Abstract:
:National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Tangcharoensathien V,Laixuthai A,Vasavit J,Tantigate NA,Prajuabmoh-Ruffolo W,Vimolkit D,Lertiendumrong Jdoi
10.1093/heapol/14.4.342subject
Has Abstractpub_date
1999-12-01 00:00:00pages
342-53issue
4eissn
0268-1080issn
1460-2237journal_volume
14pub_type
杂志文章abstract::Evidence suggests that a regular and reliable transfer of cash to households with orphaned and vulnerable children has a strong and positive effect on child outcomes. However, conditional cash transfers are considered by some as particularly intrusive and the question on whether or not to apply conditions to cash tran...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt060
更新日期:2014-10-01 00:00:00
abstract::In 1998 Bangladesh began a sector wide approach (SWAp) to the extension of health care to vulnerable groups in the country. The central feature of this approach is the funding of an essential service package (ESP) emphasizing maternal care, certain communicable diseases and child health. This study examines the way in...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/17.3.247
更新日期:2002-09-01 00:00:00
abstract::It has been argued that targeting delivery of anthelmintics to school-children by taking advantage of the existing education infrastructure and administrative system can be one of the most cost-effective approaches in minimizing the intensity of infections with both schistosomiasis and major intestinal nematodes in ma...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/13.4.384
更新日期:1998-12-01 00:00:00
abstract::There is a large body of evidence that user fees in the health sector create exclusion. Health equity funds attempt to improve access to health care services for the poorest by paying the provider on their behalf. This paper reviews four hospital-based health equity funds in Cambodia and draws lessons for future opera...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czm015
更新日期:2007-07-01 00:00:00
abstract:INTRODUCTION:Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health ser...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czu043
更新日期:2015-06-01 00:00:00
abstract::Cambodia's healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal....
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czz011
更新日期:2019-10-01 00:00:00
abstract::Most government health facilities in Cambodia perform poorly, due to lack of funds, inadequate management and inefficient use of resources, but mostly due to poor motivation of staff. This paper describes contracting as a possible tool for Ministries of Health to improve health service delivery more rapidly than the m...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/18.1.74
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVES:The Global Alliance for Vaccines and Immunization (GAVI) anticipated that growing demand for new vaccines could sufficiently impact the vaccines market to allow low-income countries (LICs) to self-finance new vaccines. But the time required to lower vaccine prices was underestimated and the amount that price...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czs123
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:To estimate the cost-effectiveness of introducing hepatitis B vaccine into routine infant immunization services in Mozambique, which took place in the year 2001. METHODS:A decision analytic model was used to estimate the impact of hepatitis B vaccination. This model was developed for the WHO to estimate the ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czi006
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czi055
更新日期:2005-12-01 00:00:00
abstract::The number of medical students trained in Nepal each year has increased nearly fifty-fold in the last 15 years, primarily through the creation of private medical schools. It is unknown where this expanding cohort of new physicians will ultimately practice. We distributed an anonymous survey to students in their last 2...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr052
更新日期:2012-08-01 00:00:00
abstract::User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria's medical pluralism. We found complex utilization patterns for conventional, complementary and a...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx131
更新日期:2018-01-01 00:00:00
abstract::During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria sugg...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/9.4.371
更新日期:1994-12-01 00:00:00
abstract::The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility d...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czy058
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Health insurance premium exemptions for pregnant women are a strategy to increase coverage of maternal health services in sub-Saharan countries. We examine health insurance registration among pregnant women before or after the introduction of a premium exemption, and test whether registration increases utili...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt086
更新日期:2014-12-01 00:00:00
abstract::The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs037
更新日期:2012-05-01 00:00:00
abstract::This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the an...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs014
更新日期:2012-12-01 00:00:00
abstract::Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa023
更新日期:2020-07-01 00:00:00
abstract::Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health worker...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa167
更新日期:2020-12-22 00:00:00
abstract:BACKGROUND:One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. METHODS:The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing funct...
journal_title:Health policy and planning
pub_type: 杂志文章,随机对照试验
doi:10.1093/heapol/czv078
更新日期:2016-05-01 00:00:00
abstract::Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw147
更新日期:2017-05-01 00:00:00
abstract::Performance-Based Financing (PBF) is a promising approach to improve health system performance in developing countries, but there are concerns that it may inadequately address inequalities in access to care. Incentives for reaching the poor may prove beneficial, but evidence remains limited. We evaluated a system of t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv130
更新日期:2016-07-01 00:00:00
abstract::The 1993 World Development Report is proving to be an influential document for the development of the health sector policies in developing countries. One important aspect of the Report concerns its proposals for Disability Adjusted Life Years as a measure of health change and hence effectiveness of interventions. This...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.2.179
更新日期:1996-06-01 00:00:00
abstract::Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries. Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects. However, there is a gap in the literature on population-wide effects of cash transfers...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa079
更新日期:2020-11-20 00:00:00
abstract:Background:Previous literature suggests that increasing numbers of development aid donors can reduce aid effectiveness but this has not been tested in the health sector, which has experienced substantial recent growth in aid volume and number of donors. Methods:Based on annual data for 1995-2010 on 139 low- and middle...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw164
更新日期:2017-05-01 00:00:00
abstract::Almost all sub-Saharan countries have adopted cost-reduction policies to facilitate access to health care. However, several studies underline the reimbursement delays experienced by health facilities, which lead to deficient implementation of these policies. In April 2016, for its free care policy, Burkina Faso shifte...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa039
更新日期:2020-08-01 00:00:00
abstract::As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to dire...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx165
更新日期:2018-02-01 00:00:00
abstract::This paper explores the nature and type of policy transfer promoted by global health partnerships to facilitate access to medication in Cameroon and the associated implementation challenges. Using concepts from policy transfer, multi-level governance and the politics of scale, the paper conceptualizes the social space...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czq018
更新日期:2011-01-01 00:00:00
abstract::'One World, One Health' has become a key rallying theme for the integration of public health and animal health priorities, particularly in the governance of pandemic-scale zoonotic infectious disease threats. However, the policy challenges of integrating public health and animal health priorities in the context of tra...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu001
更新日期:2015-03-01 00:00:00
abstract::Indonesia has seen an emergence of local health care financing schemes over the last decade, implemented and operated by district governments. Often motivated by the local political context and characterized by a large degree of heterogeneity in scope and design, the common objective of the district schemes is to addr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw101
更新日期:2017-02-01 00:00:00