| |
|
|
|
|
|
| |
IHSP ACTIVITIES
Bolivia
Date of Project: 1998-2000
Key Contact: Thomas Bossert
Sponsors: USAID/LAC Health Sector Reform Initiative and USAID/La Paz
Collaborators: Ministry of Health and Abt Associates (in PHR Project)
Main Activities: Decentralization Applied Research Study Applied Research on decentralization of health system. Bolivia has an innovative recent
decentralization of investment and supply budgets to municipalities. The study is an analysis
of the degree of decentralization and its impact on system performance using the "Decision Space"
Methodology developed by DDM Project. It is part of a regional study of four countries: Chile,
Bolivia, Colombia, Nicaragua.
Key Results: Decentralization has been limited to funding supplies and equipment and
over time even this range of choice has been restricted by earmarking a percentage that had to
be assigned to Maternal and Child Health services. Decentralization has had no demonstrable
impact on changing indicators of equity, efficiency and quality of services. It has however,
increased local innovations and a sense of local control. Evaluation of Maternal and Child Insurance System Evaluation of quality and utilization issues in an evaluation of the new Insurance system.
The evaluation found an increase in utilization by the target population and a likely increase
in quality since the insurance funds supplies that are often not available. The evaluation also
included financing and costing evaluation as well as administrative requirements.
Key Results: The evaluation found significant revisions of financing and administrative processes would
improve the insurance system.
Related Publications:
Applied
Research on Decentralization of Health Care Systems in Latin America:
Bolivia Case Study
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas,
Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, June
2000
Decentralization
of Health Systems in Latin America: A Comparative Study of Chile, Colombia,
and Bolivia
Thomas Bossert, June 2000
English
Spanish
La Descentralización
de los Servicios de Salud en Bolivia
Thomas J. Bossert, Fernando Ruiz Mier, Scarlet Escalante, Marina Cardenas,
Bruno Guisani, Katherina Capra, Joel Beauvais, and Diana Bowser, junio
2000
Workshop Report -- Cost and Cost-Effectiveness of Health
Services, La Paz, Bolivia
Julia Walsh and David Anderso, May 9-11, 1995
Resource Mobilization
for the Health Sector in Bolivia
Marina Cárdenas Robles, Jorge A. Muñoz and Mukesh Chawla, July 1996
Popular Participation in Bolivia
Oleh Wolowyna
|
|
back to the top
|
| Chile
Date of Project: 1997-2000
Key Contact: Thomas Bossert
Sponsors: USAID/LAC Health Sector Reform Initiative
Collaborators: Graduate Faculty of Economics and Public Administration, University of
Chile and Ministry of Health
Main Activities: Decentralization Applied Research Study Applied Research on decentralization of health system. Chile has experienced the longest period
of recent decentralization in Latin America. This study is an analysis of the degree of
decentralization and its impact on system performance using the "Decision Space" Methodology
developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia,
Colombia and Nicaragua.
Key Results: Decentralization appears to increase inequality of primary health
expenditures per capita with richer municipalities spending three times the others. Despite
Chile's reputation of having a significant decentralization, the actual range of choice
("decision space") in Chile at the municipal level was quite limited and was reduced over time. Health Reform Policy Process Applied Research Study Applied Research on policy process of health reform in financing and insurance focusing on
ISAPREs. This research evaluates stakeholders, institutions and role of "change team" in
producing the health reforms that began in 1979. This study is part of a regional study of
three countries: Chile, Colombia, Mexico.
Key Results: Policy processes of developing a coalition of key actors in favor of
reforms through an formal and informal legislative process occurred even under the Pinochet
dictatorship. Key to success was a carefully recruited "change team" of like-minded technocrats
with significant political skills and located in the Ministry of Finance, Planning Office, and
other key ministries and supported by horizontal and vertical linkages to other important actors.
