Title
The role of institutional design and organizational practice for health financing performance and universal coverageThe role of institutional design and organizational practice for health financing performance and universal coverage
Author
Faculty/Department
Faculty of Applied Economics
Research group
Economics
Publication type
article
Publication
Amsterdam,
Subject
Economics
Human medicine
Source (journal)
Health policy. - Amsterdam
Volume/pages
99(2011):3, p. 183-192
ISSN
0168-8510
ISI
000287887500001
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage. The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators. Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks. The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.
E-info
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