George Schieber

Health Financing in Indonesia: A Reform Road Map

Indonesia is at a critical stage in the development and modernization of its health system. The government of Indonesia has made major improvements over the past four decades, but struggles to maintain and continue to improve important health outcomes for the poor and achieve the Millennium Development Goals. Nevertheless, some key health indicators show significant progress. Infant and child (under five) mortality rates have fallen by half since the early 1990s, although the speed of the decline appears to have slowed since 2002. Maternal mortality rates show a declining trend, but remain among the highest in East Asia. Indonesias population program is one of the worlds most successful: fertility rates have declined impressively since the 1970s and continue to fall. Previously declining malnutrition rates among young children have, however, stagnated. The slowing down of progress may be explained by a poorly functioning health system as well as by new and ongoing challenges posed by demographic, epidemiological, and nutrition transitions, which require new policy directions, a reconfigured and better performing health system, and long-term sustainable financing.

Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income Countries

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 peoples health care coverage or maintained such coverage after prolonged political or economic shocks. 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. With health at the center of global development policy on humanitarian as well as economic and health security grounds, the international community and developing countries are closely focused on scaling up health systems to meet the Millennium Development Goals (MDGs), improving financial protection, and ensuring long-term financing to sustain these gains. With the scaling up of aid, both donors and countries have come to realize that money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills. This realization has sent policy makers looking for reliable evidence about what works and what does not, but they have found little to guide their search.

Health Financing in Ghana

The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghanas health system, and health financing functions and health systems goals. It also describes Ghanas health financing system. Chapter two assesses the performance of Ghanas health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghanas health system, which determine Ghanas health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghanas future fiscal space, based on Ghanas new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS.

Case-mix differences between hospital-based and freestanding skilled nursing facilities. A review of the evidence.

Many health care services are available in both hospital and freestanding settings. Hospital-based providers are usually much more expensive than freestanding providers. According to Medicare data, costs in hospital-based skilled nursing facilities (SNFs) are twice those of freestanding facilities. While critics charge that this is the result of inefficiency, hospitals counter that higher costs are caused by treatment of sicker patients and provision of higher-quality care. This paper analyzes the research on the case-mix differences between hospitalbased and freestanding SNFs. On the basis of this analysis, it appears that hospital-based facilities tend to serve more severely ill patients (i.e., have a more difficult case mix) than do freestanding facilities. Case-mix differences, however, appear to explain less than half of the cost differential between the two types of facilities.

Actuarial costing of universal health insurance coverage in Indonesia : options and preliminary results

This series is produced by the Health, Nutrition, and Population family (HNP) of the World Banks Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.