Fundação Oswaldo Cruz. Centro de Estudos Estratégicos

The impact of health insurance on health services utilization and health outcomes in Vietnan

Descrição: 
In recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam’s recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam’s commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam’s unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance – for the poor, for children and for students – impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services.Relatório publicado no Health Economics, Policy and Law, v. 9, n. 4,  p.359–382, 2014.

Universal health coverage: a commitment to close the gap

Descrição: 
Sumário Executivo do Relatório publicado por Save the Children, 2013.Support for universal health coverage (UHC) – ensuring "that all people obtain the health services they need, of good quality, without suffering financial hardship when paying  for them" 1 – is fast gaining momentum. The World Health Organization (WHO), the World Bank and many developing and donor countries have already adopted UHC as their top health  priority. This report focuses on how and why inequity – unfair and avoidable inequalities – should be prioritised as countries progress on the path towards UHC. It identifies policy options that governments and donors should consider when implementing reforms for UHC and estimates the effect this could have on health outcomes, setting out the implications for the post- 2015 sustainable development framework.Research for this report included:- A structured literature review to identify lessons from countries;- key informant interviews with a range of experts;- An econometric analysis to estimate the impact of more equitable health financing on mortality rates;- A Lives Saved analysis to estimate the impact of eliminating in-country wealth inequities incoverage of maternal and child health services.

The new global health agenda: universal health coverage

Descrição: 
Relatório elaborado por Oren Ahoobim ; Daniel Altman ; Laurie Garrett ; Vicky Hausman ; Yanzhong Huang, publicado em abril de 2012.Realizing the benefits of UHC for households is a formidable challenge.Not only do the political, legislative, and regulatory hurdles to launching a UHC program need to be overcome; the program needs to be implemented and fine-tuned in ways that respond to the behavior of the targeted population, as well as other economic and health-relatedtrends. No one country has a UHC program that is viewed as a model for the entire world. Rather, governments and their partners seeking to implement UHC need to use a combination of insights from a collection of countries operating in similar contexts. Evidence underlining the benefits of UHC continues to accrue, especially as the introduction of UHC is increasingly designed with controlled trials in mind. Of course, because no two systems are identical, positive results in one country will not necessarily imply success in another. Yet even the evidence collected to date makes a strong case for UHC as a way to cut costs, reduce financial hardship, and potentially improve health. 

The long road to universal health coverage: a century of lessons for development strategy.

Descrição: 
Relatório de autoria de  Jesse B. Bump,  publicado em outubro 2010.Universal health coverage (UHC) has risen to the forefront of the global health agenda in the past few years, as reflected by donor pledges, international  declarations, and high‐profile publications (BBC News 2009; Garrett, Chowdhury et  al. 2009). The next World Health Report will focus on UHC, and other recent efforts  have worked to identify sustainable financing for health systems strengthening. For  instance, to coincide with the final report of the Taskforce on Innovative  International Financing for Health Systems (TIIFHS)1 in September of 2009, donors  announced commitments and new financing strategies expected to generate US$5.3  billion. At the same time, six developing countries announced policy reforms to  increase access to health services, including the elimination of user fees, the  provision of free care, and new insurance mechanisms (TIIFHS 2009).

Financial protection in health in rural China, 1978-2005: trends and current status.

Descrição: 
This paper is a comprehensive review of journal articles as well as grey literature. PubMed, CINAHL, and EMBASE, published  March 2008  on Future healt systems.org.Amid public health sector reforms, China’s health care system is currently at a critical point, encountering unprecedented opportunities as well as challenges as a result of recent rapid economic development. The World Bank report identified acute serious illnesses to be the major risk factor for 30% of Chinese people who live below the official poverty line; other research studies have also indicated that chronic illnesses are major contributing factors for financial impoverishment in China. (World Bank, 1993; J. Chen, Lucas, & Gong, 2004) Unfortunately, the burden of health payment in China has been enormous and, according to the World Health Report 2000, China ranks 188 out of 191countries in ―fairness of financial contribution‖ in terms of health spending relative to income.In this paper, we focus on financial protection in rural China, where 745 million–57% of the Chinese people–reside (National Bureau of Statistics of China, 2006). First, we illustrate the degree of financial protection that rural residents have after a series of reforms and changes since 1978. Then we review the current rural health insurance reforms as well as the results from the pilot programs. We conclude with recommendations for future policies and programs. 

