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ABSTRACT: Administrative costs are an important spending category in total health insurance expenditure. Yet, they have rarely been a topic outside the US and there is no cross-country comparison available. This paper provides a global overview and analysis of administrative costs for social security schemes (SSS) and private health insurance schemes (PHI).
The analysis is based on data of the World Health Organization (WHO) National Health Accounts (NHA) and the Organisation for Economic Cooperation and Development (OECD) System of Health Accounts (SHA). These are the only worldwide databases on health expenditure data. Further data was retrieved from a literature search. Administrative costs are presented as a share of total health insurance costs.
Data is available for 58 countries. In high-income OECD countries, the average SSS administrative costs are 4.2%. Average PHI administrative costs are about three times higher. The shares are much higher for low- and middle-income countries. However, considerable variations across and within countries over time are revealed.
Seven explanatory factors are explored to explain the variations: health financing system aspects, administrative activities undertaken, insurance design aspects, context factors, reporting format, accounting methods, and management and administrative efficiency measures. More detailed reporting of administrative costs would enhance comparability and provide benchmarks. Improved administrative efficiency could free resources to expand coverage.
Health Policy 08/2011; 102(2-3):235-46. · 1.51 Impact Factor
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ABSTRACT: AuszugDieser Artikel erörtert den Prozess, die Ergebnisse und die Konsequenzen einer Untersuchung zur finanziellen Realisierbarkeit sozialer Krankenversicherung (SKV) im Rahmen der in Lesotho durchgeführten Abklärung der Frage, wie das Land vorzugehen hat, um das Ziel einer allgemeinen Krankenversicherung zu erreichen. Quantitative Daten des Staates sowie aus weiteren Quellen und qualitative Daten aus Diskussionen mit Interessenvertretern wurden in SimIns eingegeben, einer Krankenversicherungs-Simulationssoftware, mit der modellhaft SKV-Einnahmen und -Ausgaben für einen Zeitraum von elf Jahren berechnet wurden. Wie die Untersuchung im Prinzip zeigt, könnten alle Bürger Lesothos, unter den beschriebenen grundsatzpolitischen Annahmen mittels einer Mischung aus Steuerfinanzierung und SKV-Beiträgen, Deckung durch Gesundheitsleistungen in einem festgelegten Umfang erhalten. Ein solches Finanzierungssystem böte Schutz vor gesundheitsbedingten Finanzrisiken und mehr Chancengerechtigkeit in Bezug auf den Zugang und die Gesundheitsfinanzierung.
Internationale Revue für Soziale Sicherheit 05/2011; 64(2):51 - 72.
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ABSTRACT: RésuméCet article examine les processus, les résultats et les implications d'une évaluation de faisabilité financière d'une assurance sociale maladie (ASM), dans le cadre de la recherche par le Lesotho des moyens d'atteindre une couverture universelle en matière de soins de santé. Des données quantitatives fournies par les pouvoirs publics et d'autres sources, et des données qualitatives résultant de discussions avec les parties prenantes, ont été entrées dans SimIns, un logiciel de simulation d'assurance maladie. Avec ce dernier, on a ensuite projeté les recettes et les dépenses de l'ASM pour une période de onze ans. En principe, l'évaluation révèle que, par le biais d'une combinaison de financement fiscal et de cotisations sociales, tous les citoyens du Lesotho pourraient être couverts pour un ensemble de prestations sanitaires définies dans le cadre des hypothèses directrices déterminées. Ce dispositif de financement fournirait une protection du risque financier et renforcerait l'équité dans l'accès et le financement de la santé.
Revue Internationale de Sécurité Sociale 05/2011; 64(2):53 - 73.
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ABSTRACT: ResumenEn este artículo se examina el proceso, los resultados y las repercusiones de una evaluación de la viabilidad financiera del seguro social de salud (SHI, por sus siglas en inglés), que forma parte del intento de Lesotho de explorar la forma de avanzar hacia una cobertura universal en la asistencia médica. Se introdujeron datos cuantitativos provenientes del Gobierno y de otras fuentes, y datos cualitativos obtenidos en conversaciones con las partes interesadas en el programa de simulación de seguros de salud SimIns, y se hizo una previsión a once años de los ingresos y gastos del SHI. La evaluación muestra que, en principio, se podría proporcionar cobertura para todos los ciudadanos de Lesotho con un paquete determinado de prestaciones de servicios de salud acordes con una política definida mediante una combinación de financiación con cargo a los impuestos y contribuciones al SHI. Un sistema de financiación de estas características proporcionaría protección contra el riesgo financiero y aumentaría la igualdad en el acceso y la financiación de la salud.