Related Publications:
Decentralization
and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas
Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana
Bowser, January 2003
Decentralization
of Health Systems in Latin America: A Comparative Study of Chile, Colombia,
and Bolivia
Thomas Bossert, June 2000
English
Spanish
Applied Research
on Decentralization of Health Systems in Latin America: Chile Case Study
Thomas J. Bossert, Osvaldo Larrañaga, Antonio Infante, Joel Beauvais,
Consuelo Espinosa, and Diana Bowser, June 2000
Enhancing
the Political Feasibility of Health Reform: The Chile Case
Alejandra
González-Rossetti,
Tomas Chuaqui and Consuelo Espinosa June 2000
Enhancing the Political
Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia,
and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Privatization and Payments
: Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
|
back to the top
|
|
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: DDM: USAID/LAC Health Sector Reform Initiative
Collaborators: Ministry of Health
Main Activities:
Decentralization Applied Research Study
Applied Research on decentralization of health system. Colombia may have one of the most
decentralized health system in Latin America. The study is an analysis of the degree of
decentralization and its impact on system performance using the "Decision Space" Methodology
developed by DDM Project. It is part of a regional study of four countries: Chile, Bolivia,
Colombia, and Nicaragua.
Health Reform Policy Process Applied Research Study
Applied Research on policy process of health reform of the Law 100 in 1993. This research
evaluates stakeholders, institutions and role of "change team" in producing the health reforms.
This study is part of a regional study of three countries: Chile, Colombia, Mexico.
Key Results:
Key to the success of the Colombian health reform (Law 100) was a
carefully recruited "change team" of like-minded technocrats with significant political skills
and located in the Ministry of Finance, National Planning Department, and other key ministries
and supported by horizontal and vertical linkages to other important actors.
Related Publications:
Decentralization
and Equity of Resource Allocation: Evidence from Colombia and Chile
Thomas
Bossert, Osvaldo Larranaga, Ursula Giedion, Jose Jesus Arbelaez, Diana
Bowser, January 2003
Enhancing the Political
Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia,
and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Applied
Research on Decentralization of Health Care Systems in Latin America: Colombia
Case Study
Thomas J. Bossert, Mukesh Chawla, Diana Bowser, Joel Beauvais, Ursula Giedion,
Jose Jesus Arbelaez,and Alvaro Lopez Villan, June 2000
Enhancing
the Political Feasibility of Health Reform: The Colombia Case (Final)
Alejandra González-Rossetti and Patricia Ramírez, June 2000
Enhancing
The Political Feasibility of Health Reform: The Colombia Case
Alejandra González-Rossetti and Patricia Ramírez, June 2000
Decentralization
of Health Systems in Latin America: A Comparative Study of Chile, Colombia,
and Bolivia
Thomas Bossert, June 2000
English
Spanish
Privatization and Payments
: Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
|
back to the top
|
|
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: World Bank and Caja de Seguro Social Costarricense
Collaborators: Caja de Seguro Social Costarricense
Main Activities:
Political feasibility of three options for reform of the Social Security System in Costa Rica
using the Policy Maker Software developed by Michael Reich at Harvard School of Public Health.
Key Results:
The Social Security System can consider the introduction of competition with private providers
but this option will require special additional strategies to gain sufficient support for
adoption and implementation. Options to continue and expand existing modernization programs
have sufficient support without major new strategies. |
back to the top
|
|
Date of Project: September 1993
Key Contact: Peter Berman
Sponsors:
DDM: 1994-1997
PHR: 1997-1998
Policy Project: 1999-2000
Collaborators: Ministry of Health and Population, Arab Republic of Egypt, and
American University of Cairo
Main Activities:
IHSP has been engaged in a wide range of activities in Egypt since 1994. Initially, under the DDM
project, we developed a three-year program with the Department of Planning, Ministry of Health
and Population to put in place a comprehensive information base for analysis of Egypt's health
and health care system problems and for the design of appropriate reform strategies. This program
included:
Based on this work, we facilitated several workshops with senior staff of the MOHP to discuss
and analyse health and health care system problems and strategies for Egypt. Our 1995 report
"Egypt: Strategies for Health Sector Change" was widely discussed and used by Egyptian and
international authorities.
