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Article
Publication date: 26 March 2021

Nikolaos Grigorakis, Georgios Galyfianakis and Evangelos Tsoukatos

In this paper, the authors assess the responsiveness of OOP healthcare expenditure to macro-fiscal factors, as well as to tax-based, SHI, mixed systems and voluntary PHI…

Abstract

Purpose

In this paper, the authors assess the responsiveness of OOP healthcare expenditure to macro-fiscal factors, as well as to tax-based, SHI, mixed systems and voluntary PHI financing. Although the relationship between OOP expenditure, macroeconomy, aggregate public and PHI financing is well documented in the existing empirical literature, little is known for the impact of several macro-fiscal drivers and the existing health financing arrangements associated with voluntary PHI on OOP expenditure.

Design/methodology/approach

The authors gather panel data by applying three official organizations’ databases. They elaborate static and dynamic panel data methodology to a dataset of 49 European and OECD countries from 2000 to 2015.

Findings

The authors’ findings do not indicate a considerable impact of GDP growth and general government debt as a share of GDP on OOP payments. Unemployment rate presents as a positive driver of OOP payments in all three compulsory national health systems post to the 2008 economic crisis. OOP payments are significantly influenced by countries’ fiscal capacity to increase general government expenditure to GDP in SHI and mixed health systems. Additionally, study findings present that government health financing, irrespective of the different health systems structure characteristics, and OOP healthcare payments follow different directions. Voluntary PHI financing considerably counteracts OOP payments only in tax-based health systems.

Practical implications

In the backdrop of a new economic crisis associated to the COVID-19 epidemic, health policy planners have to deal with the emerging unprecedented challenges in financing of health systems, especially for these economies that have to face the fiscal capacity constraints owing to the 2008 financial crisis and its severe recession.

Originality/value

To the best of authors’ knowledge, there is no empirical consensus on the effects of macro-fiscal parameters, different compulsory health systems financing associated with the parallel voluntary PHI institution funding on OOP expenditure, for the majority of European and OECD settings.

Details

EuroMed Journal of Business, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1450-2194

Keywords

Content available
Article
Publication date: 23 March 2020

Yara Ahmed, Racha Ramadan and Mohamed Fathi Sakr

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the…

Abstract

Purpose

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Design/methodology/approach

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

Findings

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

Originality/value

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

Details

Journal of Humanities and Applied Social Sciences, vol. 3 no. 1
Type: Research Article
ISSN: 2632-279X

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Article
Publication date: 24 May 2011

Mercy Akosua Akortsu and Patience Aseweh Abor

The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health

Abstract

Purpose

The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted.

Design/methodology/approach

To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus.

Findings

The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally‐generated funds and donor‐pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor‐pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put.

Originality/value

The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

Details

Journal of Health Organization and Management, vol. 25 no. 2
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 June 2020

Georgios Sfakianakis, Nikolaos Grigorakis, Georgios Galyfianakis and Maria Katharaki

Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by…

Abstract

Purpose

Because of the 2008 global financial crisis aftermaths, economic downturn and prolonged recession, several OECD countries have adopted an austerity compound by significantly reducing public health expenditure (PHE) for dealing with their fiscal pressure and sovereign-debt challenges. Against this backdrop, this study aims to examine the responsiveness of PHE to macro-fiscal determinants, demography, as well to private health insurance (PHI) financing.

Design/methodology/approach

The authors gather annual panel data from four international organizations databases for the total of OECD countries from a period lasting from 2000 to 2017. The authors apply static and dynamic econometric methodology to deal with panel data and assess the impact of several parameters on PHE.

Findings

The authors’ findings indicate that gross domestic product, fiscal capacity, tax revenues and population aging have a positive effect on PHE. Further, the authors find that both unemployment rate and voluntary private health insurance financing present a negative statistically significant impact on our estimated outcome variable. Different specifications and sample periods applied in the regression models reveal how inseparably associated are PHE and OECD's economies compliance on macro-fiscal policies for offsetting public finances derailment.

Practical implications

Providing more evidence on the responsiveness of PHE to several macro-fiscal drivers, it can be a helpful tool for governments to reconsider their persistence on fiscal adjustments measures and rank public health financing to the top of their political agenda. Health systems policies for meeting Universal Health Coverage (UHC) objectives, they should also take into consideration the voluntary PHI institution, especially for economies with insufficient fiscal capacity to raise public health financing.

Originality/value

To the best of knowledge, the impact of unemployment and voluntary PHI funding on public health financing, apart from other macro-fiscal and demographical parameters effect, remains unnoticed in the existing published studies on the topic.

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Article
Publication date: 5 October 2020

Nirjhar Nigam, Sondes Mbarek and Afef Boughanmi

Financing investments in a knowledge-intensive sector may be more difficult as there is a greater degree of uncertainty and asymmetries of information. This paper aims to…

Abstract

Purpose

Financing investments in a knowledge-intensive sector may be more difficult as there is a greater degree of uncertainty and asymmetries of information. This paper aims to examine whether a company’s intellectual capital (human capital, relational capital and structural capital) can serve as a quality signal in the financing of health care startups with new business models.

Design/methodology/approach

The study constructed a manual database using several paid and unpaid databases. This paper collected random data from 204 startups that obtained funding during the 2014–2017 period and used signaling theory to examine the factors that impact access to external financing for Indian health care technology startups.

Findings

This paper found that venture capitalists partly base their financing decisions on the relational capital of the startup represented by startups’ age and the average number of website visits, the presence of a syndicate of investors. Human capital variables and structural variables do not show much significant impact. This paper also find some business models show a negative impact on financing implying that investors are reluctant to invest in new technologies that carry more uncertainty and take a longer time to become profitable.

