Health Financing for Poor People : Resource Mobilization and Risk Sharing.

Intro -- Contents -- Foreword -- Preface -- Acknowledgments -- PART 1 GLOBAL AND REGIONAL TRENDS -- 1. Rich-Poor Differences in Health Care Financing -- Overview and Context -- Conceptual Underpinnings for Community-Based Action in Health Care Financing -- Methodology for Assessing Impact, Strengths, and Weaknesses -- Discussion of Main Findings from Background Reviews -- Conclusions and Recommendations -- Appendix 1A Statistical Data (Summary Tables) -- 2. Review of the Strengths and Weaknesses of Community Financing -- Methods -- What Is Community-Based Health Financing? -- Performance of Community-Based Health Financing -- Determinants of Successful Resource Mobilization, Social Inclusion, and Financial Protection -- Concluding Remarks -- Appendix 2A Performance Variables Reported in the Reviewed Studies -- Appendix 2B Core Characteristics of Community Financing Schemes from the Review of the Literature -- 3. Experience of Community Health Financing in the Asian Region -- What Is Community Financing? -- A Summary of the Value Added by Types of Community-Financing Schemes -- A Review of Selected Asian Community-Financing Schemes -- 4. Experience of Community Health Financing in the African Region -- Conceptual Framework -- Evidence -- Discussion -- Conclusion -- PART 2 COUNTRY CASE STUDIES USING HOUSEHOLD SURVEY ANALYSIS -- 5. Analysis of Community Financing Using Household Surveys -- Background -- Methods -- Results -- Discussion -- Concluding Remarks -- Appendix 5A List of Reviewed Survey Instruments -- 6. Financial Protection and Access to Health Care in Rural Areas of Senegal -- Health Insurance in Rural Sub-Saharan Africa -- Research Design and Methodology -- Results -- Conclusions -- 7. Community-Based Health Insurance in Rwanda -- Background -- Data Sources and Methodology -- Results -- Discussion and Conclusion.

8. The SEWA Medical Insurance Fund in India -- Methods -- Results -- Discussion -- 9. The Potential Role of Community Financing in India -- Community Financing in India and the SEWA Program -- Research Design and Methodology -- Results -- 10. Impact of the Thailand Health Card -- Methods -- Discussion -- Conclusions and Recommendations -- PART 3 EXPENDITURE GAPS AND DEVELOPMENT TRAPS -- 11. Deficit Financing of Health Care for the Poor -- Progress toward Achieving the MDGs -- Key Drivers of Accelerated Progress toward Achieving the MDGs -- Estimating the Cost of Achieving the MDGs -- Financing the Expenditure Gap -- Conclusions -- 12. Impact of Risk Sharing on the Attainment of Health System Goals -- Health System Goals and Functions in a Nutshell -- The Organizational Form of Health Financing and Its Link to the Attainment of Health System Goals -- Organization of Health Financing in the World -- Modeling the Impact of the Organizational Form of Health Financing on Health System Attainment Indicators -- Community Risk-Sharing Arrangements: Further Need to Measure Their Impact -- Concluding Remarks -- Appendix 12A Statistical Data -- About the Coeditors and Contributors -- The Coeditors -- Other Contributing Authors -- Index -- BOXES -- 1.1 Revenue Mobilization -- 1.2 Strengths of Community-Financing Schemes -- 1.3 Weaknesses of Community-Financing Schemes -- 2.1 Definitions of Community Health Financing -- 2.2 Contribution of CF Schemes to Operational Revenues -- 2.3 The Bamako Initiative -- 2.4 Turning Potatoes and Labor into Cash Revenues in Bolivia -- 2.5 Poor Management in the Nkoranza Scheme -- 4.1 Ghana's Policy Thrusts to Enable Evolution of Community Health Insurance -- 11.1 Millennium Development Goals (1990-2015) -- FIGURES -- 1.1 Less Pooling of Revenues in Low-Income Countries -- 1.2 Flow of Funds through the System.

1.3 Low-Income Countries Have Weak Capacity to Raise Revenues -- 1.4 Out-of-Pocket (OOP) Expenditure and Poverty without Risk Sharing -- 1.5 Pro-Rich Bias of Public Subsidies in Many Low-Income Countries -- 1.6 Determinants of Financial Protection, Health, and Social Inclusions -- 1.7 Hospitalization and Impoverishment -- 1.8 Stages of Financial Protection -- 2.1 Analytical Framework -- 3.1 Feasibility of Establishing Community Financing and the Amount the Average Person Is Willing to Pay as a Function of Expected Gains and Social Capital -- 3.2 Plausible Relationship between Locus of Control and Economic and Quality Gains -- 3.3 The Trade-Offs between Health Gains and Risk Protection by Type of Service Funded -- 4.1 Relationships between Stakeholders and the Scheme -- 4.2 Percentage of Community Enrolled, by Distance -- 4.3 Premiums, Participation, and Revenues: Predictions for Option C -- 4.4 Willingness to Pay for Adult Insurance -- 4.5 Stages of Financial Protection and Supporting Policies -- 6.1 Urban and Rural Health Insurance Schemes in Sub-Saharan Africa, Year of Inception and Size -- 7.1 Monthly Monetary Expenditure per Capita -- 11.1 Millennium Development Goals, Global Aggregate -- 11.2 Strong Correlation between Wealth and Health across Time -- 11.3 Income and Child Mortality -- 11.4 Cost-Effective and Affordable Public Health and Clinical Services -- 11.5 Three Non financial Determinants of Good Outcomes -- 11.6 Lack of Management Capacity, Adverse Incentives, and Weak Institutions Break the Fulcrum -- 11.7 Expenditure Frontier and Six Countries -- 11.8 Production Frontiers for Total Expenditure on Health Care (Using Best Performance on Various Health Outcomes) -- 11.9 Production Frontiers for Public Expenditure on Health Care (Using Best Performance on Various Health Outcomes) -- 11.10 Income and Health Spending.

