** Fair financing in health systems
Abstract Of Paper Presented At The Equinet Conference, Durban, 8-9 June 2004, by Lucy Gilson, Centre for Health Policy, University of the Witwatersrand
Fair financing in health systems Lucy Gilson, Centre for Health Policy, University of the Witwatersrand and Di McIntyre, Health Economics Unit, University of Cape Town The starting point of this paper is to briefly discuss alternative definitions of ‘fair financing’. The term ‘fair financing’ was popularised by the WHO in their 2000 World Health Report, which set about evaluating and ranking health systems around the world. The WHO has defined this concept as individuals paying for health services in proportion to their income. Others suggest that a more ‘progressive’ definition of fair financing would be appropriate. The focus of the paper is to review the key findings of work relating to health care financing that has been supported by Equinet over the past few years. In addition, other striking health care financing trends in the SADC region will be referred to. There has been a particular emphasis in recent Equinet work on alternative mechanisms for allocating the limited government (and sometimes donor ‘basket fund’) resources available for health care in an equitable or fair way. Equinet funded case studies have been undertaken in Namibia and Tanzania, while other studies by Equinet-linked researchers have been undertaken in Zambia, Zimbabwe and South Africa. Key lessons from these country studies will be discussed, particularly in relation to the relevance of composite deprivation indices compiled using statistical techniques and the importance of eliciting stakeholder preferences to guide resource allocation decisions. Equinet has also supported a range of research that raises issues related to increasing private sector involvement in the health system. In some instances, this relates to generating additional funds from private sources by introducing and extending community-based pre-payment schemes. In others, it reviews the potential for generating additional funds by opening private beds in public sector hospitals, or other forms of ‘public-private partnerships’. In yet other instances, there has been a move in the opposite direction with some governments removing user fees from some or all health services, thereby reducing the relative reliance on private financing sources. This paper will consider some of the factors underlying these public-private financing shifts, any information on their impact, as well as key issues relating to the process of developing and implementing these policies. The paper ends with some ideas on what specific future areas of focus may be of relevance in pursuing ‘fair financing’ for the health sector in the SADC region.