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This chapter on health care financing introduces financing as one aspect of the health system that affects health equity. The configuration of financing, defined as both mobilization of financial resources and the allocation of those resources to the population, will affect health outcomes in two important ways. First, it determines, in part, the availability of health care and who has access to it. Second, it dictates the degree of financial protection offered against catastrophic costs of illness. It is argued that although financing issues often tend to dominate debates and prescriptions for health systems reform, methods of financing are but one aspect of a broad health system that involves institutions, policies, and human resources.

This chapter discusses the financing aspect of health-care planning. It outlines the pressures that have led to the current interest in health-care financing, and argues that country-specific analysis of these pressures needs to be undertaken by planners as a basis for policy formulation. Criteria for assessing funding mechanisms are introduced, and the major alternatives for financing health care are described. Recent developments in the way in which external support is provided are discussed.

This chapter focuses on two of the key functions of a health sector financing system: revenue collection and fund pooling. It uses as its starting point the World Health Organization resolution calling for health care financing systems to provide universal coverage and financial protection for citizens. Revenue collection concerns the sources of funds, contribution structures, and the means by which they are collected, while fund pooling addresses the need to spread the risk of incurring unexpected health care costs over as broad a population group as possible. In terms of revenue collection, the chapter reviews the equity, sustainability, and feasibility of alternative financing mechanisms (e.g., donor and tax funding, a range of health insurance mechanisms, and out-of-pocket payments) and highlights key lessons from recent research in low- and middle-income countries on these mechanisms. It also highlights the importance of carefully considering who the most appropriate revenue collection organization may be in different political contexts. The main focus of the section on fund pooling is on alternative strategies for reducing fragmentation in health care financing in order to maximize both income and risk cross-subsidies in the overall health care financing system. Such cross subsidies are critical to achieving universal coverage and adequate financial protection.

This chapter examines health economics, financing, and management from the contrasting perspectives of mainstream and social justice-oriented approaches. It evaluates how health care is different from other goods and services and why a free-market approach cannot guarantee equitable or efficient distribution of health care. It scrutinizes different approaches to health care financing, comparing revenue-raising and remuneration arrangements, and the US and Canadian health care systems. It analyzes the aims, assumptions, and uses of cost-analyses and implications for equity, efficiency, and priority-setting. It also assesses the role of World Bank and other dominant global health actors in shaping market approaches to health care in low- and middle-income countries since the 1980s as well as current donor financing strategies. The chapter also covers issues of corruption and medical tourism that jeopardize health care equity. It concludes by presenting alternative social justice approaches to investing for, rather than in, health and health equity.

This chapter discusses private health insurance, social health insurance, and tax-financed health care. These three health insurance systems differ in terms of three Cs: costs, coverage, and choice. Private health insurance is the most costly one to manage. Coverage is limited to people who have taken out insurance, but the choice to do so is of course voluntary. The contrasting system is taxation: it is cheap, it involves universal coverage, but it is compulsory. Social health insurance (SHI) lies between the two contrasting systems, but in practice is quite similar to tax-funded health care on two crucial issues. First, there is no link between size of the individual's contribution and their expected use of health care. Hence, the inefficiencies in the labour market associated with direct taxation would be the same, no matter whether some part of the compulsory taxation is ‘earmarked’ or not. Second, in high-income countries SHI has developed to universal coverage through top-up tax-financed contributions to the sickness funds from the state to cover non-member groups outside the workforce. Exercises and suggested readings are included at the end of the chapter.

This chapter provides a narrative of the complex origins of the American Exceptionalism in health care and the main impediments to the realization of health care as a social right afforded to all Americans. As the chapter discusses, at the heart of American Exceptionalism in health care is “The Great Unsustainable Compromise”, that is, a fragmented mixed-public and private system of health care finance and delivery that has been built around a subsidized employment-based insurance system with selective entitlements to health care for the poor and aged. After tracing the development of the Great Unsustainable Compromise from the demise of the Truman Plan in the late 1940's at the behest of the American Medical Association through the enactment of the Medicare and Medicaid entitlements in 1965, the chapter explains the seeds of its demise and its gradually unraveling over the final decades of the 20th century. In its concluding section, the chapter advances the arguments for the inevitability of the evolvement of the health care system to a publicly financed universal entitlement to comprehensive health care as a social right of citizenship.

The Greek health care system relies on expensive medical inputs to deliver basic health care services, and is characterized by a lack of primary care focus, which disallows care integration and coordination, particularly in chronic care management. Consequently, care delivery remains fragmented and disjointed and often results in access to care disparities. This chapter proposes three areas where structural reform is essential to address budgetary constraints, improve coverage, and deliver better quality of care. First, the health care financing and contracting model and reimbursement mechanisms need to be overhauled. Transitioning to a funding system through general taxation would be advantageous in increasing levels of coverage over the short- to medium-term, but needs to be accompanied by significant changes in the provision and contracting of services to improve efficiency and quality. Second, the role of primary health care needs to be strengthened so that it becomes the backbone of health service delivery. And, finally, pharmaceutical policy needs fundamental review, including a re-alignment of the different incentives on the supply and the demand side. These reforms require a mix of structural and tactical interventions by decision-makers.

The Health Care Financing Administration (HCFA), an agency of the Department of Health and Human Services, in its National Health Accounts (NHA), and the Bureau of Economic Analysis (BEA), an agency of the Department of Commerce, in its National Income and Product Accounts (NIPA), each publish national data on expenditures for health care. The NHA show the interaction between health care services and funding sources and how these relationships change over time, while the NIPA provide an up-to-date, overall view of domestic and national production, its distribution, and its use as shown by the interrelated receipts and expenditures of producers, consumers, investors, government, and the foreign suppliers and customers of the United States. In an effort to improve the consistency of these two sets of estimates, HCFA and BEA are engaged in a joint program to reconcile the health care estimates in the NHA and in the NIPA. This chapter focuses on the reconciliation of hospital care and physician services.

This chapter focuses on the United States’ approach to health care distribution, with particular emphasis on the reform measures recently passed by Congress and signed into law by President Barack Obama. These health care reform measures are being attacked both in the courts and by some politicians. The chapter first considers arguments in favor of social subsidization of health care based on the work of John Rawls, as well as libertarian and conservative objections to the Rawlsian arguments. It then reviews other, non-Rawlsian grounds for the justice of subsidized health care finance schemes. It also examines two debates that apply to every sort of national health-insurance scheme: the question of the treatment of illegal immigrants within national plans, and the question of the proper approach to health care rationing for cost control; and the debate about the justice of the so-called individual mandate, which forces citizens to purchase health insurance.

The author recounts his final trip to Kragur in 2011, staying there from the beginning of February through early March, for some unfinished business. He had finished organizing the clan history information that he started in 2008 and putting it in neat digital charts with the help of a fellow anthropologist. Then he mailed copies of each clan's chart to its straksa project participants, asking them to check the charts for errors or omissions. When he returned to Kragur, he brought paper copies of linguist Richard Wivell's lexicon of the Kairiru language and his book describing its grammar, to be given to villagers. The author talks about mining and its impact on Kragur's water supply, along with local political issues such as health care financing. He also discusses some of the changes in Kragur and in Papua New Guinea more generally, including the proliferation of mobile phones and the launch of massive liquefied natural gas projects.