Bulletin of the World Health Organization
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Bull. World Health Organ. · Nov 2008
Comparative StudyBeyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania.
The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as " access to adequate health care for all at an affordable price". A crucial aspect in achieving universal coverage is the extent to which there are income and risk cross-subsidies in health systems. Yet this aspect appears to be ignored in many of the policy prescriptions directed at low- and middle-income countries, often resulting in high degrees of health system fragmentation. ⋯ The analysis suggests that South Africa has made the least progress in addressing fragmentation, while Ghana appears to be pursuing a universal coverage policy in a more coherent way. To achieve universal coverage, health systems must reduce their reliance on out-of-pocket payments, maximize the size of risk pools, and resource allocation mechanisms must be put in place to either equalize risks between individual insurance schemes or equitably allocate general tax (and donor) funds. Ultimately, there needs to be greater integration of financing mechanisms to promote universal cover with strong income and risk cross-subsidies in the overall health system.
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Bull. World Health Organ. · Nov 2008
Resource allocation and purchasing in the health sector: the English experience.
The United Kingdom of Great Britain and Northern Ireland has extensive experience in allocating health service funds to regions and localities using funding formulae. This paper focuses on England. ⋯ The paper also examines the issues that arise when seeking to allocate funds to very small organizational units, such as general practices. The English example is relevant to less-developed health systems, especially for those governments seeking to decentralize, to improve accountability and to promote equity.