Tax and Insurance Funding for Health Systems

overview | facilitator notes | country case studies

Health Economics Unit
University of Cape Town

OBJECTIVES

The main objectives of this set of country case studies are to:

  • Develop an understanding of the key health care financing functions of revenue collection, pooling of funds and purchasing in relation to tax and insurance mechanisms;
  • Develop an understanding of the role of tax and insurance in the funding of health services in different contexts, particularly in relation to:
    • Providing financial protection to households against the costs of illness, and
    • Promoting cross-subsidies in the overall health system; and
  • Critically evaluate issues relating to achieving universal coverage.

Given the recent emphasis on health insurance as a key health care financing mechanism (e.g. the World Health Assembly’s resolution in 2005 on “Sustainable health financing, universal coverage and social health insurance”), many of the country case studies focus particularly on alternative types of health insurance.

THE TASK: INDIVIDUAL WORK

Each participant should read two country case studies overnight (you will be allocated two readings from different regions – Africa, Asia and Latin America and the Caribbean). While reading the case studies, you should try to identify information that can answer the following questions (which will be discussed in your group tomorrow):

  • How is revenue collected in this country (who are health care funding contributions collected from, how are these contributions structured and who collects them)?
  • How are funds pooled in this country (what is the size of the population and which groups are covered by each financing mechanism and what are the allocation mechanisms for distributing pooled resources)?
  • How are services purchased in this country (what services are included in the benefit package and what provider payment mechanisms are used)?
  • What were the motivations for adopting this approach to health care financing in this country?
  • How equitable is health care financing (both in terms of who bears the burden of health care financing and who benefits from health care) and what factors contribute to equity or inequity in financing in this country?
  • To what extent are households provided with financial protection in this country?

You should draw out whatever information is available in the country case studies in order to answer these questions and should critically evaluate the overall health care financing system. A table is provided below to assist you in summarising relevant information.

THE TASK: GROUP WORK

Within each group, each member will have reviewed two of the country case studies and all six countries can be discussed within the group. Each country should be briefly discussed in turn, in relation to the above questions. The group is then asked to critically compare alternative approaches to tax and insurance funding for health care across these countries. Each group will be asked to report back to plenary on this critical comparison (i.e. you should not present the full table below, but just an overview of striking features from each country and try to draw out key lessons for how to promote equitable health care financing).

Issue Chile Costa Rica Korea Sri Lanka Ghana South Africa
How is revenue collected?            
How are funds pooled?            
How are services purchased?            
What were the motivations for this financing approach?            
How equitable is financing & what contributes to equity or inequity?            
To what extent are households financially protected?            

Country case studies

Chile | Costa Rica | Korea | Sri Lanka | Ghana | South Africa