Edited by Alistair McGuire and Joan Costa-Font
Chapter 10: Social Health Protection: Policy Options for Low- and Middle-income Countries
Philipa Mladovsky 1. INTRODUCTION Financing health care has become an increasingly central policy issue in national and international efforts to improve health and health care in low- and middle-income countries (LMIC). The increased attention can partly be explained by the realisation that high levels of out-of-pocket expenditure on health reduce access to health care, especially among the poorest (Hjortsberg, 2003; Preker et al., 2002; Lagarde and Palmer, 2008), and increase the financial risks of ill health to households due to selling of assets, indebtedness, impoverishment and reduction of essential expenditure on food, education and so on, in addition to the costs of being unable to carry out normal income-generating activities due to ill health (van Doorslaer et al., 2006; Xu et al., 2003; Wagstaff, 2009; McIntyre et al., 2006). Another driving factor for the focus on health financing is the further realisation that international development mechanisms aiming to support public health, such as aid, loans, debt reduction and global health initiatives, are unlikely to succeed without the presence of strong health, including health-financing, systems (Travis et al., 2004). Before commencing an overview of the various policy options for financing health care available to LMIC, it is important to understand what the objectives of such policies might be. WHO outlined a set of objectives for health financing policy in the resolution on ‘Sustainable health financing, universal coverage and social health insurance’ (World Health Assembly, 2005), as well as in two world health reports (WHO, 2000, 2010) and other policy documents (Kutzin,...
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