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Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.

Health systems across Africa are in urgent need of improvement. The public sector should not be expected to shoulder the burden of directly providing the needed services alone, nor can it, given the current realities of African health systems. Therefore to achieve necessary improvements, governments will need to rely more heavily on the private health sector. Indeed, private providers already play a significant role in the health sector in Africa and are expected to continue to play a key role, and private providers serve all income levels across sub- Saharan Africa's health systems. The World Health Organization (WHO) and others have identified improvements in the way governments interact with and make use of their private health sectors as one of the key ingredients to health systems improvements. Across the African region, many ministries of health are actively seeking to increase the contributions of the private health sector. However, relatively little is known about the details of engagement; that is, the roles and responsibilities of the players, and what works and what does not. A better understanding of the ways that governments and the private health sector work together and can work together more effectively is needed. This Report assesses and compares the ways in which African governments are engaging with their private health sectors. Engagement is defined, for the purposes of this report, to mean the deliberate, systematic collaboration of the government and the private health sector according to national health priorities, beyond individual interventions and programs. With effective engagement, one of the main constraints to better private sector contributions can be addressed, which in turn should improve the performance of health systems overall.

A Guide to Competitive Vouchers in Health provides a broad outline of the problems health systems face, the rationale behind government intervention particularly in the form of subsidies, and the different ways that governments and donors subsidize health care. The guide provides readers with an understanding of the concept of competitive voucher schemes in health; the advantages competitive voucher schemes might offer as an instrument to delivery subsidies; circumstances where competitive voucher schemes are better suited than other instruments to deliver subsidies; and steps to follow when designing, implementing, monitoring and evaluating a competitive voucher scheme. Aimed at raising awareness among policymakers about voucher schemes, this book helps identify situations where vouchers may better achieve health objectives and provides guidance on the choices available and the decisions to be made. It highlights some of the pitfalls that voucher schemes have experienced to date, as well as the wide variation in format that a voucher scheme can take depending upon the health problems being addressed and the objectives that the policy-maker wishes to achieve.

This paper assesses the relative efficiency of government spending on health care and education in Croatia by using the so-called Data Envelopment Analysis. The analysis finds evidence of significant inefficiencies in Croatia''s spending on health care and education, related to inadequate cost recovery, weaknesses in the financing mechanisms and institutional arrangements, weak competition in the provision of these services, and weaknesses in targeting public subsidies on health care and education. These inefficiencies suggest that government spending on health and education could be reduced without undue sacrifices in the quality of these services. The paper identifies ways to do that

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbors has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world’s most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world’s best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the \"cardiovascular revolution\" that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or \"Getting Better\".

Good practice suggests that budget allocations should reflect spending priorities and that spending should provide cost-effective delivery of public goods and services. This paper analyzes the composition of public expenditure in the Slovak Republic. It also assesses the relative efficiency of spending in education and health. The Slovak Republic spends more on social benefits and less on wages compared to the EU and OECD average. While it manages to translate the low expenditures into outcomes in an efficient manner in the education sector, this is not true for health. Moreover, the recent increases in expenditure levels have not improved outcomes, suggesting that significant budgetary savings could be achieved through increases in efficiency.

Meeting the health needs of a community involves developing relationships with a wide range of partners. The purpose of this study was to determine the effect of environmental uncertainty on the level of interorganizational relations among nonprofit hospitals with the intent of providing community benefit. Findings indicate that nonprofit hospitals in California are collaborating to provide community benefit. Significant relationships were found between select hospital characteristics, perceived environmental uncertainty, and components of interorganizational relations.

There is little doubt that a strategic approach to community engagement would produce beneficial results for nonprofit hospitals and, more importantly, the communities they serve. However, to achieve these results, a successful strategy needs to be equally focused on internal as well as external strategies. Bringing all stakeholders to the table for a meaningful dialogue on how best to support a healthier community requires a long-term commitment on everyone's part. This also means that health care professionals need to broaden their view of what constitutes health which can be accomplished by first carefully examining the factors that contribute to poor health. A move towards a more strategic approach in the community will require some very creative approaches inside the institutions of traditional health care.