Mukesh Chawla

Financing health services in Poland: new evidence on private expenditures

This paper estimates total expenditure on health care in Poland in 1994 and provides new evidence on high levels of private spending on health care. The analysis shows that health care expenditures in Poland are higher than has usually been maintained, and are comparable with the prevailing levels in many other European countries. Private expenditure on health is a significant proportion of total expenditure on health, and in particular on financing outpatient care. Available evidence indicates that informal payments made by patients to physicians contribute as much as double of the physicians salary, and thus form an important source of earnings for physicians. This situation of high private expenditures on health care and informal payments to physicians is likely to be true of other transitional economies of Central and Eastern Europe as well. One policy implication that emerges is these transitional economies face a big challenge in managing existing resources, as opposed to finding new resources, in the health sector more effectively to meet the health care needs of their population. The paper highlights the need for better understanding of the current availability and distribution of resources in the health sector and their directions of flow, in both public and private sectors, and suggests using tools such as National Health Accounts to track and monitor changes in the financing of the health care system.

Provision of ambulatory health services in Poland: a case study from Krakow

This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.

Health reform for children: the Egyptian experience with school health insurance

In June 1992, the Peoples Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it effectively increased the number of beneficiaries covered by the Health Insurance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1993. This paper first examines the policy processes for the introduction of this innovation in Egypts health system. Next, the paper discusses the implementation and consequences of the new policy in terms of coverage, financing, benefits, and delivery of services, along with data on utilization and expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitment and the proposed program and solutions are acceptable to the key stakeholders. Second, compromises and trade-offs are essential to construct a politically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long term may undermine the reforms capacity to achieve the anticipated equity enhancements and can potentially undermine the financial sustainability of the reform.

Utilization of outpatient care in Egypt and its implications for the role of government in health care provision.

This paper uses data from a household survey to analyze the utilization of health care by the poor in Egypt. We find that even though the government provides free care, a significant proportion of the poor visit fee-for-service private providers. As a result, the poor and the indigent spend disproportionately larger amounts on health compared to the rich. We take this as evidence of the failure of the governmental policy of public provision of health care to lead to considerable gains in rates of utilization by the poor. Our study provides empirical support for arguments favoring greater emphasis on government financing of health care instead of the direct provision that characterizes many developing countries.

Truck Drivers and Casual Sex : An Inquiry into the Potential Spread of HIV/AIDS in the Baltic Region

This study, perhaps the first of its kind in this region, is based on a study that explores the practice of casual sex among truck drivers, and commercial sex workers in the border areas of the Baltic region at a point of time, and, uses this evidence to extrapolate the potential impact on the spread of HIV/AIDS in these countries. While the threat of an HIV/AIDS epidemic cannot be taken lightly in any country of the Europe and Central Asia region, four countries - Poland, Latvia, Lithuania, and Estonia - stand out as being particularly vulnerable. First, the prevalence of HIV/AIDS is relatively high, and is rapidly increasing in locations neighboring these countries to the east, like Ukraine, Kaliningrad, Belarus, and Moldova, where public health conditions are also rapidly deteriorating. Second, because of their geographical location, those four countries stand at the crossroads of the main east-west, and north-south transport corridors, and represent the link between countries of the former Soviet Union and western Europe. The open borders, and rapid transit threatens to broaden the sweep of the HIV epidemic, as drug injectors and sex workers come into contact with other population groups. After the Introduction which provides background, Section 2 reviews similar studies carried out elsewhere in the world. Section 3 describes the methodology employed in this study, followed by a brief description of the data in Section 4. Finally, Section 5 contains a discussion of the results, and policy implications.

Health care spending in the new EU member states : controlling costs and improving quality

The main objectives of this study, Health care spending in the new EU member states: controlling costs and improving quality, are to take stock of recent trends in health expenditure aggregates in the public sector and to identify specific areas of reform consistent with the objectives of consolidating the fiscal situation in these countries without adversely affecting the production, delivery and utilization of health services. The book begins with an introduction and the rest of this study is organized as follows: Chapter 2 discusses trends and structure of health expenditures in the EU8. Chapter 3 assesses the nature and extent of indebtedness in the health sectors. Chapter 4 discusses the key expenditure areas. Chapter 5 presents population ageing and proliferation of medical technology as the future spending pressure points in the health sector. Chapter 6 focuses on the management of health expenditures. Finally, Chapter 7 concludes.