration and delivery of health care services as well as the regulation, inspection, licensing, and monitoring of health-related premises, institutions and personnel within their jurisdictions. In formulating health care policies, the provincial governments must abide by the conditions stipulated in the Canada Health Act in order to receive federal transfer payments on health.
The conditions set out in the Canada Health Act for provinces to receive federal transfer payments on health include:
(a) provision of insured health care services by each provincial government must adhere to the following five principles:
(i) public administration: publicly financed and administered by a not-for-profit public authority;
(ii) comprehensiveness: comprehensive provision of all medically necessary services;
(iii) universality: universal coverage;
(iv) portability: coverage for insured health care services should be maintained when a person moves or travels within Canada or travels outside Canada; and
(v) accessibility: accessibility of medically necessary services without being impeded by financial or other barriers;
(b) financial contribution of patients for insured health services are discouraged by a mandatory dollar-for-dollar penalty to be deducted from federal transfer payments; and
(c) the provincial governments are required to provide the federal government with information about how the conditions set out in the Canada Health Act are met as well as how the federal government’s financial contribution to health services has been recognized, e.g. by recognizing the federal government’s financial contribution to health services in the provincial budget document.
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