In 1997, we collaborated with the new Minister of Health, Prof. Ismail Sallam, in applying the
data and analysis to the design of a reform strategy for primary care in Egypt. The process of
collaboration included intensive meetings with the Minister to review options, in-depth reviews
and discussions with a high-level working group in Egypt, and production of new policy strategy: "A Reform Strategy for Primary Care in Egypt". This strategy was adopted as official
government policy and became the basis for a major multi-donor program in Egypt.
At present, IHSP continues to work with the MOHP through the PHR project to develop the pilot
implementation of the new strategy in Alexandria. One of our staff is posted to the resident team
in Cairo and we continue to contribute to policy analysis as well as new work on quality
assurance.
In 1999, we initiated a new study in Egypt to estimate the total national expenditure on
population and reproductive health care services, based on the national health accounts
methodology. This study will be done in collaboration with American University of Cairo.
Key Results:
Related Publications:
The Relative Importance
of Price and Quality in Consumer Choice of Provider: The Case of Egypt
Winnie Yip and Aniceto Orbeta, September 1999
The Distribution of
Health Care Resources in Egypt: Implications for Equity An Analysis Using
A National Health Accounts Framework
Ravindra Rannan-Eliya, September 1999
Understanding the Supply
Side: A Conceptual Framework for Describing and Analyzing the Provision
of Health Care Services With an Application to Egypt
Peter Berman, September 1999
Perception of Health
Status and Limitations in Activities of Daily Living among the Egyptian
Elderly
A.K. Nandakumar, Maha El-Adawy, Marc A. Cohen, December 1998
Health Budget Tracking
System -- Egypt Phase II: Final Report
Gordon Cressman, July 2, 1998
25.1 Egypt National Health
Accounts 1994/95
Department of Planning/Ministry of Health, Egypt and Data for Decision
Making Project, October 15, 1997
Cost Analysis and Efficiency
Indicators for Health Care: Report Number 1 Summary Output for Bani Suef
General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision
Making, Harvard School of Public Health, University of California, Berkeley,
School of Public Health, January 1997
Cost Analysis and Efficiency
Indicators for Health Care: Report Number 2 Summary Output for Suez General
Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision
Making, Harvard School of Public Health, University of California, Berkeley,
School of Public Health, January 1997
Cost Analysis and Efficiency
Indicators for Health Care: Report Number 3 Summary Output for El Gamhuria
General Hospital, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision
Making, Harvard School of Public Health, University of California, Berkeley,
School of Public Health, January 1997
Cost Analysis and Efficiency
Indicators for Health Care: Report Number 4 Summary Output for 19 Primary
Health Care Facilities in Alexandria, Bani Suef and Suez, 1993-1994
Department of Planning, Ministry of Health and Population, Data for Decision
Making, Harvard School of Public Health, University of California, Berkeley,
School of Public Health, January 1997
Health Budget Tracking System -- Egypt Phase I: Software Guide
Gordon Cressman, October 1996
Health Budget Tracking
System -- Egypt Phase I: Final Report
Gordon Cressman and Mahmoud Abdel Latif, September 1996
National Health Accounts
of Egypt
Department of Planning/Ministry of Health, Egypt and Data for Decision
Making Project, October 20, 1995
Cuentas Nacionales
de Salud: El Caso de Egipto
El Departamento de Planification/Ministerio de Salud, Egipto y el Proyecto
Data Decision Making, 20 de Octubre de 1995
Egypt: Strategies for Health Sector Change
