Lecture 5 - Financing Healthcare in LMICs Flashcards
In LMICs, what is the main source of increased health spending?
Out of pocket payments
What are the 3 external/international sources of funding in LMICs?
- Humanitarian aid (emergency aid)
- Development aid (support economic and social development)
- Private organisations (e.g. Gates Foundation)
What is one problem with raising revenue via user fees in LMICs?
You are trying to raise money from people that don’t have it.
Explain the 3 delay model
Used to understand the factors that contribute to morbidity/mortality.
- First delay is teh delay in the decision to seek care (Lack of knowledge about symptoms and risks. Cultural beliefs or social stigma, Fear of cost or lack of trust in the healthcare system, Difficulty in reaching a healthcare provider)
- Second delay is related to reaching an appropriate health facility (Long distances to hospitals or clinics, especially in rural areas. Lack of transportation or affordable means to travel. Poor road conditions or infrastructure.)
- Third delay when patients waits to see medical professional (Shortage of qualified healthcare professionals, equipment, or medication. Poor quality of care or inadequate services. Communication issues or cultural insensitivity.)
What are the 3 challenges with taxation in LMICs?
- Large informal section makes taxation difficult
- Lack of infrastructure makes coordination and collection difficult
- Poorer states tend to have lower tax rates
Why do some people in LMICs not want health insurance?
They don’t want to manifest ill health
What is community-based health insurance?
Community-based health insurance (CBHI) is a type of micro-health insurance scheme designed specifically for low-income and often rural communities.
Focus on Low-Income Populations: CBHI targets individuals and families who may struggle to afford traditional health insurance but still need financial protection against healthcare costs.
Community Driven: Local communities play a central role in establishing, managing, and participating in CBHI programs. This fosters a sense of ownership and helps ensure the program meets the specific needs of the community.
Voluntary Participation: Enrollment in CBHI is typically voluntary, allowing individuals to choose whether to participate based on their budget and healthcare needs.
Pooling Resources: Community members contribute small premiums to a common fund that is then used to pay for covered healthcare services. This concept is similar to traditional health insurance, but the scale is smaller and more localized.
Limited Benefits Package: Compared to comprehensive health insurance plans, CBHI programs might offer a more limited range of covered healthcare services. This helps keep premiums affordable for low-income participants.
What are some limitations to community-based health insurance?
- if one member has an expensive ailment, the fund can collapse
- small risk pools and limited cross-subsidy
- mixed evidence on financial protection
- population coverage is often low
- individuals from richest quintile are more likely to be enrolled (Chankova et al, 2008)
What are the key political challenges in LMICs?
- inequality in service utilisation and health outcomes
- weak costing, financial management and budgeting
- limited accountability and transparency
What are the key economic challenges in LMICs?
- low tax revenue based for raising domestic funds
- large informal sector
- financial barriers to accessing care (distance, user charges)
- insufficient, volatile external funds
- high admin cost
Why is there a risk of a “top down” approach to financing in LMICs? What does this mean?
Risk of covering the formal sector first, when people in the informal sector may need it more
Explain the case of community health funds (CHF) in Tanzania in 2001/2009. What went right? What went wrong?
- Established a community health fund (CHF) in 2001 for rural areas and in 2009 for urban areas
- Low uptake and renewal of the scheme
Issues - Timing of collection
- Drug and medical supplies shortages
- Poor quality healthcare
- Poor revenue management
- Limited benefit packages
- Low community awareness
- Decentralised management hindered effective fund collection and management, reducing risk pooling and financial viability
- Higher fees from user fees motivated healthcare workers to prioritize those patients over CHF members
- Exemption policies negatively impacted enrolment in CHF
o Maybe people perceived it as a plan for the poor – paying people don’t enrol
o Difficult to identify who is supposed to be exempt
Positives - Improved access to services for disadvantaged groups
