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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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The health equity and financial protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. This report show how health outcomes, risky behaviors and health care utilization vary across asset (wealth) quintiles and periods. Benefit-incidence analysis (BIA) shows whether, and by how much, government health expenditure disproportionately benefits the poor the distribution of subsidies depends on the assumptions made to allocate subsidies to households. This reports whether overall health financing, as well as the individual sources of finance, is regressive (i.e. a poor household contributes a larger share of its resources than a rich one), progressive (i.e. a poor household contributes a smaller share of its resources than a rich one) or proportional.

Breast Cancer --- Cervical Cancer --- Child Health --- Diabetes --- Diarrhea --- Disease Control & Prevention --- Gender --- Health Economics & Finance --- Health Insurance --- Health Monitoring & Evaluation --- Health Outcomes --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Household Income --- Household Surveys --- Infant Mortality --- Living Standards --- Malaria --- Measles --- Mortality --- Obesity --- Polio --- Poverty Reduction --- Public Health --- Purchasing Power --- Purchasing Power Parity --- Tuberculosis --- User Fees --- Violence

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The health equity and financial protection datasheets provide a picture of equity and financial protection in the health sectors of low-and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the demographic and Health Surveys (DHS), World Health Surveys (WHS), Multiple indicators cluster Surveys (MicS), living Standards and Measurement Surveys (lSMS), as well as other household surveys where available. The tables in this section show how health outcomes, risky behaviors and health care utilization vary across asset (wealth) quintiles and periods. The quintiles are based on an asset index constructed using principal components analysis. The tables show the mean values of the indicator for each quintile, as well as for the sample as a whole. Also shown are the concentration indices which capture the direction and degree of inequality.

Breast Cancer --- Cervical Cancer --- Child Health --- Diabetes --- Diarrhea --- Gender --- Health Economics & Finance --- Health Monitoring & Evaluation --- Health Outcomes --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Household Income --- Household Surveys --- Infant Mortality --- Living Standards --- Malaria --- Measles --- Mortality --- Obesity --- Polio --- Population Policies --- Purchasing Power --- Purchasing Power Parity --- Tuberculosis --- User Fees --- Violence

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Over the past two decades Russia experienced a significant increase in state-financed entitlements for health care through the Program of State Guarantees for Medical Care (PSG). The PSG, which is underpinned by the Constitution was an important element of the social contract implemented by the State on the back of rapid economic growth during the 2000s. The PSG is a universal program with uniform benefits paid for through a single national pool. The PSG was accompanied by significant supply side investments to develop a multi-level service delivery system, substantially increase tertiary care provision, strengthen the diagnostic capacity of medical facilities and reduce geographic variations in funding and services. This case study examines what the increase in state financed entitlements for health meant for coverage of the poor in Russia, using the health sector in Russia in the early 1990s as the starting point. The economic and political transformations of the early 1990s resulted in a significant deterioration in health outcomes and financial protection. Although health outcomes have improved, they continue to lag behind that of comparator countries. Large PSG related investments and reforms during the 2000s supported the achievement of health gains and moderated the reversal of trends during the fiscal crisis. Fiscal redistribution has been used to increase resource allocation to less well-off areas. Increased public spending on hospital care helped improve access to inpatient care for the poor, particularly the elderly. Increased investment in diagnostic equipment at outpatient care facilities is associated with increased access to tests and services, albeit only in major cities. A push to reallocate spending towards primary care increased access to both physicians and services in rural areas. Limited PSG coverage for outpatient drug purchases means that OOP drug payments remain one of the biggest threats to financial risk protection. To further deepen and expand coverage for the poor, there is a critical need to narrow the divergence between PSG's de jure and actual coverage. In principle, the PSG provides a uniform benefits package that all Russians are entitled to under the Constitution. In practice, underfunding and a lack of clarity over the benefits package lead to implicit health care rationing through inadequate access to good quality health care services and affordable drugs and supplies. Additional fiscal space for health is needed and health policy must make more effective use of available resources. Expanding coverage for outpatient drugs and strengthening primary care are immediate priorities.

Access of Poor to Social Services --- Health and Poverty --- Health Economics and Finance --- Health Finance --- Health Systems Development and Reform --- Health, Nutrition and Population --- Poverty Reduction

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The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a 'mashup' index that captures both aspects of UHC: that everyone-irrespective of their ability-to-pay-gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35-57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data-by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare.

Communities & human settlements --- Equity --- Financial protection --- Health economics & finance --- Health law --- Health monitoring & evaluation --- Health systems development & reform --- Health, nutrition and population --- Housing & human habitats --- Law and development --- Service coverage --- Universal health coverage