Tracking universal health coverage: First global monitoring report.

Descrição: 
Livro editado em 2015, elaborado pela Organização Mundial de Saúde e Banco Mundial. Universal health coverage (UHC) means that all people receive the quality, essential health services they need, without being exposed to financial hardship.A significant number of countries, at all levels of development, are embracing the goal of UHC as the right thing to do for their citizens.  It is a powerful social equalizer and contributes to social cohesion and stability. Every country has the potential to improve the performance of its health system in the main dimensions of UHC: coverage of quality services and financial protection for all. Priorities, strategies and implementation plans for UHC will differ from one country to another. Moving towards UHC is a dynamic, continuous process that requires changes in response to shifting demographic, epidemiological and technological trends, as well as people’s expectations.But in all cases, countries need to integrate regular monitoring of progress towards targets into their plans.In May 2014, the World Health Organization and the World Bank jointly launched a monitoring framework for UHC, based on broad consultation of experts from around the world. The framework focuses on indicators and targets for service coverage – including promotion, prevention, treatment, rehabilitation and palliation – and financial protection for all. This report provides the first global assessment of the current situation and aims to show how progress towards UHC can be measured.  

Universal Health Protection: progress to date and the way foward

Descrição: 
This paper proposes policy options based on ILO research and experiences that aim at universal coverage and equitable access to health care. The policy options discussed focus on ensuring the human rights to social security and health and on the rights-based approaches underpinning the need for equity and poverty alleviation. The paper also provides insights into aspects of implementation and related challenges. It includes an overview of ILO concepts, definitions and strategic approaches to achieving socially inclusive and sustainable progress and highlights recent global trends.  

Relatório da 154ª Sessão do Comitê Executivo da OPAS: Estratégia para a Cobertura Universal em Saúde.

Descrição: 
Cobertura Universal de Saúde significa que todas as pessoas têm acesso equitativo a ações e serviços de saúde integrais e de qualidade, de acordo com as suas necessidades ao longo da vida. A cobertura universal de saúde reforça a necessidade de definir e implantar políticas e intervenções intersetoriais, com o objetivo de atuar sobre os fatores determinantes sociais da saúde e fomentar o compromisso da sociedade, como um todo, na promoção da saúde e do bem-estar, com ênfase na equidade.

Monitoring progress towards universal health coverage at country and global levels: Framework, measures and targets

Descrição: 
Framework, measures and targets, May 2014, 12 p. A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes. This paper was written jointly by the World Health Organization (WHO) andThe World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations. 

Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage

Descrição: 
This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage.  The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in particular, as they are in charge of overseeing and guiding the progress toward UHC.Universal health coverage (UHC) is defined as all people receiving quality health services that meet their needs without being exposed to financial hardship in paying for the services. Given resource constraints, this does not entail all possible services, but a comprehensive range of key services that is well aligned with other social goals. UHC was firmly endorsed by the World Health Assembly in 2005 and further supported in the World Health Report 2010. Since then, more than seventy countries have requested policy support and technical advice for UHC reform from the World Health Organization (WHO). In response, WHO developed a plan of action that included providing guidance on how countries can manage the central issues of fairness and equity that arise on the path to UHC. The WHO Consultative Group on Equity and Universal Health Coverage was set up to develop this guidance.To achieve UHC, countries must advance in at least three dimensions. Countries must expand priority services, include more people, and reduce out-of-pocket payments. However, in each of these dimensions, countries are faced with a critical choice: Which services to expand first, whom to include first, and how to shift from out-of-pocket payment toward prepayment? A commitment to fairness—and the overlapping concern for equity—and a commitment to respecting individuals’ rights to health care must guide countries in making these decisions.

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