The world’s attention has tuned to the struggle of expanding health insurance coverage for 40 million people in the US but is largely ignoring the 4 billion people in low- and middle- income countries face the same hardship. Millions of the poor have already fallen back into poverty as a result of the recent global financial crisis. Millions more are at risk before full recovery. It is the poor and most vulnerable that are at greatest risk from due to lack of protection against the impoverishing effects of illness.
Europeans, Canadians, Australians and many others who live in countries where universal coverage was achieved many years ago, watched with bewilderment the recent debates in the US Congress and Senate. How could anyone in the world’s richest country be opposed-they ask-to reforms aimed at securing access to affordable health insurance to those who currently do covered in the world’s richest country? What argument-they ask-could anyone possibly give to oppose a reform that would extend protection to vulnerable segments of the population that currently does not enjoy such benefits? Yet, it is precisely the same type of debate-often fuelled by ideologically-oriented stake holders and donors -that one hears in India, Kenya, Pakistan, Senegal, Uganda, and many other countries struggling to introduce health insurance reforms themselves.
This course will review the key principles of health care financing in the context of low- and middle-income countries in which a large share of the population live below the poverty level of one dollar per day. Students will learn about the following: (a) Role of health financing in addressing key development challenges at low-income levels; (b) Objectives of health care financing (what to expect and what not to expect); (c) health financing sub functions - revenue collection, risk pooling and purchasing; (d) funding sources: general revenues, labor taxes, premiums, households, donors; (e) pooling mechanisms: subsidies, insurance, savings, consumption shifts; (f) spending: targeting, setting priorities, selecting providers, setting prices, payment systems; (g) the politics of health care financing (vested interests); and (h) the devil is in the details (implementation).
• More money is needed to address the health problems in low- and middle-income countries
• Without specific policies to protect them, the poor often get left out (equity dimension)
• Ensuring value for money requires spending scarce resources wisely (efficiency dimension).
Key controversial issues
• Fee exemption vs subsidies
• Supply-side subsidized national health services vs demand-side strategies under insurance
• Public vs private insurance
• Old vs new approaches to development assistance.