Financing health systems
RESYST research on financing for Universal Health Coverage in South Africa, Kenya and Nigeria has shown that it is possible to substantially increase domestic tax revenue, even in low-income countries, by expanding the tax base and improving the efficiency of tax collection systems. This source of revenue is more stable and sustainable than donor funding, and more equitable than insurance schemes, which often exclude the poorest and most marginalised populations. However, the research also reveals that Ministries of Health face a critical challenge in making a case for health so as to expand its share of government spending.
A team at RESYST led by Kara Hanson and colleagues from the University of Cape Town has advanced the concept of ‘strategic purchasing’, ie. the way in which money raised from taxes or insurance contributions is transferred to health providers. The strategic purchasing framework considers key purchasing actions in relation to citizens, providers and governments. This has involved comparative analysis across ten countries in Africa and Asia, showing a lack of strategic purchasing in most countries.
Josephine Borghi and colleagues at the Ifakara Health Institute, and Christian Michelsen Institute in Norway have been researching the effects of payment- for-performance (P4P) on the health system. They found that P4P was associated with improvements in the availability of drugs and supplies, and more frequent supportive supervision, and improved relationships between providers and their managers. The study also found that initially facilities serving wealthier groups were more likely to meet targets and obtain bonus payouts than those serving poorer groups, but that there was convergence in performance over time.
The School is also leading two major health systems financing studies in the Asia-Pacific region led by Virginia Wiseman with colleagues including Marco Liverani, Lorna Guinness and Anne Mills, in collaboration with the University of New South Wales, Thailand Ministry of Public Health, National University of Timor Leste, Fiji National University and the University of Cape Town. The first is the Sustainable Health-financing in Fiji and Timor Leste (SHIFT) Project funded by Australian Aid, Department of Foreign Affairs and Trade and the second is the Cambodia Health Equity and Financing (CHEF) Project funded by the Australian Research Council. These studies represent the first attempt to quantify financing and benefit incidence for the entire health systems of these countries. This evidence will help ensure the poor are not left behind in health financing reform.