The main purpose of this report is to assess the degree to which progress has been made by the Government of Uzbekistan in increasing the transparency, accountability, and efficiency of its primary ...health services, and to identify what further steps could be taken to improve the effectiveness of delivery, some of which may be applicable to other sectors as well. The report examines public spending, public financial management, and human resource management and remuneration in the primary health care sector at the local level. It draws lessons from the experience of Ferghana and Samarkand, two oblasts that have implemented reforms in primary health care, and incorporates the findings drawn from other sources, such as public expenditure data, the laws and regulations governing these systems, and the Service Quality Delivery Survey (SQDS) conducted in 2007. This report discusses the key governance issues related to improving service delivery in the primary health care area, and concludes with recommendations tailored to decision makers at the central and local government levels and those in local facilities.
The authors report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what ...determines their performance, and how the government can improve it. They find current performance leaves room for improvement in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. In contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.
In this paper, it is discuss methods to allocate national health care funds to purchasers or insurers of health care. For administrative reasons, resources are usually allocated as they always have ...been-which relates more closely to the existing structure and demand than to need. Resource allocation through capitation is needed to achieve equity in access to health care or health outcome. Capitation should be based on epidemiological or socio-demographic need factors. The author discusses how to select and weight need factors and provides examples from high and low income countries.
Despite India's great strides since independence, fertility, mortality, and morbidity remain unacceptably high. Although poverty and low levels of education are the root causes of poor health ...outcomes, poor stewardship over the health system bears some responsibility. Although India's states exhibit a wide variation in health outcomes, all but the best-performing states need to focus on improving both sexual and reproductive health care and child health care, and on reducing communicable diseases for the poor. This paper examines the public and private responses to this situation detailing the reasons behind the failure of the public sector and ways in which the private sector can be encouraged to play a role in providing health care for the poor in India. The paper concludes that there are three promising areas for the private sector including; (i) contracting out the primary health centers, (ii) social franchising and (iii) demand-led financing. The study is focused on what to do to improve health care for the poor, while a series of separate background papers focus on how to do it, and state specific issues in Andhra Pradesh, Bihar, Karnataka, and Punjab.
The public expenditures review (PER) of the health sector was prepared in response to a request from the government of Egypt as part of a broader PER work that covers other sectors. This policy note ...is intended to inform government policymakers of the key findings from the PER and recommend strategies for improving the efficiency, equity, and sustainability of public financing in the health sector, with a special emphasis on expanding the coverage of social health insurance - a major plank in the health reform strategy announced by President Mubarak in July 2005. There are four sections in the report. The first section provides background information. The second section presents a summary of health outcomes, trends, and financing in Egypt; an analysis of inequities in the allocation and utilization of health resources; and an assessment of the efficiency of the delivery of health services. The third section summarizes existing government policies toward the health sector. The fourth section proposes strategies and recommendations for expanding social insurance coverage and enhancing incentives to deliver health services more efficiently and effectively.
