TY - JOUR
T1 - Revisiting the debate on health financing in Low and Middle-income countries
T2 - An integrative review of selected models
AU - Domapielle, Maximillian Kolbe
AU - Sumankuuro, Joshua
AU - Bebelleh, Frederick Der
N1 - Funding Information:
The first is the Ministry of Health's public health system (MSP), which provides free primary healthcare to all Ecuadorians. This scheme covers about 51% of the population, most of whom are poor people. It is funded through general taxes, contingency, and emergency funds. The second financing stream is the Ecuadorian Social Security System (IESS). This scheme purchases healthcare for all formal sector workers and their families through taxes that employers pay into the fund. A component of the IECSS is the Rural Social Security System (SSC), which targets the rural poor and overlaps with MoH rural services. However, the SSC only enrols families through legally recognised peasant organisations. In addition, there is cross‐subsidisation as Urban IESS affiliates contribute a small part of their insurance premium towards the financing of the SSC. Approximately 20% of the population is enroled under this scheme. Other purchasers include the Armed Forces Social Security Institute (ISSFA) and the National Police Social Security Institute (ISSPOL), each covering 5% of the population. The third sector is a private system that relies on out‐of‐pocket payments for health care. This financing scheme covers only 3% of the people; the upper‐ and middle‐class. 17 91
Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - Universal Health Coverage (UHC) as a health policy goal is gaining added currency in the policy agendas of many Low and Middle-Income Countries (LMIC) following the onslaught of the coronavirus (COVID-19) pandemic. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without suffering financial hardship. Whereas most industrialised countries have achieved UHC through the implementation of various traditional health financing mechanisms, most LMIC have not made significant progress in providing financial protection against the costs of illness for majority of the population due to limited fiscal space and or lack of political commitment to raise government revenues and increase fiscal space for health. While the onslaught of COVID-19 refreshes the call for reform of countries' health financing policies to reflect the healthcare needs of the population, the debate about the type or combination of health financing models to employ in LMIC has yet to reach a consensus. This review critically analyses five health financing models to ascertain their appropriateness in providing financial risk protection against the cost of illness, especially in this era of COVID-19. Given the limited fiscal space for health in LMICs, we argue that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms. Moreover, because the creation of fiscal space is context-specific, and UHC is a political issue rather than technical, securing strong political support is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.
AB - Universal Health Coverage (UHC) as a health policy goal is gaining added currency in the policy agendas of many Low and Middle-Income Countries (LMIC) following the onslaught of the coronavirus (COVID-19) pandemic. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without suffering financial hardship. Whereas most industrialised countries have achieved UHC through the implementation of various traditional health financing mechanisms, most LMIC have not made significant progress in providing financial protection against the costs of illness for majority of the population due to limited fiscal space and or lack of political commitment to raise government revenues and increase fiscal space for health. While the onslaught of COVID-19 refreshes the call for reform of countries' health financing policies to reflect the healthcare needs of the population, the debate about the type or combination of health financing models to employ in LMIC has yet to reach a consensus. This review critically analyses five health financing models to ascertain their appropriateness in providing financial risk protection against the cost of illness, especially in this era of COVID-19. Given the limited fiscal space for health in LMICs, we argue that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms. Moreover, because the creation of fiscal space is context-specific, and UHC is a political issue rather than technical, securing strong political support is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.
KW - COVID-19
KW - Ecuador
KW - Ghana
KW - health financing
KW - LMIC
KW - Thailand
KW - universal health coverage
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U2 - 10.1002/hpm.3566
DO - 10.1002/hpm.3566
M3 - Review article
C2 - 36030531
AN - SCOPUS:85136921409
SN - 0749-6753
VL - 37
SP - 3061
EP - 3074
JO - International Journal of Health Planning and Management
JF - International Journal of Health Planning and Management
IS - 6
ER -