Analyses the experience with the financing reforms implemented by the countries of Central Europe, Eastern Europe, the Cauxasus and Central Asia.

Since 1990 the social and economic policies of the transition countries of central and eastern Europe the Caucasus and central Asia have diverged including the way they have reformed the financing of their health systems. This book analyses this rich experience in a systematic way. It reviews the background to health financing systems and reform in these countries starting with the legacy of the systems in the USSR and central and eastern Europe before 1990 and the consequences (particularly fiscal) of the transition for their organization and performance. Using in-depth country case experienc.

This book establishes a framework for assessing health care reform proposals and their implementation. It helps clarify objectives, identifies issues to be addressed in proposals, distinguishes between short- and long-term expectations and achievements, and directs attention to important but sometimes neglected questions about the organization and provision of health care services. In addition, the volume presents a discussion and analysis of issues essential to achieving fundamental goals of health care reform: to maintain and improve health and well-being, to make basic health coverage universal, and to encourage the efficient use of limited resources. The book is a useful resource for anyone developing or assessing options for reform.

This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks (e.g., following the collapse ofthe Soviet Union). In doing so, this report seeks to expand the evidence base on "good performance" in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam.

In 2004 the Indonesian government made a commitment to provide its entire population with health insurance coverage through a mandatory public health insurance scheme. It has moved boldly already provides coverage to an estimated 76.4 million poor and near poor, funded through the public budget. Nevertheless, over half the population still lacks health insurance coverage, and the full fiscal impacts of the government's program for the poor have not been fully assessed or felt. In addition, significant deficiencies in the efficiency and equity of the current health system, unless addressed will exacerbate cost pressures and could preclude the effective implementation of universal coverage (Ue and the desired result of improvements in population health outcomes and financial protection. For Indonesia to achieve UC, systems' performance must be improved and key policy choices with respect to the configuration of the health financing system must be made. Indonesia's health system performs well with respect to some health outcomes and financial protection, but there is potential for significant improvement. High-level political decisions are necessary on key elements of the health financing reform package. The key transitional questions to get there include: [ the benefits that can be afforded and their impacts on health outcomes and financial protection; [ how the more than 50 percent of those currently without coverage will be insured; [ how to pay medical care providers to assure access, efficiency, and quality; [ developing a streamlined and efficient administrative structure; [ how to address the current supply constraints to assure availability of promised services; [ how to raise revenues to finance the system, including the program for the poor as well as currently uninsured groups that may require government subsidization such as the more than 60 million informal sector workers, the 85 percent of workers in firms of less than five employees, and the 70 percent of the population living in rural areas.

In 2015, the government of Ukraine initiated transformative reforms of its health system with the goals of improving the health outcomes of the population and providing financial protection from excessive out-of-pocket health care payments. This was to be implemented through modernizing and integrating the service delivery system, introducing changes to provider payment arrangements that incentivize efficiency, and improving the quality of care. It culminated in the passage of a new health financing law--the Law on Financial Guarantees for Health Care Services 2017--which established a health benefit package called the Program of Medical Guarantees (PMG), and also created the National Health Services of Ukraine (NHSU) to serve as strategic purchaser for this program. A joint World Health Organization--World Bank review of the early reforms was published in 2019 that took stock of reform progress since 2017. Two years later, implementation of the health financing reforms has progressed substantially, and it is time to again review where things stand and what the future directions should be. There have been many important accomplishments over the past two years, both in terms of institutional reform and expansion in access to care. The COVID-19 pandemic precipitated adjustments to existing health financing levels and arrangements. At the same time, the pandemic delayed implementation of some aspects of the health financing reforms, such as the anticipated transition to case-based payments. This report provides a comprehensive description and assessment of the development and implementation of policies associated with the PMG reform from the start of the reform in 2017 through mid-2021. It examines (1) how the PMG is financed, (2) strategic purchasing of the different components of PMG benefit package, and (3) the governance arrangements of the PMG. This includes changes in the packages, their contracting arrangements, how they are paid, their complementary enabling reforms, and the extent to which the population is benefiting from them. The report also positions these developments within broader contextual discussions of the financing and organization of health care in Ukraine in order to make the key features of the financing reforms and their importance accessible to domestic and international audiences. Adjustment by the health sector to cope with the COVID-19 pandemic is a common thread. Each section concludes with a set of key recommendations.

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.