Intro Contents Foreword Preface Acknowledgments PART 1 GLOBAL AND REGIONAL TRENDS 1. Rich-Poor Differences in Health Care Financing Overview and Context Conceptual Underpinnings for Community-Based Action in Health Care Financing Methodology for Assessing Impact, Strengths, and Weaknesses Discussion of Main Findings from Background Reviews Conclusions and Recommendations Appendix 1A Statistical Data (Summary Tables) 2. Review of the Strengths and Weaknesses of Community Financing Methods What Is Community-Based Health Financing? Performance of Community-Based Health Financing Determinants of Successful Resource Mobilization, Social Inclusion, and Financial Protection Concluding Remarks Appendix 2A Performance Variables Reported in the Reviewed Studies Appendix 2B Core Characteristics of Community Financing Schemes from the Review of the Literature 3. Experience of Community Health Financing in the Asian Region What Is Community Financing? A Summary of the Value Added by Types of Community-Financing Schemes A Review of Selected Asian Community-Financing Schemes 4. Experience of Community Health Financing in the African Region Conceptual Framework Evidence Discussion Conclusion PART 2 COUNTRY CASE STUDIES USING HOUSEHOLD SURVEY ANALYSIS 5. Analysis of Community Financing Using Household Surveys Background Methods Results Discussion Concluding Remarks Appendix 5A List of Reviewed Survey Instruments 6. Financial Protection and Access to Health Care in Rural Areas of Senegal Health Insurance in Rural Sub-Saharan Africa Research Design and Methodology Results Conclusions 7. Community-Based Health Insurance in Rwanda Background Data Sources and Methodology Results Discussion and Conclusion. 8. The SEWA Medical Insurance Fund in India Methods Results Discussion 9. The Potential Role of Community Financing in India Community Financing in India and the SEWA Program Research Design and Methodology Results 10. Impact of the Thailand Health Card Methods Discussion Conclusions and Recommendations PART 3 EXPENDITURE GAPS AND DEVELOPMENT TRAPS 11. Deficit Financing of Health Care for the Poor Progress toward Achieving the MDGs Key Drivers of Accelerated Progress toward Achieving the MDGs Estimating the Cost of Achieving the MDGs Financing the Expenditure Gap Conclusions 12. Impact of Risk Sharing on the Attainment of Health System Goals Health System Goals and Functions in a Nutshell The Organizational Form of Health Financing and Its Link to the Attainment of Health System Goals Organization of Health Financing in the World Modeling the Impact of the Organizational Form of Health Financing on Health System Attainment Indicators Community Risk-Sharing Arrangements: Further Need to Measure Their Impact Concluding Remarks Appendix 12A Statistical Data About the Coeditors and Contributors The Coeditors Other Contributing Authors Index BOXES 1.1 Revenue Mobilization 1.2 Strengths of Community-Financing Schemes 1.3 Weaknesses of Community-Financing Schemes 2.1 Definitions of Community Health Financing 2.2 Contribution of CF Schemes to Operational Revenues 2.3 The Bamako Initiative 2.4 Turning Potatoes and Labor into Cash Revenues in Bolivia 2.5 Poor Management in the Nkoranza Scheme 4.1 Ghana's Policy Thrusts to Enable Evolution of Community Health Insurance 11.1 Millennium Development Goals (1990-2015) FIGURES 1.1 Less Pooling of Revenues in Low-Income Countries 1.2 Flow of Funds through the System. 1.3 Low-Income Countries Have Weak Capacity to Raise Revenues 1.4 Out-of-Pocket (OOP) Expenditure and Poverty without Risk Sharing 1.5 Pro-Rich Bias of Public Subsidies in Many Low-Income Countries 1.6 Determinants of Financial Protection, Health, and Social Inclusions 1.7 Hospitalization and Impoverishment 1.8 Stages of Financial Protection 2.1 Analytical Framework 3.1 Feasibility of Establishing Community Financing and the Amount the Average Person Is Willing to Pay as a Function of Expected Gains and Social Capital 3.2 Plausible Relationship between Locus of Control and Economic and Quality Gains 3.3 The Trade-Offs between Health Gains and Risk Protection by Type of Service Funded 4.1 Relationships between Stakeholders and the Scheme 4.2 Percentage of Community Enrolled, by Distance 4.3 Premiums, Participation, and Revenues: Predictions for Option C 4.4 Willingness to Pay for Adult Insurance 4.5 Stages of Financial Protection and Supporting Policies 6.1 Urban and Rural Health Insurance Schemes in Sub-Saharan