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The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.

It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.

One of the major concerns for developing countries is improving the use of health services by the general population, and in particular, maternal and child health services. This concern reflects the Sustainable Development Goals 3, which aim to ensure the health and well-being of all by improving reproductive health, and especially maternal and child health. This study analyses the extent to which modern energies improve women’s empowerment and the demand for maternal health services in a low income country. The empirical estimations were based on the 2017 Benin Demographic Health Survey data. We adopted the trivariate recursive probit modelling to find out the extent to which modern energies improve women’s empowerment and the demand for maternal health services. The results revealed that the demand for maternal health services was significantly and positively associated with women’s empowerment. Notably, being an empowered woman (social independence and decision-making) increases the chance of completing antenatal care visits. We further highlighted the importance of women’s wealth in accessing maternal health services. To address maternal mortality in sub-Saharan African countries, policymakers should improve women’s social independence, decision making power and attitude to violence by promoting access to modern energies such as electricity, Liquefied petroleum gas, and bio gas.

This is an exciting time in East Asia and the Pacific region. No region will appear to be moving so rapidly. In this dynamic environment, many countries in the region have been approaching the World Bank requesting technical assistance and knowledge about health financing best practices and options. There is great interest in expanding knowledge sharing and learning from other East Asian and Pacific countries about their experiences in health financing. Moreover, some common issues appear to be emerging: universal insurance, options for financing health insurance, institutional setups of health financing options, provider payment mechanisms, equity considerations, ways to reach the poor and impoverished, and ways to meet the challenges of a changing demographics and epidemiologic profile. Under a generous grant from the Health, Nutrition, and population hub in the World Bank in fiscal year 2008, the region was requested to provide an overview of health financing systems in the region. This overview examined the different health financing mechanisms in terms of performance on dimensions of efficiency and equity and in terms of relative roles of government. In addition, the analysis was to identify, gaps in knowledge needing to be addressed strengthen and reform existing health financing mechanisms and thereby expand health coverage and benefits.

To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals, the challenges it will face in achieving UC, and key reforms needed to overcome those challenges. It does so through a health financing lens, focusing on how resources are mobilized, pooled, and allocated, and how services are purchased. The report also examines the stewardship of financing that is, the organization, management, and governance of SHI as it has direct implications for achieving UC. The report ends by pulling together the recommendations in the form of an implementation road map.

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

Worldwide countries are recognising the need for and significance of universal health coverage (UHC); however, health inequality continues to persist. This study evaluates the status and equity of residents’ demand for and utilisation of health services and expenditure by considering the three components of universal health coverage, urban-rural differences, and different income groups. Sample data from China’s Fifth Health Service Survey were analysed and the ‘five levels of income classification’ were used to classify people into income groups. This study used descriptive analysis and concentration index and concentration curve for equity evaluation. Statistically significant differences were found in the demand and utilisation of health services between urban and rural residents. Rural residents’ demand and utilisation of health services decreased with an increase in income and their health expenditure was higher than that of urban residents. Compared with middle- and high-income rural residents, middle- and lower-income rural residents faced higher hospitalisation expenses; and, compared with urban residents, equity in rural residents’ demand and utilisation of health services, and annual health and hospitalisation expenditures, were poorer. Thus, equity of health service utilisation and expenditure for urban and rural residents with different incomes remain problematic, requiring improved access and health policies.

Background Since 1993, Colombia has had a mandatory social health insurance scheme that aims to provide universal health coverage to all citizens. However, some contributory regime participants purchase voluntary private health insurance (VPHI) to access better quality health services (i. e., physicians and hospitals), shorter waiting times, and a more extensive providers’ network. This article aims to estimate the price elasticity of demand for the VPHI market in Colombia. Methods We use data from the 2016–2017 consumer expenditure national survey and apply a Heckman selection model to address the selection problem into purchasing private insurance. Using the estimation results to further estimate the price semi-elasticity for VPHI, we then calculate the price elasticity for the households’ health expenditure and acquisition of VHPI. Results Our main findings indicate that a 1% VPHI price increase reduces the proportion of households affiliated to a VPHI in the country by about 2.32% to 4.66%, with robust results across sample restrictions. There are relevant differences across age groups, with younger households’ heads being less responsive to VPHI price changes. Conclusions We conclude that the VPHI demand in Colombia is noticeably elastic, and therefore tax policy changes can have a significant impact on public health insurance expenditures. The government should estimate the optimal VPHI purchase in order to reduce any welfare loss that the current arrangement might be generating.

Uninsured individuals receive fewer healthcare services for at least three reasons: responsibility for the entire bill, higher prices, and potential provider reductions for concern of nonpayment. I isolate reductions when uninsured patients are solely financially responsible by capitalizing on Maryland's highly regulated health care system. Prices are set by the state, are uniform across all patients, and hospitals are compensated for free care and bad debt, I use a unique feature of the data, multiple readmissions for patients who gain or lose insurance between visits, to isolate the reductions in quantity demanded when individuals are faced with paying the full price without an insurance contribution. A Blinder-Oaxaca decomposition estimates uninsured individuals receive 6% fewer services after accounting for differences in patient, illness, and hospital characteristics than when these same individuals are insured.

Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.