Revista Internacional de Seguridad Social 05/2011; 64(2):51 - 71.
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ABSTRACT: This article discusses the process, results and implications of a financial feasibility assessment of social health insurance (SHI), as one part of Lesotho's exploration of how to move towards achieving universal health care coverage. Quantitative data from government and other sources, and qualitative data from discussions with stakeholders, were entered into SimIns, a health insurance simulation software, through which SHI revenue and expenditure for 11 years was projected. In principle, the assessment reveals that through a mix of tax financing and SHI contributions, all citizens of Lesotho could be covered with a defined benefit package of health services under the defined policy assumptions. Such a financing scheme would provide financial risk protection and enhance equity in access and health financing.
International Social Security Review 03/2011; 64(2):45 - 63.
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ABSTRACT: The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population.
The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team.
SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 03/2011; 101(3):179-83. · 2.04 Impact Factor
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ABSTRACT: Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage. The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators. Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks. The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.
Health Policy 10/2010; 99(3):183-92. · 1.51 Impact Factor
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ABSTRACT: In 2005, the Member States of WHO adopted a resolution encouraging countries to develop health financing systems capable of achieving and/or maintaining universal coverage of health services - where all people have access to needed health services without the risk of severe financial consequences. In doing this, a major challenge for many countries will be to move away from out-of-pocket payments, which are often used as an important source of fund collection. Prepayment methods will need to be developed or expanded but, in addition to questions of revenue collection, specific attention will also have to be paid to pooling funds to spread risks and to enable their efficient and equitable use. Developing prepayment mechanisms may take time, depending on countries' economic, social and political contexts. Specific rules for health financing policy will need to be developed and implementing organizations will need to be tailored to the level that countries can support and sustain. In this paper we propose a comprehensive framework focusing on health financing rules and organizations that can be used to support countries in developing their health financing systems in the search for universal coverage.
Bulletin of the World Health Organisation 12/2008; 86(11):857-63. · 4.64 Impact Factor
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Guy Carrin,
Chris James,
Michael Adelhardt,
Ole Doetinchem,
Peter Eriki,
Mohammed Hassan,
Henri van den Hombergh,
Joses Kirigia,
Burkard Koemm,
Rolf Korte, [......],
Zipora Mumani,
Benjamin Nganda,
James Nyikal,
Joyce Onsongo,
Chris Rakuom,
Bernd Schramm,
Xenia Scheil-Adlung,
Friedeger Stierle,
Dan Whitaker,
Manfred Zipperer
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ABSTRACT: Kenya has had a history of health financing policy changes since its independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a transition period. Questions of economic feasibility and political acceptability continue to be discussed, with stakeholders voicing concerns on design features of the new proposal submitted to the Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress towards effective universal coverage can be planned and achieved.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 02/2007; 97(2):130-5. · 2.04 Impact Factor
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ABSTRACT: There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya.
The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software.
The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers.
The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their professionalism and addressing professional goals such as recognition, career development and further qualification. It must be the aim of human resources management/quality management (HRM/QM) to develop the work environment so that health workers are enabled to meet their personal and the organizational goals.
Human Resources for Health 02/2006; 4:24. · 1.83 Impact Factor
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ABSTRACT: This paper contributes to analysing and understanding the demand for (social) health insurance of informal sector workers in Kenya by assessing their perceptions and knowledge of and concerns regarding health insurance and the Kenyan National Hospital Insurance Fund (NHIF). It serves to explore how informal sector workers could be integrated into the NHIF. To collect data, focus group discussions were held with organized groups of informal sector workers of different types across the country, backed up by a self-administered questionnaire completed by heads of NHIF area branch offices. It was found that the most critical barrier to NHIF enrollment is the lack of knowledge of informal sector workers about the NHIF, its enrollment option and procedures for informal sector workers. Inability to pay is a critical factor for some, but people were, in principle, interested in health insurance, and thus willing to pay for it. In sum, the mix of demand-side determinants for enrolling in the NHIF is not as complex as expected. This is good news, as these demand-side determinants can be addressed with a well-designed strategy, focusing on awareness raising and information, improvement of insurance design features and setting differentiated and affordable contribution rates.
International Journal of Health Planning and Management 23(1):51-68. · 0.64 Impact Factor
