A policy brief prepared for the International Dialogue on Evidence-Informed Action to Achieve Health Goals in Developing Countries (IDEAHealth), Khon Kaen, Thailand, 13-16 December 2006.
The purpose of IDEAHealth is to improve the appropriate use of research evidence to inform policy-making. This brief considers the strength of evidence of the effects of five approaches designed to encourage the uptake of health care by poorer groups in low and middle income countries. These approaches are: 1. The introduction or removal of user fees 2. Community based insurance 3. Social health insurance 4. Contracting out service provision to non-state providers, and 5. Conditional cash transfers The capacity of government to manage and administer alternative health financing schemes is critical to all of the mechanisms considered. For social health insurance both the rate of participation in the formal labour market, and the income per capita will influence the likely success of any scheme. The state of existing health systems is also a crucial consideration. Contracting out may work well in contexts where public health systems have deteriorated, provided there is a pool of health care providers who can bid on contracts. Societal attitudes and values are particularly important when considering user fee policies, and health insurance mechanisms.
Geneva: The Alliance for Health Policy and Systems Research, WHO, 67 pp.