Research limitations/implications

Before concluding this paper, it is important to acknowledge the limitations of the study and some implications for future research purposes. First, the study is conducted on only 204 startups from India, and as such, it suffers from a small sample size, like many other comparable survey-based studies in entrepreneurship. Second, the results are obtained with respect to data collected from Indian startups and represent the Indian context which limits the generalization on a global level.

Practical implications

The results suggest that years of experience and prior relevant experience, do not actually impact the financing of a new venture. These results are crucial as India has a unique demographic advantage over other countries in relation to age. If young minds are adequately nurtured, this can result in innovation, entrepreneurship and job creation (which still remains as a foremost challenge for India).

Social implications

From a policy perspective, a number of implications emerge from the current study. There is a need for ameliorating the capacity of the education system in providing top-quality support including a greater focus on entrepreneurship courses and to replicate the education delivery model from top foreign institutes. The government should take this opportunity to revive the system of education and follow the methodology of elite institutes and to develop entrepreneurship spirit in other colleges and schools.

Originality/value

Financing the investments of young startups with new business models in knowledge-based sectors may be more difficult. In this paper, this paper demonstrates that startups have to effectively use and manage their intellectual assets to achieve sustainable competitive advantage. The findings of the paper emphasize the role of intellectual capital in securing financing through venture capital.

Details

Journal of Knowledge Management, vol. 25 no. 1
Type: Research Article
ISSN: 1367-3270

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Book part
Publication date: 11 June 2009

Josephine Borghi, John Ataguba, Gemini Mtei, James Akazili, Filip Meheus, Clas Rehnberg and Di McIntyre

Objective – Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms…

Abstract

Objective – Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings.

Methodology – FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socio-economic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised.

Results – LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g. wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with ‘public transport’ use. Hence, calculations of fuel tax on public transport were based on individual expenditure on public transport, the average cost per kilometre and average rates of fuel consumption for each form of transport. For insurance contributions, employees will not report on employer contributions unless specifically requested to and are frequently unsure of their contributions. Therefore, we collected information on total health insurance contributions from individual schemes and regulatory authorities. OOP payments are likely to be under-reported due to long recall periods; linking OOP expenditure and illness incidence questions – omitting preventive care; and focusing on the last service used when people may have used multiple services during an illness episode. To derive more robust estimates of financing incidence, we collected additional primary data on OOP expenditures together with insurance enrolment rates and associated payments. To link primary data to the LSMS, a composite index of SES was used in Ghana and Tanzania and non-durable expenditure was used in South Africa.

Policy implications – We show how data constraints can be overcome for FIA in lower income countries and provide recommendations for future studies.

Details

Innovations in Health System Finance in Developing and Transitional Economies
Type: Book
ISBN: 978-1-84855-664-5

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Article
Publication date: 7 October 2020

Chukwuedo Susan Oburota and Olanrewaju Olaniyan

The purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in…

Abstract

Purpose

The purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.

Design/methodology/approach

The Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.

Findings

The major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.

Originality/value

This paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

Details

International Journal of Social Economics, vol. 47 no. 11
Type: Research Article
ISSN: 0306-8293

Keywords

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Book part
Publication date: 30 September 2020

Dmitry V. Didenko

This chapter sheds light on long-term trends in the level and structural dynamics of investments in Russian human capital formation from government, corporations, and…

Abstract

This chapter sheds light on long-term trends in the level and structural dynamics of investments in Russian human capital formation from government, corporations, and households. It contributes to the literature discussing theoretical issues and empirical patterns of modernization, human development, as well as the transition from a centralized to a market economy. The empirical evidence is based on extensive utilization of the dataset introduced in Didenko, Földvári, and Van Leeuwen (2013). Our findings provide support for the view expressed in Gerschenkron (1962) that in late industrializers the government tended to substitute for the lack of capital and infrastructure by direct interventions. At least from the late nineteenth century the central government's and local authorities' budgets played the primary role. However, the role of nongovernment sources increased significantly since the mid-1950s, i.e., after the crucial breakthrough to an industrial society had been made. During the transition to a market economy in the 1990s and 2000s the level of government contributions decreased somewhat in education, and more significantly in research and development, but its share in overall financing expanded. In education corporate funds were largely replaced by those from households. In health care, Russia is characterized by an increasing share of out-of-pocket payments of households and slow development of organized forms of nonstate financing. These trends reinforce obstacles to Russia's future transition, as regards institutional change toward a more significant and sound role of the corporate sector in such branches as R&D, health care, and, to a lesser extent, education.

Details

Research in Economic History
Type: Book
ISBN: 978-1-83909-179-7

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Book part
Publication date: 11 June 2009

Joseph Kutzin, Melitta Jakab and Sergey Shishkin

Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health

Abstract

Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.

Methodology/approach – The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.

Findings – The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.

Implications for policy – The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.

Details

Innovations in Health System Finance in Developing and Transitional Economies
Type: Book
ISBN: 978-1-84855-664-5

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Article
Publication date: 19 September 2018

Telma Zahirian Moghadam, Pouran Raeissi and Mehdi Jafari-Sirizi

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the…

Abstract

Purpose

Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran’s health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.

Design/methodology/approach

This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.

Findings

The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization’s report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people’s request to reduce health costs.

Research limitations/implications

The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.

Practical implications

The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.

Social implications

This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.

Originality/value

This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon’s model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study.

Details

International Journal of Human Rights in Healthcare, vol. 12 no. 2
Type: Research Article
ISSN: 2056-4902

Keywords

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