Going Universal: How Twenty-Four Countries are Implementing Universal Health Coverage from the Bottom Up

Going Universal: How Twenty-Four Countries are Implementing Universal Health Coverage from the Bottom Up

by World Bank


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"The quest for universal health coverage (UHC) has gathered real momentum over the past decade, with countries on every continent now taking part. This is welcome news, since a lack of universal coverage means that hundreds of millions of people around the world either do not get the health care services they need, or they have to pay dearly for them, often falling into poverty as a result. But the UHC agenda also poses an enormous challenge to policy makers across the globe, and many countries are eager to learn from the experiences of others as they undertake the long journey toward UHC.

Going Universal: How 24 Developing Countries Are Implementing Universal
Health Coverage Reforms from the Bottom Up draws on a wealth of new evidence to help enrich the global knowledge base on UHC. It provides a synthesis of UHC reform programs that placed a special focus on expanding coverage in ways inclusive of the poor. The main objective was to document and analyze their experiences based on a systematic data collection effort that sought to capture in great detail how they have been implementing UHC
reforms. The main chapters oer an in-depth analysis of how countries are addressing five key challenges: covering people, expanding benefits, managing money, improving the supply of health care services, and strengthening accountability.

The UHC reform programs described in the volume are new, massive, and transformational. Most were launched during the past decade, and together they now cover more than 2 billion people. But most importantly, the authors find that the programs are fundamentally changing the way health systems operate, offering the potential to achieve greater equity and better results for the money spent. The authors identify key risks that lie ahead, as well as an emerging agenda that requires more country and global learning. Overall, this book offers those contributing to the achievement of UHC worldwide a valuable new resource to help chart a way forward."

Product Details

ISBN-13: 9781464806100
Publisher: Bernan Distribution
Publication date: 07/23/2015
Pages: 304
Product dimensions: 7.00(w) x 9.90(h) x 0.80(d)

Table of Contents

Foreword xiii

About the Authors xv

Acknowledgments xvii

Abbreviations xix

Overview 1

1 Introduction 13

Going Universal-A Focus on "How" 20

Methodology-Countries, Programs, and Data 23

Attacking Inequality-The Common Starting Point for Diverse Paths to UHC 27

A Guide to the Book 30

References 31

2 Covering People Tine Bottom Up Approach 35

Segmented Populations, Fragmented Health Systems 36

Identifying and Targeting the Poor-And Getting Better at It 39

Enrolling People-Two Phases, Two Paths 44

Using Fundamentals and Investing in Learning 54

Conclusions and Policy Implications 60

Notes 62

References 63

3 Expanding Benefits: Exercising Choices to Expand the Scope of Health Care Services 67

Adding Services-Moving Beyond the MDGs 69

Defining Benefits-Toward Explicit Benefit Packages 76

Prioritizing Services-Mechanics and Complexities 79

Breaking Promises-De Facto Benefit Packages 86

Contracting Benefits-Engaging Private Providers, Using Closed-Ended Payments, and Improving Linkages to Performance 90

Conclusions and Policy Implications 94

Notes 95

References 96

4 Managing Money: Financing the Bottom-Up Expansion of Universal Health Coverage 99

Spending Some, Leveraging More 101

Collecting Contributions-Government and Other Sources 111

Sharing Costs-Low Copayments but Still-High OOPE 119

Pooling Risk and Allocating Resources 122

Conclusions and Policy Implications 131

Annex 4A 134

Notes 136

References 137

5 Improving Health Care Provision 141

Introduction 141

Human Resources for Health-Trends in Retention and Outreach 141

Increasing Managerial Flexibility in Public Facilities 144

Increasing Participation of Private Providers 146

Accrediting Health Facilities 147

Continuum of Care: Integrating the Health System, Strengthening Primary Care 152

Conclusions and Policy Implications 156

Note 158

References 158

6 Strengthening Accountability 161

Introduction 161

Features and Key Relationships 162

Delegating-Toward Arm's-Length Relationships and Explicit Responsibilities 166

Financing-Paying for Outputs and Results Instead of Inputs 172

Information and Enforcement-Collecting More Data, but Not Always Making Use of It 175

Empowerment-Strengthening Citizen Voice and Client Power 179

Conclusions 181

References 183

7 Conclusions 187

Policy Convergence, Implementation Variations 187

Policy Choices and Paths to UHC 190

Stepping Stones 191

New Risks 192

Final Words… 194


A Universal Health Coverage Studies Series-Studies and Authors 195

B UNICO Country Context 197

Macroeconomic Indicators 198

Key Population Health Outcomes 203

Health Financing 207

Health Inputs and Coverage 208

Notes 216

References 216

C The Impact of Universal Health Coverage Programs on Access, Financial Protection, and Health Status-A Literature Review 217

Introduction 217

Impact of UHC Programs in a Nutshell 217

Methods 218

The UHC Programs Evaluated 220

Does the Evidence Show Beneficial Impacts of UHC Programs? 221

A Synopsis of Some Other Literature Reviews 228

Thoughts on the Strengths, Limitations, and Usefulness of Evidence for Policy Advice 230

Notes 242

References 243

D UNICO Questionnaire and Universal Health Coverage Study Series 249

Index 251

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