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This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

Despite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.

This research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.

The authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.

Accounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.

This research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.

Objective – Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as “developing”: they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice.

Method – The chapter contrasts the nature of the developing health care system with the common goals, objectives, and principles of the Emerging Paradigm (EP) in developed, integrated – yet decentralized –systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined.

Findings – In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, “silos” that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits – substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors.

Policy implications – The situation can be rectified by (a) “centralizing” – at any level of development and resource availability – health system finance around a set package of core medical benefits that is made available to the entire population and (b) “decentralizing” consumption and provision of care. The first serves equity and cost containment and sustainability. The second supports efficiency and client satisfaction.

Originality/value of chapter – The chapter views commonly discussed problems of the health care system – a lack of insurance coverage and income protection – as symptoms of a large problem: health system segregation.

This paper considers the eligibility criteria for NHS continuing healthcare funding in England ‐ with particular focus on the revised framework guidance issued by the Department of Health in July 2009. It commences with a brief review of the tensions that exist between the guidance and the law (in the form of court judgments) and provides an overview of the aspects of the guidance of most relevance to those working with disabled people with severe head and spinal injuries.The paper advises how professionals involved in this difficult area should interpret the new materials so as to reach an outcome in individual cases that is in accordance with the law. It suggests, however, that even with the July 2009 revisions, the framework and the associated decision support tool remain problematic.The paper concludes with a cautionary note, that the recent increase in the numbers of patients qualifying for NHS continuing healthcare funding may be attributable, not to the detail of the framework, but to the Department of Health's rhetoric of change and the additional monies that it has made available to primary care trusts (PCTs) for this sector.

This paper aims to investigate funding and performance monitoring practices in Zambia’s health sector from an institutional and stratified ontology perspective. Such an approach was deemed appropriate in view of pluralistic institutional environments characterising most African economies that are also considered to be highly stratified.

Blended with insights from stratified ontology, the paper draws on institutional pluralism as a theoretical lens to understand the institutional structures, mechanisms, events and experiences encountered by actors operating at different levels of Zambia’s health sector. The study adopted an interpretive approach that helped to investigate the multifaceted and subjective nature of social phenomena and practices being studied. Data were collected from both archival sources and interviews with key stakeholders operating within Zambia’s health sector.

The study’s findings indicate the high levels of stratification within Zambia’s health sector as evidenced by the three sector levels that possessed different characteristics in terms of actor responses to donor influence. This study equally demonstrates the capacity of agents operating under highly fragmented institutional environments to engage in enabling and constraining responses depending on the understanding of their empirical world.

Through blending insights from stratified ontology with institutional pluralism, the study contributes to the literature by demonstrating the enabling and constraining reflexive capacity of agents to exercise choices under highly fragmented institutional environments while responding to multiple demands and expectations to sustain the co-existence of diverse stakeholders. Accordingly, the study advances thinking on the application of institutional theory to critical accounting research in line with recent ontological and epistemological shifts in institutional theory.

Many health systems face challenges such as rising costs and lacking quality, both of which can be addressed by improving the integration of different health care sectors and professions. The purpose of this viewpoint is to present the German health care Innovation Fund (IF) initiated by the Federal Government to support the development and diffusion of integrated health care.

This article describes the design and rationale of the IF in detail and provides first insights into its limitations, acceptance and implementation by relevant stakeholders.

In its first period, the IF offered € 1.2 billion as start-up funding for model implementation and evaluation over a period of four years (2016–2019). This period was recently extended to a second round until 2024, offering € 200 million a year as from 2020. The IF is triggering the support of relevant insurers for the development of new integrated care models. In addition, strict evaluation requirements have led to a large number of health service research projects which assess structural and process improvements and thus enable evidence-based policy decisions.

This article is the first of its kind to present the German IF to the international readership. The IF is a political initiative through which to foster innovations and promote integrated health care.

We adopt a standard distributional impact methodology, based on Atkinson's cost of inequality approach, to estimate the degree of implicit redistribution created through public funding of health insurance in Canada. The first stage of the exercise is to determine the public health insurance benefits received by families of various age and composition and to add these to measured after-tax incomes. In our base case, which uses the Atkinson Mean Logarithmic Deviation as inequality index, we find that accounting for public health insurance benefits implies a reduction in inequality equivalent to 2.4% of per capita income. We then model the implications of moving to a hypothetical fully privatized system while proportionately refunding to individuals the tax revenues saved in doing so. This would give rise to a further 2.4% equivalent per capita income reduction resulting from increased inequality in the distribution of after-tax income. Thus, for this scenario, moving from public financing of health insurance in Canada to a fully privatized system implies an overall increase in inequality equivalent to a loss of 4.8% of per capita income. This corresponds to an increase of about 25% in existing inequality. Not surprisingly, the impact of publicly financed health insurance in reducing inequality is strongest for the elderly.

Population‐based indices of needs have an influence on mental health care funding. Over the last 30 years, a number of needs indices have been developed that utilise sociodemographic and service utilisation data to calculate a proxy indicator of population‐based need. This approach is used because indicators of socio‐economic disadvantage expressed as weighted deprivation show a strong relationship with mental health morbidity. In this paper, we review the existing indices, illustrate the application of these indices using east London as an example, and consider the methodological and conceptual limitations of these indices. Although none of the current indices provide a definitive picture, commissioners and providers may find them to be a useful source of contextual information, which may be useful in combination. In England, this is particularly relevant in the light of the increased liberalisation of commissioning services and changes in the funding process.

In 1988 the Government of Israel appointed a Commission of Inquiry (of which the authors were members) to examine the state of its health‐care services. Although relating to Israel, some of the problems contributing to the crisis in the health services are shared by other industrialized nations. In 1991 the findings and recommendations of the Commission were adopted by the Government. They related to the major problem areas analysed by the Commission: poor standard of service to the public; health ministry structure and performance; funding and budgeting; poor labour relations in the public health sector; surplus of physicians; mix of public and private health care; shortage of qualified health‐care managers. The main recommendations adopted were: legislation for compulsory health insurance (due to be effective on 1 January 1995), establishing a National Health Authority, running of hospitals by autonomous corporations and reform in salary structure.