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WHO study group on the evaluation of recent changes in the financing of health services
... Such changes can have a substantial impact on healthcare access and, as a result, the health outcomes of various population groups. The volume and composition of healthcare expenditures, as well as the number and categories of healthcare personnel involved, depend on the adopted financing methods [4] . ...
2024, № 1(50) 159 ամբուլատոր պոլիկլինիկական ոլորտի ֆինանսական հաշվետվությունները: Հետազոտությունները ցույց են տվել, որ առաջնային խնամքի ծառայություններ մատուցողներին վճարվում է ֆիքսված գումար՝ առանց պացիենտի ռիսկին համապատասխանեցնելու կամ առաջնային օղակի բժիշկների համար խթաններ ստեղծելու պացիենտներին ուղարկել հիվանդանոցներ կամ այլ մասնագիտացված խնամքի կենտրոններ: Կատարված հետազոտության արդյունքները ցույց են տալիս, որ մեկ շնչի հաշվով հաշվարկված ֆինանսավորման նորմը հիմնականում ապահովում է ամբուլատոր պոլիկլինիկական հիմնարկի աշխատավարձի ֆոնդի 90-95%-ը, մնացած 5-10%-ն ուղղվում է կոմունալ, վարչական, ներպոլիկլինիկական դեղորայքային ծախսեր և այլն: Ավե-լին, ամբուլատոր բժշկական զննումների և սպասարկման համար սահմանված ֆիքսված գները հիմնականում չեն կիրառվում։ Հանգուցաբառեր՝ առողջապահություն, ֆինանսավորում, բժշկական ծառայություններ, ամբուլատոր պոլիկնինիկական հաստատություններ, աշխատավարձ, ծախսեր գնագոյացում Финансирование и ценообразование амбулаторно-поликлинической медицинской помощи в Армении Агаджанян Сусанна С. к.э.н., старший преподаватель кафедры международных экономических отношений, Армянский государственный экономический университет (Ереван, РА) Варданян Татевик Г. к.э.н., преподаватель кафедры международных экономических отношений, Армянский государственный экономический университет (Ереван, РА) Бадалян Мари В. к.э.н., доцент, декан факультета бухгалтерского учета и аудита, Армянский государственный экономический университет (Ереван, РА) Айвазян Анна А. аспирант кафедры управления, Армянский государственный экономический университет (Ереван, РА) Аршакян Ани А. аспирант кафедры делового администрирования, Армянский государственный экономический университет (Ереван, РА) Аннотация: В данной статье рассматриваются основные особенности финансирования амбулаторно-поликли-нических учреждений в системе здравоохранения РА, нормативы подушевого финансирования и цены, установленные на медицинские услуги. С целью определения параметров нормативов подушевого финанси-рования были проанализированы действующие нормативные документы, финансовая отчетность амбулаторно-поликлинического сектора. Исследования показали, что поставщикам первичной медико-санитарной помощи платят фиксированную сумму без учета риска для пациентов и создания стимулов для врачей первичной медико-санитарной помощи. Результаты проведенного исследования показывают, что подушевой норматив финансирования в основном обеспечивает 90-95% фонда оплаты труда амбулаторно-поликлинического учреждения, остальные 5-10% направляются на коммунальные, административные, внутри-поликлинические расходы, на лекарства и т.д.
... Equally, these organizations provide some billions of dollars in grants or loans to countries in sub-Saharan Africa and as such give them conditions that are aimed at cutting government expenditures and privatizing state-owned companies inter alia [9]. As it were, these proponents strongly recommend privatization in the form of user fees for health services, the promotion of health insurance schemes and increased investments in private care [9,10]. On the contrary, opponents view the introduction of user fees in health services as a diametrical opposition towards the actualization of universal health coverage and as such argue that it should be reduced or even removed at the point of service [11]. ...
The momentum towards achieving the United Nations Millennium Development Goals re-invigorated concerns around sustainable health care financing and the adequacy of the financing arrangements in many low- resource settings. Accordingly, this necessitated the institution of user-fees as part of health financing reform in many countries in sub-Saharan Africa. These fees are charges levied at the point of service with the intent of reducing 'frivolous' consumption of health services, increasing the quality of services available and at the same time increasing coverage and utilisation of services. Likewise, as a 'decisive' policy to cushion the existing challenges facing health care financing in the region, a critical assessment of the assertions of proponents of user fees who use the principle of cost recovery and revenue mobilization to drive the concept of rational utilization, efficiency and equitable distribution of health care services is often exaggerated. As it were, the available evidence suggests that user fees alone will not likely accomplish equity, efficiency, or the sustainability objectives in health services in the region. What is critical is that user fees should be linked to the broader package of financing -such as insurance coverage- and with a view to averting any form of equity danger that may thus arise.
Health care financing involves huge economic burden, which cannot be borne by the government alone. Breaking even in health care financing in the 21st century demands that government corporate with agencies, donors, individuals, and communities to finance health care services in their domains. This article presents a view of rational approach to health care financing and discussed ways of promoting and fostering health development through partnership. Literature search using Embase, Medline and relevant official documents was conducted based on identified criteria. Current trends in health care financing was driven by determination to change the poor health indices, rising need for health care and huge economic burden it places on the government and the realization that most countries with better health care services use different types of public private partnership (PPP) for health care development and sustainability. This is being driven by policy reforms to improve access for affordable health care while ensuring sustainability. This study suggests that improved health care development, financing, and sustainability are possible through public private partnership. It underscored the need to explore other methods of funding apart from the traditional government budgetary spending, which has not greatly favoured our health care development.