Africa, Year of Inception and Size 7.1 Monthly Monetary Expenditure per Capita 11.1 Millennium Development Goals, Global Aggregate 11.2 Strong Correlation between Wealth and Health across Time 11.3 Income and Child Mortality 11.4 Cost-Effective and Affordable Public Health and Clinical Services 11.5 Three Non financial Determinants of Good Outcomes 11.6 Lack of Management Capacity, Adverse Incentives, and Weak Institutions Break the Fulcrum 11.7 Expenditure Frontier and Six Countries 11.8 Production Frontiers for Total Expenditure on Health Care (Using Best Performance on Various Health Outcomes) 11.9 Production Frontiers for Public Expenditure on Health Care (Using Best Performance on Various Health Outcomes) 11.10 Income and Health Spending. 11.11 Only 11 Percent of Global Spending for 90 Percent of the World's Population 11.12 Low-Income Countries Have Less Pooling of Revenues 11.13 Types of Private Financial Flows TABLES 1.1 Conceptual Underpinnings of Community-Financing Schemes 1.2 Summary Statistics of the Literature Reviewed, by Publication Type 1.3 Core Characteristics of the Community-Based Financing Schemes 1.4 Characteristics of Five Survey Instruments 1.5 Types of Community-Based Financing 1.6 Number of Studies That Examined Core Health-Financing Subfunctions 1.7 Studies That Looked at Ways to Prevent Impoverishment 1.8 Studies That Looked at Ways to Combat Social Exclusion 1.9 Potential Value Added by Types of Community-Financing Schemes 1.10 Statistically Signi ficant Determinants of Inclusion in Community Financing 1.11 Summary Findings: Statistically Significant Determinants of Utilization and Out-of-Pocket Expenditure Patterns 1.12 Estimation Results for the Basic Models 1.13 Estimation Results for the Enlarged Models 2.1 Summary Statistics of the Literature Reviewed, by Publication Type 2.2 Summary of Literature Reviewed on Community-Based Health Financing Schemes, Based on Nature of Study and by Region 2.3 Selection Criteria to Assess the Performance of Community-Based Health Financing 2.4 Often Encountered Forms of Community Financing 2.5 Summary of Case Studies by Modalities 2.6 Cost Recovery from Prepaid Premiums 2.7 Summary of Findings: Who Is Covered by CF Arrangements? 2.8 Summary of Findings: Does CF Reduce the Burden of Seeking Health Care? 2.9 Determinants Associated with Effective Revenue Collection and Financial Protection 2.10 Performance Variables Reported in the Reviewed Studies 2.11 Core Characteristics of Community-Financing Schemes, from the Review of Literature. 3.1 How Community Members Valued Service Availability, Quality, Risk Protection, and Costs 3.2 A Typology of Selected Characteristics of Community-Financing Schemes 3.3 Assessment of Potential Value Added by Selected Types of Community-Financing Schemes 3.4 Potential Value Added by Types of Community-Financing Schemes 3.5 Prevalence and Benefits of Community Health Financing in Five Provinces, 1991 3.6 Prevalence and Benefits of Community Health Financing in 30 Poor Counties, 1993 3.7 Management of Community Health Financing in 30 Poor Counties, 1993 3.8 Community Health Financing by Source in Selected Counties and Provinces, 1991 and 1993 3.9 Two Prototype Benefit Packages for China's Rural Poor 3.10 Current Financing of Health Spending by Source in China's Poverty Regions 3.11 Percentage of 2,236 Surveyed Community Leaders Citing Major Reasons for Lack of Rural Community Financing 4.1 Scheme Design Options 4.2 An Example of Goals Matched to Design Options 4.3 Features of "Potentially Large Population" Schemes for Informal Sector Households 4.4 "Potentially Large Population" Schemes' Financial Risk-Protection Performance 5.1 Socioeconomic Characteristics of Rwanda, Senegal, India, and Thailand, 1999 5.2 Health Outcomes and Expenditures in Rwanda, Senegal, India, and Thailand, 1999 5.3 Characteristics of Five Survey Instruments 5.4 Statistically Significant Determinants of Inclusion in Community Financing 5.5 Summary Findings: Statistically Significant Determinants of Utilization and Out-of-Pocket Expenditure Patterns 5.6 Reviewed Surveys for 21 Countries 6.1 Hospitalization Fees for Members and Nonmembers at St. Jean de Dieu Hospital 6.2 Selection Criteria for Mutual to Be Included in the Survey 6.3 Overview of Variables Used. 6.4 Marginal Coefficients for Determinants of Participation in Mutual Health Insurance (Household Level).
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