11.11 Only 11 Percent of Global Spending for 90 Percent of the World's Population -- 11.12 Low-Income Countries Have Less Pooling of Revenues -- 11.13 Types of Private Financial Flows -- TABLES -- 1.1 Conceptual Underpinnings of Community-Financing Schemes -- 1.2 Summary Statistics of the Literature Reviewed, by Publication Type -- 1.3 Core Characteristics of the Community-Based Financing Schemes -- 1.4 Characteristics of Five Survey Instruments -- 1.5 Types of Community-Based Financing -- 1.6 Number of Studies That Examined Core Health-Financing Subfunctions -- 1.7 Studies That Looked at Ways to Prevent Impoverishment -- 1.8 Studies That Looked at Ways to Combat Social Exclusion -- 1.9 Potential Value Added by Types of Community-Financing Schemes -- 1.10 Statistically Signi ficant Determinants of Inclusion in Community Financing -- 1.11 Summary Findings: Statistically Significant Determinants of Utilization and Out-of-Pocket Expenditure Patterns -- 1.12 Estimation Results for the Basic Models -- 1.13 Estimation Results for the Enlarged Models -- 2.1 Summary Statistics of the Literature Reviewed, by Publication Type -- 2.2 Summary of Literature Reviewed on Community-Based Health Financing Schemes, Based on Nature of Study and by Region -- 2.3 Selection Criteria to Assess the Performance of Community-Based Health Financing -- 2.4 Often Encountered Forms of Community Financing -- 2.5 Summary of Case Studies by Modalities -- 2.6 Cost Recovery from Prepaid Premiums -- 2.7 Summary of Findings: Who Is Covered by CF Arrangements? -- 2.8 Summary of Findings: Does CF Reduce the Burden of Seeking Health Care? -- 2.9 Determinants Associated with Effective Revenue Collection and Financial Protection -- 2.10 Performance Variables Reported in the Reviewed Studies -- 2.11 Core Characteristics of Community-Financing Schemes, from the Review of Literature.

3.1 How Community Members Valued Service Availability, Quality, Risk Protection, and Costs -- 3.2 A Typology of Selected Characteristics of Community-Financing Schemes -- 3.3 Assessment of Potential Value Added by Selected Types of Community-Financing Schemes -- 3.4 Potential Value Added by Types of Community-Financing Schemes -- 3.5 Prevalence and Benefits of Community Health Financing in Five Provinces, 1991 -- 3.6 Prevalence and Benefits of Community Health Financing in 30 Poor Counties, 1993 -- 3.7 Management of Community Health Financing in 30 Poor Counties, 1993 -- 3.8 Community Health Financing by Source in Selected Counties and Provinces, 1991 and 1993 -- 3.9 Two Prototype Benefit Packages for China's Rural Poor -- 3.10 Current Financing of Health Spending by Source in China's Poverty Regions -- 3.11 Percentage of 2,236 Surveyed Community Leaders Citing Major Reasons for Lack of Rural Community Financing -- 4.1 Scheme Design Options -- 4.2 An Example of Goals Matched to Design Options -- 4.3 Features of "Potentially Large Population" Schemes for Informal Sector Households -- 4.4 "Potentially Large Population" Schemes' Financial Risk-Protection Performance -- 5.1 Socioeconomic Characteristics of Rwanda, Senegal, India, and Thailand, 1999 -- 5.2 Health Outcomes and Expenditures in Rwanda, Senegal, India, and Thailand, 1999 -- 5.3 Characteristics of Five Survey Instruments -- 5.4 Statistically Significant Determinants of Inclusion in Community Financing -- 5.5 Summary Findings: Statistically Significant Determinants of Utilization and Out-of-Pocket Expenditure Patterns -- 5.6 Reviewed Surveys for 21 Countries -- 6.1 Hospitalization Fees for Members and Nonmembers at St. Jean de Dieu Hospital -- 6.2 Selection Criteria for Mutual to Be Included in the Survey -- 6.3 Overview of Variables Used.

6.4 Marginal Coefficients for Determinants of Participation in Mutual Health Insurance (Household Level).

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