Measurements, assessments and alternatives to improve equity and performance of health financing systems: Essays on low- and middle-income countries with a focus on Argentina.

摘要

One of the major objectives of this thesis is to contribute to the understanding of the direct and indirect effects of the health financing system on equity, financial risk protection and performance of the health system. We examine low- and middle income countries, with a focus on Argentina.;This thesis is divided into two main parts and comprises six self-contained research papers, each with its own set of findings and conclusions. One of the reasons behind the division of this thesis into Parts I and II is the fact that countries at different levels of development face different challenges, and the health system is no exception. Consequently, we can group together specific problems encountered by low-, middle- and high-income counties, respectively. As discussed by Gottret and Schieber (2006), the focus of most middle-income countries is currently on the performance of health systems, including an equitable resource mobilization and use of health care services, financial risk protection and universal coverage by consolidating multiple risk pools within a common framework. These are the issues we investigate in Part I, as applied to the particular case of Argentina as a middle-income country. Chapters II to IV focus on: performance of health financing functions, equity in financing and utilization and financial risk protection. Finally, Chapter V investigates and proposes different ways to move towards universal coverage.;Most low-income countries are being challenged to provide essential health care services to their population with the meagre funds they have. Indeed, without a substantial increase in external assistance, the reach of the Millennium Development Goals (MDGs) is highly unlikely. Therefore, two of the most important issues in most low-income and some middle-income countries, are how to raise the funding needed (including donor funding) and how this money should be used to improve health outcomes and meet the MDGs. Part II examines some of these issues through its two chapters, which focus on comparative analysis across countries. In particular, Chapters VI and VII discuss specific health system and financing issues faced by aid-dependent countries and those seeking to attain the MDGs.