Suchergebnisse

A low-income country, Ethiopia has made impressive progress in improving health outcomes. The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Significant challenges remain, however, with the maternal mortality ratio at 420 out of 100,000 live births. The government has introduced a three-tier public health care delivery system to deliver essential health services and ensure referral linkages, with level three as specialized hospitals (one per 3.5 million 5 million population), level two as general hospitals (one per 1 million 1.5 million), level one as primary hospitals (one per 60,000 100,000) with satellite health centers (one per 15,000 25,000) and health posts (one per 3,000 5,000). One initiative contributing greatly toward universal health coverage (UHC) is the Health Extension Program (HEP) that provides free primary care services at health posts and communities. The country is at its early stage initiating insurance schemes to provide financial protection for its citizens: Social Health Insurance (SHI) for formal sector employees and Community-Based Health Insurance (CBHI) for rural residents and informal sector employees. Public facilities are expected to provide exempted services for free, and there is a fee-waiver system for the poor.

Since the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, health care in China has become a leading national concern. Often highlighted by the popular phrase, kan-bing-nan, kan-bing-gui (seeking care is difficult and expensive), healthcare costs can be devastating. Prior to 2007, there were two formal insurance programs: the Urban Employee Basic Medical Insurance (UEBMI) for the urban employed population, and the New Rural Cooperative Medical Insurance (NRCMI) for rural residents. A third major group-urban resident without formal employment-was essentially left out of the state health security system. In July 2007, the State Council initiated a pilot experiment in 79 cities-the Urban Resident Basic Medical Insurance (URBMI). The plan targeted urban residents without formal employment, especially the elderly and children (State Council 2007). The present health policy note provides an updated review of healthcare settings and policy reforms, focusing primarily on urban health financing. It discusses urban insurance in the context of universal coverage and how to harmonize insurance schemes across urban and rural areas. This discussion is placed in the context of global experience and emerging principles of best practices.

The East Asia and Pacific region is characterized by wide variations in sources of healthcarefinancing, pooling of funds, purchasing of care services, and the extent to which thesepolicy instruments and programs provide social protection. Existing healthcare financingsystems in the region are under increasing pressure from a continued prevalence ofcommunicable diseases, an emergence of non communicable diseases, and a rapidlyaging population.Large inequalities between the poor and the prosperous in their access to healthcarefinancing mechanisms can be reformed and strengthened to improve outco

This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.