Suchergebnisse

Egypt and Cuba are both lower-middle income countries with a history of socialist rule and which have embarked on economic liberalisation since the 1990s. Health status in both countries is extremely different. While life expectancy of the Cuban population in all age-groups is similar to that of many high-income industrialised countries, health status in Egypt is relatively poor compared to countries with a similar national income and compared to regional comparators. Health care systems in both countries are also markedly different, although both share a socialist origin with centralised administration of funding and delivery, funding mainly from general taxation, and state-employed providers. In this article, health care financing mechanisms in both countries are analysed on their effectiveness, efficiency, and equity, with the objective of identifying the determinants of success in the Cuban health care system from which valuable lessons for current health reforms in Egypt may be derived.

Introduction: The Government of Egypt has embarked on a process of reforming health care financing in the country. Under the influence of external advisers it has so far focused on social health insurance as the main funding mechanism. Other options, in particular tax-based financing, have hardly been considered. Methods: Review of current health care financing arrangements in Egypt, of potential areas for improvement, and of stated health policy goals. Analysis of social health insurance and taxation-based financing on their ability to meet the stated policy goals and their viability. Results: Although both funding mechanisms have distinct advantages and disadvantages when applied to the Egyptian health system, tax-based financing seems better able to meet the official policy goals of the Government of Egypt than social health insurance on grounds of efficiency, equity and technical feasibility. Conclusions: The Government of Egypt will have to raise public health expenditure substantially to finance care at an adequate level. Expanding and refining the present tax-based financing scheme, rather than switching to an insurance-based scheme seems the technically superior strategy. Other measures to improve the coordination of financing, such as the creation of a single fundholding agency, are needed as well as tighter regulation of private providers and the pharmaceutical market.

In Germany, cost-sharing for health care has been used as a financing mechanism since 1923. In this article, the historical development of user charges in Germany since the 1980s is presented in more detail by type of private expenditure, including direct payments, cost-sharing measures, and voluntary health insurance. This is followed by a mapping of current cost-sharing measures including a discussion of protection mechanisms and responsibility for decision-making on cost-sharing measures and a summary of national policy debates. In the final section, the results of a systematic review of the literature on the impact of cost-sharing on equity, efficiency and health outcomes in Germany are presented.