Abstract:
:Community-based health insurance (CBHI) has gained popularity in many low- and middle-income countries, partly as a policy response to calls for low-cost, pro-poor health financing solutions. In Africa, Rwanda has successfully implemented two types of CBHI systems since 2005, one of which with a flat rate premium (2005-10) and the other with a stratified premium (2011-present). Existing CBHI evaluations have, however, tended to ignore the potential distributional aspects of the household contributions made towards CBHI. In this paper, we investigate the pattern of socioeconomic inequality in CBHI household premium contributions in Rwanda within the implementation periods. We also assess gender differences in CBHI contributions. Using the 2010/11 and 2013/14 rounds of national survey data, we quantify the magnitude of inequality in CBHI payments, decompose the concentration index of inequality, calculate Kakwani indices and implement unconditional quantile regression decomposition to assess gender differences in CBHI expenditure. We find that the CBHI with stratified premiums is less regressive than CBHI with a flat rate premium system. Decomposition analysis indicates that income and CBHI stratification explain a large share of the inequality in CBHI payments. With respect to gender, female-headed households make lower contributions towards CBHI expenditure, compared with male-headed households. In terms of policy implications, the results suggest that there may be a need for increasing the premium bracket for the wealthier households, as well as for the provision of more subsidies to vulnerable households.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Chirwa GC,Suhrcke M,Moreno-Serra Rdoi
10.1093/heapol/czaa135subject
Has Abstractpub_date
2020-12-02 00:00:00eissn
0268-1080issn
1460-2237pii
6017195pub_type
杂志文章abstract::Public sector price analyses of antiretroviral (ARV) medicines can provide relevant information to detect ARV procurement procedures that do not obtain competitive market prices. Price benchmarks provide a useful tool for programme managers and policy makers to support such planning and policy measures. The aim of the...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs011
更新日期:2012-12-01 00:00:00
abstract::Caesarean section rates have been increasing worldwide, raising the question of the appropriateness of the selection of cases for the procedure. This paper examines the levels and correlates of delivery-related complications and caesarean section deliveries in 18 selected states of India in terms of specific maternal ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/17.1.90
更新日期:2002-03-01 00:00:00
abstract::BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aim...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr012
更新日期:2012-01-01 00:00:00
abstract::In many developing countries people are expected to contribute to the cost of health care from their own pockets. As a result, people's ability to pay (ATP) for health care, or the affordability of health care, has become a critical policy issue in developing countries, and a particularly urgent issue where households...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/11.3.219
更新日期:1996-09-01 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::During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective impleme...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czu017
更新日期:2015-05-01 00:00:00
abstract::Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs106
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Many clients of HIV care and treatment services have unmet contraceptive needs. Integrating family planning (FP) services into HIV services is an increasingly utilized strategy for meeting those unmet needs. However, numerous models for services integration are potentially applicable for clients with diverse...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt043
更新日期:2014-08-01 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::Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv053
更新日期:2016-03-01 00:00:00
abstract::In August 2003, the Ghanaian Government made history by implementing the first National Health Insurance System (NHIS) in sub-Saharan Africa. Within 2 years, over one-third of the country had voluntarily enrolled in the NHIS. To discourage households from selectively enrolling their sickest (high-risk) members, the NH...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr057
更新日期:2012-08-01 00:00:00
abstract::Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this lit...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czw123
更新日期:2017-03-01 00:00:00
abstract::Neonatal deaths account for about half of all deaths among children under 5 years of age in Bangladesh, making prevention a major priority. This paper reports on a study of neonatal deaths in 12 areas of Bangladesh served by a large NGO programme, which had high coverage of reproductive health outreach services and re...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czl024
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt073
更新日期:2014-10-01 00:00:00
abstract::This paper provides guidance on how to do a stakeholder analysis, whether the aim is to conduct a policy analysis, predict policy development, implement a specific policy or project, or obtain an organizational advantage in one's dealings with other stakeholders. Using lessons learned from an analysis of alcohol polic...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/15.3.338
更新日期:2000-09-01 00:00:00
abstract::This article aims to describe the inappropriate use of medicines in the Brazilian urban population and to identify associated factors. We conducted a data analysis of a household survey carried out in Brazil in 2013-14. The sampling plan was done by clusters with representativeness of the urban population and large re...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czz038
更新日期:2019-12-01 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::It is well known that cardiovascular diseases (CVD) are a growing cause of mortality and morbidity in low-and middle-income countries (LMIC). While hypertension (HTN), a leading risk factor for CVD, can be easily managed with widely available medicines, there is a huge gap in treatment for HTN in many LMIC. One such c...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw080
更新日期:2016-12-01 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::Approximately 900 000 newborn children die every year in India, accounting for 28% of neonatal deaths globally. In 2011, India introduced a home-based newborn care (HBNC) package to be delivered by community health workers across rural areas. We estimate the disease and economic burden that could be averted by scaling...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv113
更新日期:2016-06-01 00:00:00
abstract::In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provide...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa015
更新日期:2020-07-01 00:00:00
abstract::The end of the Cold War brought with it opportunities to resolve a number of conflicts around the world, including those in Angola, Cambodia, El Salvador and Mozambique. International political efforts to negotiate peace in these countries were accompanied by significant aid programmes ostensibly designed to redress t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/14.3.229
更新日期:1999-09-01 00:00:00
abstract:Background:Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. Methods:We used an interrupted time-series design, including a con...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx034
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Lebanon, characterized by a free-market health care system, has one of the highest reported per capita rates of cardiac catheterization facilities and coronary angiographies in the world. The aim of this study is to evaluate the appropriateness of performance of coronary angiography procedures in Lebanon. M...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czn005
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private provider...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czp065
更新日期:2010-07-01 00:00:00
abstract::Increasingly, low- and middle-income countries are looking to community-based health insurance (CBHI) as a means of ensuring access to health care for the poor. However, little evidence exists about the determining factors that affect poor individuals' insurance decisions. This article reviews the economic and social ...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czh050
更新日期:2004-11-01 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::Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexu...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.1.84
更新日期:1996-03-01 00:00:00
abstract::This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of o...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/13.3.311
更新日期:1998-09-01 00:00:00
abstract::The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case s...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/17.suppl_1.40
更新日期:2002-12-01 00:00:00