George Schieber

Cheryl Cashin

Karima Saleh

Rouselle Lavado

This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.

Health Financing in Ghana

Sarah Thompson

Y-Ling Chi

Michael Borowitz

Health spending continues to grow faster than the economy in most OECD countries. In 2010, the OECD published a study of strategies to increase value for money in health care, in which pay for performance (P4P) was identified as an innovative tool to improve health system efficiency in several OECD countries. However, evidence that P4P increases value for money, boosts quality of processes in health care, or improves health outcomes is limited.This book explores the many questions surrounding P4P such as whether the potential power of P4P has been over-sold, or whether the disappointing results to date are more likely rooted in problems of design and implementation or inadequate monitoring and evaluation. The book also examines the supporting systems and process, in addition to incentives, that are necessary for P4P to improve provider performance and to drive and sustain improvement. The book utilises a substantial set of case studies from 12 OECD countries to shed light on P4P programs in practice.Featuring both high and middle income countries, cases from primary and acute care settings, and a range of both national and pilot programmes, each case study features: Analysis of the design and implementationdecisions, including the role of stakeholders Critical assessment of objectives versus results Examination of the of 'net' impacts, includingpositive spillover effects and unintended consequences The detailed analysis of these 12 case studies together with the rest of this critical text highlight the realities of P4P programs and their potential impact on the performance of health systems in a diversity of settings. As a result, this book provides critical insights into the experience to date with P4P and how this tool may be better leveraged to improve health system performance and accountability. This title is in the European Observatory on Health Systems and Policies Series.

Paying for Performance in Healthcare: Implications for Health System Performance and Accountability

Lydia Dsane-Selby

Fred Adomako-Boateng

Yakubu Agada-Amade

Arturo Clemente Alcantara

Caren Althauser

Edwine W. Barasa

Vergil Manatad de Claro

Gilda Salvacion Abrenica Diaz

Stanley Wilson Effah

Fauziah Zainal Ehsan

Mohd Fozl Bin Kamarudin

Kanyenje Karangaita Gakombe

Joseph Githinjl

Maria Lifclu

To Hong Luong

Ousmane Ly

Donna Madeiros

Balarabe Mohammed

Arun B. Nair

Edward Peregrino Nelson

Donald Orbih

Nguyen Khanh Phuong

Alice Ogink

Chelsea Taylor

Tsolmongerel Tsilaajav

Nguyen Tuan Viet

Muhammed Anis Bin Abd Wahab

John Waiganjo

A Toolkit for Countries Working Toward Universal Health Coverage

Using Data Analytics to Monitor Health Provider Payment Systems

Joseph Kutzin

Melitta Jakab

Analyses the experience with the financing reforms implemented by the countries of Central Europe, Eastern Europe, the Cauxasus and Central Asia.

Lessons from Countries in Transition

Implementing Health Financing Reform

Ghana is one of only several African countries to enact legislation and earmark financing for universal health insurance coverage for its entire population. Seven years into its implementation the Ghana National Health Insurance Scheme (NHIS) has made significant progress in transitioning to universal coverage, but faces significant fiscal and coverage challenges. This study reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme. Such an assessment is important because Ghana is often considered a global 'good practice' in terms of earmarking significant amounts of its general revenues for health insurance coverage, providing formal coverage to its vulnerable population groups, and extending coverage by transitioning its existing community health insurance schemes into a national health insurance program. In addition to the global interest in the Ghana 'model', this review is timely in view of recent critiques of the system and questions about its financial sustainability. The study is also unique in terms of evaluating Ghana's NHIS in terms of basic health system goals of health outcomes, financial protection, consumer satisfaction, equity, efficiency, and financial sustainability. The strengths and weaknesses of Ghana's health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. The assessment is also based on several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. It also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities (i.e., the revaluation of Ghana's Gross Domestic Product (GDP) upward by some 60 percent in November 2010, making Ghana a lower middle income country). The study concludes with an assessment of potential structural and operational reform options to assure NHISs long-term efficacy and sustainability in the context of its future available fiscal space.

John C. Langenbrunner

Jack Langenbrunner

Sheila O'Dougherty

A set of manuals to help low- and middle-income countries design and implement performance-based health care provider payment systems.

How-to Manuals

Designing and Implementing Health Care Provider Payment Systems

Joseph Harris

Naoki Ikegami

Michael R. Reich

Akiko Maeda

Edson Araujo

Las metas de la cobertura universal de salud son asegurar que todas las personas puedan tener acceso a los servicios de salud de calidad, proteger a todas las personas de los riesgos para la salud publica y del empobrecimiento debido a enfermedad, ya sea por pagos directos por atencion sanitaria 0 por perdida de ingresos cuando un miembro de la familia se enferma. Paises tan diversos como Brasil, Francia, Japan, Tailandia y Turquia han mostrado como la cobertura universal de salud puede servir como un mecanisma vital para mejorar la salud. Garantizar el acceso universal a los servicios de salud asequibles y de calidad sera una contribucion importante para acabar con la pobreza extrema para el 2030 en los paises de bajos ingresos y de ingresos medios, donde vive la mayor parte de los. mas pobres del mundo. La cobertura universal de salud para el desarrollo inclusivo y sostenible sintetiza las experiencias de Bangladesh, Brasil, Etiopia, Francia, Ghana, Indonesia, Japan, Peru, Tailandia, Turquia y Viet Nam en cuanto a la implernentacion de las politicas y estrategias para lograr y mantener la cobertura universal de salud. Estos paises representan condiciones geograticas y econ6micas diversas, pero todos se han comprometido can la cobertura universal de salud como una aspiracion nacional clave y estan acercandose a ella de maneras diferentes. En ellibro se examinan las politicas de cobertura universal de salud de cada pais alrededor de tres temas comunes: la economia politica y el proceso de forrnulacion de la polltica para adoptar, lograr y mantener la cobertura universal de salud; las politicas de financiacion sanitaria para mejorar la cobertura sanitaria; y los recursos humanos para las politicas de salud para lograr la cobertura universal de salud. Los hallazgos de estos estudios de pais tienen por objeto proporcionar enseiianzas que pueden ser utilizadas por los paises que aspiran a adoptar, tograr y mantener la cobertura universal de salud. Aunque el camino ala cobertura universal de salud es especifico para cada pais, los paises pueden beneficiarse de las experiencias de otros al conocer acerca de diferentes enfoques y evitar los riesgos previsibles.

Una síntesis de 11 estudios de caso de país

Cobertura universal de salud para el desarrollo inclusivo y sostenible

Cheryl Cashin

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