Analizar al Sistema Nacional de Salud desde una perspectiva económica, identificando las sinergias positivas con otros sectores de la economía, su problemática financiera, la relevancia del “Complejo Médico Industrial” y sus potencialidades como actor económico; así como estudiar las fortalezas, amenazas, debilidades y oportunidades que enfrentará el Sistema de Salud en el periodo 2007 – 2012 y la generación de una serie de recomendaciones de política para la consolidación del aseguramiento universal en salud en México.
Objetivos específicos: Realizar un Diagnóstico del Financiamiento del Sistema Nacional de Salud.
Analizar las sinergias positivas, los costos y los beneficios entre la Política de Salud y las Políticas: Fiscal, Social y de Combate a la Pobreza, Laboral, Educativa, del Medio Ambiente, del Sector Externo y Comercial y del Sector Turismo.
Estudiar las: Fortalezas, Amenazas, Debilidades y Oportunidades que enfrenta el Sistema Nacional de Salud y el Complejo Médico Industrial para el periódo 2007 – 2012
Proponer una serie de recomendaciones de política para la consolidación del Sistema de Aseguramiento Universal en Salud, para el desarrollo del Complejo Médico Industrial Mexicano y para la Sinergia Positiva entre la Política de Salud y otras Políticas Sectoriales.
La estructura de gasto familiar en México está muy restringida, sus efectos sobre el gasto de bolsillo en salud son: porcentaje de gasto en salud bajo e insuficiente para resolver las necesidades de atención, primeros deciles de ingreso aplazarán gastar hasta que se presente una demanda ineludible; y aunados a la incipiente política social en salud que incrementan la probabilidad de incurrir en gastos catastróficos. Cuando se analiza por hogares la ENIGH 2006, 42% no reportó gasto en salud, 44% reportó gasto de bolsillo en salud sin que fuera catastrófico y 14% sufrió un gasto de bolsillo en salud catastrófico. Los dos rubros de gasto más importantes en materia de Cuidados Médicos y Conservación de la Salud son los Medicamentos, según la ENIGH 2006, el 1° decil de ingreso destinó 37.3% de su gasto de bolsillo en salud a medicamentos no recetados, 28.6% en medicamentos recetados, en total de 66%. Se estima la probabilidad de que un hogar que ha realizado gasto en medicamentos, sufra gasto catastrófico; se utiliza un modelo Probit cuya variable dependiente es gasto catastrófico / gasto no catastrófico y los regresores son condiciones de derechohabiencia, escolaridad, índice de dependencia económica y decil de ingreso. Resultados: los hogares con derechohabiencia tienen factor de protección 32% de tener gastos catastróficos; hogares con niños y ancianos incrementan un 27% su probabilidad y los primeros 4 deciles tienen el doble de probabilidad de gasto catastrófico sobre el resto de los deciles.
Since the 1980s user fees for government services have become an accepted financing option for the health and social sectors in developing countries. Even countries which had a tradition of providing health services free of charge have now introduced fees and the focus of debate has shifted from whether or not to introduce them, to when and how they should be introduced. Proponents of user fees stress that equity and efficiency gains can be achieved through the implementation of a cost-recovery policy package. Within this package user fees are complemented by decentralization and combined with two targeting mechanisms favouring low income groups: exemptions, and the use of fee revenue to improve the services offered to them. The extension and improvement of primary health care, for example, will disproportionately benefit low income groups by addressing their health needs in a cost-effective way.
However, targeting mechanisms, and exemptions in particular, have received little attention in theoretical debates within the health sector and current practices have rarely been reviewed. Relatively little is known about their effectiveness or about the conditions required to ensure and enhance it. This paper seeks to contribute to health financing policy debates by reviewing targeting options and assessing the available evidence concerning these issues. Success in protecting the poor appears to be limited and there are considerable informational, administrative, resource and socio-political constraints undermining the development of effective targeting mechanisms. The paper, therefore, urges-caution in developing health care financing policy and identifies a relevant research agenda.
Thesis (M.Soc.Sc.)--University of Hong Kong, 1998. Includes bibliographical references (leaves 201-207) Mode of access: World Wide Web.
A household survey of 230 episodes of infant and child illness in rural Haiti was analyzed to identify sociocultural and environmental factors that determine allocation of family resources for health care. The analysis tested the hypothesis that expenditures of time and money would vary according to expectations about the prognosis for the disease in question, the age and sex of the child, the household composition and family structure, and seasonal fluctuations in weather and financial resources. The results show that these factors are significant predictors of resource allocation, although they do not always produce the kind of influence that was hypothesized. The findings emphasize the importance of cultural and ecological variables, as well as of purely medical and economic factors, in understanding family response to illness. The importance of nonmometary resources (such as the free time available to adult family members) in that response is also indicated. The study has methodological and practical implications for Haiti and other areas.
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