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This paper examines the determinants of child nutritional status in seven provinces of China during the 1990s, focusing specifically on the role of two areas of public policy, namely health system reforms and the one child policy. The empirical relationship between income and nutritional status, and the extent to which that relationship is mediated by access to quality healthcare and being an only-child, is investigated using ordinary least squares, random effects, fixed effects, and instrumental variables models. In the preferred model - a fixed effects model where income is instrumented - the author find that being an only-child increases height-for-age z-scores by 0.119 of a standard deviation. The magnitude of this effect is found to be largely gender and income neutral. By contrast, access to quality healthcare and income is not found to be significantly associated with improved nutritional status in the preferred model. Data are drawn from four waves of the China Health and Nutrition Survey.
Antenatal care --- Health Monitoring and Evaluation --- Health services --- Health Systems Development and Reform --- Health, Nutrition and Population --- Immunization --- Influenza --- Medicines --- Nutrition --- Nutritional Status --- Population Policies --- Postnatal care --- Siblings --- Transport --- Transport Economics, Policy and Planning --- Walking
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In 2015, the government of Ukraine initiated fundamental reform of its health system with the goals of improving the health outcomes of the population and providing financial protection from excessive out-of-pocket health care payments. This reform was to be implemented through modernizing and integrating the service delivery system, introducing changes to provider payment arrangements that incentivize efficiency, and improving the quality of care. It culminated in the passage of a new health financing law-the Law on Financial Guarantees for Health Care Services 2017-which established a health benefit package called the Program of Medical Guarantees (PMG) and created the National Health Service of Ukraine to serve as the strategic purchaser for this program. This publication provides a comprehensive description and assessment of the development and implementation of policies associated with the PMG reform from the start of the reform in 2017 through mid-2021. It examines (1) how the PMG is financed, (2) strategic purchasing of the different components of the PMG benefit package, and (3) the governance arrangements of the PMG. The report also positions these developments within broader contextual discussions of the financing and organization of health care in Ukraine to make the key features of the financing reforms and their importance accessible to domestic and international audiences.
Medical care --- Medical policy. --- Medical care, Cost of. --- Finance.
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This paper examines the determinants of child nutritional status in seven provinces of China during the 1990s, focusing specifically on the role of two areas of public policy, namely health system reforms and the one child policy. The empirical relationship between income and nutritional status, and the extent to which that relationship is mediated by access to quality healthcare and being an only-child, is investigated using ordinary least squares, random effects, fixed effects, and instrumental variables models. In the preferred model - a fixed effects model where income is instrumented - the author find that being an only-child increases height-for-age z-scores by 0.119 of a standard deviation. The magnitude of this effect is found to be largely gender and income neutral. By contrast, access to quality healthcare and income is not found to be significantly associated with improved nutritional status in the preferred model. Data are drawn from four waves of the China Health and Nutrition Survey.
Antenatal care --- Health Monitoring and Evaluation --- Health services --- Health Systems Development and Reform --- Health, Nutrition and Population --- Immunization --- Influenza --- Medicines --- Nutrition --- Nutritional Status --- Population Policies --- Postnatal care --- Siblings --- Transport --- Transport Economics, Policy and Planning --- Walking
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This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.
Case-Mix --- Costing --- Diagnostic Related Groups --- Fee for Service --- Global Budget --- Health Financing --- Health System --- Hospital --- Patients --- Provider Payment --- Sustainability
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This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.
Exercises --- Health care --- Health Economics and Finance --- Health for All --- Health Monitoring and Evaluation --- Health services --- Health, Nutrition and Population --- International organizations --- Migration --- Nutrition --- Patient --- Primary health care --- Public health
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This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.
Exercises --- Health care --- Health Economics and Finance --- Health for All --- Health Monitoring and Evaluation --- Health services --- Health, Nutrition and Population --- International organizations --- Migration --- Nutrition --- Patient --- Primary health care --- Public health
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Providing protection against the financial risk of high out-of-pocket health spending is one of the main goals of the Philippines' health strategy. Yet, as this paper shows using eight household surveys, health spending increased by 150 percent (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has trebled since 2000, from 2.5 to 7.7 percent. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance for the poor, a deepening of the benefit package, and provider payment reform aimed at cost-containment-are to be applauded. Between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, possible quick wins could include issuing health insurance cards for the poor to increase awareness of coverage and introducing a fixed copayment for non-poor members. Over the medium term, complementary investments in supply-side readiness are essential. Finally, an in-depth analysis of the pharmaceutical sector would help to shed light on why medicines continue to place such a large financial burden on households.
Health Economics & Finance --- Health Economics And Finance --- Health Equity And Access --- Health Insurance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Law and Development --- Out-Of-Pocket --- Poverty Measurement And Analysis --- Poverty Reduction --- Rural Poverty Reduction
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Providing protection against the financial risk of high out-of-pocket health spending is one of the main goals of the Philippines' health strategy. Yet, as this paper shows using eight household surveys, health spending increased by 150 percent (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has trebled since 2000, from 2.5 to 7.7 percent. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance for the poor, a deepening of the benefit package, and provider payment reform aimed at cost-containment-are to be applauded. Between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, possible quick wins could include issuing health insurance cards for the poor to increase awareness of coverage and introducing a fixed copayment for non-poor members. Over the medium term, complementary investments in supply-side readiness are essential. Finally, an in-depth analysis of the pharmaceutical sector would help to shed light on why medicines continue to place such a large financial burden on households.
Health Economics & Finance --- Health Economics And Finance --- Health Equity And Access --- Health Insurance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Law and Development --- Out-Of-Pocket --- Poverty Measurement And Analysis --- Poverty Reduction --- Rural Poverty Reduction
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Sociology of health --- Social policy --- Hygiene. Public health. Protection --- Balkan Peninsula
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This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have succeeded in providing financial protection against adverse health events. The authors examine disparities in health status, healthcare utilization, and out-of-pocket payments for healthcare (including informal payments), and explore the impact of healthcare expenditures on household economic status and poverty. Methodologies include (i) generating a descriptive assessment of health and healthcare disparities across socioeconomic groups, (ii) measuring the incidence and intensity of catastrophic healthcare payments, (iii) examining the effect of out-of-pocket payments on poverty headcount and poverty gap measures, and (iv) running sets of country-specific probit regressions to model the relationship between health status, healthcare utilization, and poverty. On balance, the findings show that the impact of health expenditures on household economic wellbeing and poverty is most severe in Albania and Kosovo, while Montenegro is striking for the financial protection that the health system seems to provide. Data are drawn from Living Standards and Measurement Surveys.
Alternative Medicine --- Health Care --- Health Monitoring and Evaluation --- Health Services --- Health Systems Development and Reform --- Health, Nutrition and Population --- Hospitalization --- Hospitals --- Medicines --- Morbidity --- Nurses --- Nutrition --- Outpatient Care
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