Peter Berman, Michael Reich, Julia Walsh, A.K. Nandakumar, Nancy Pollock,
Hassan Salah, Winnie Yip, Nihal Hafez and Ali Swelam, August 1995
Workshop Proceedings: First Health Budget Tracking System Workshop,
Cairo, Egypt, June 18-20, 1995
Gordon Cressman, Oleh Wolowyna (RTI) and Mahmoud Abdel Latif
Health Care Utilization
and Expenditures in the Arab Republic of Egypt
Department of Planning, Ministry of Health, Data for Decision Making,
Harvard School of Public Health, 1994-1995
Egypt Provider Survey
Report
Department of Planning, Ministry of Health, Data for Decision Making,
Harvard School of Public Health, 1994-1995
Health Budget Tracking System -- Phase I Pilot Study Results:
Bani Suef 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
Health Budget Tracking System -- Phase I Pilot Study Results:
Suez 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
School Health Insurance -- The Experience in Egypt: A Case Study
A.K. Nandakumar and Ali Swelam, 1995
Health Budget Tracking System -- Phase I Pilot Study Results:
Alexandria 1992/93
Gordon Cressman and Oleh Wolowyna, April 18, 1995
Workshop Report:
Using Cost-Effectiveness Analysis to Identify a Package of Priority Health
Interventions, Port Said, Egypt, January 8-13, 1995
Julia Walsh and Hassan Salah
Case Studies of Mosque
and Church Clinics in Cairo, Egypt
Priti Dave Sen, December 1994
Workshop Report: Using
Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions,
Ismailia, Egypt, July 3-7, 1994
Julia Walsh and Hassan Salah
Egypt: Health
Sector Brief
Dayl Donaldson, November 12, 1993
Health Budget Tracking
System: Classification of Health Expenditures by Function
Gordon Cressman and Mahmoud Abdel Latif |
back to the top
|
|
Date of Project: 1998
Key Contact: Peter Berman
Sponsors: Government of Estonia
Main Activities:
Providing technical assistance in the launching of Estonia's national health accounts study.
Main Results:
Ongoing activity. |
back to the top
|
Ghana
Date of Project:
Key Contact:
Sponsors:
Main Activities:
Main Results:
Related Publications:
Decentralization and the Health Logistics System Ghana
Thomas Bossert, Ph.D., Diana Bowser, M.P.H., Johnnie Amenyah, B.Pharm., MBA, Rebecca Copeland, M.S.P.H., July 30, 2004
Decentralization of health systems in
Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision
space
Thomas Bossert and Joel Beauvais, March 2002
Hospital Autonomy in Ghana: The Experience of Korle Bu and
Komfo Anokye Teaching Hospitals
Ramesh Govindaraj, A.A.D. Obuobi, N.K.A. Enyimayew, P. Antwi and S.
Ofosu-Amaah, August 1996
|
| back to the top |
Guatemala
Date of Project:
Key Contact:
Sponsors:
Main Activities:
Main Results:
Related Publications:
Guatemala: Decentralization and Integration in Health Logistics Systems
Thomas Bossert, Ph.D.,
Diana Bowser, M.P.H., Johnnie Amenyah,
Rebecca Copeland, Management and Technology in Health and Development Guatemala (GETSA) |
back to the top
|
|
Date of Project: 1998
Key Contact: Thomas Bossert
Sponsors: World Bank and Ministry of Health and Welfare, Hungary
Collaborators: Falso Pannon Region of Hungary
Main Activities:
Assist the Falso Pannon Regional Consoritum prepare a proposal for the World Bank Health
Service and Management Project, Health Service Delivery Modernization Subcomponent.
Key Results:
The report recommended that Hungary adopt an incentive program to reward municipalities which consolidated hospitals by
closing excess hospitals, experiment with optional payment mechanisms, develop uniform
information systems in accounting and medical records for a more effective DRG system,
strengthen the regulatory capacity at the county office, and develop strategic planning skills
in regional hosptials.
Related Publications: |
back to the top
|
India
Health System Reform Strategy for Andhra Pradesh State, India |
back to the top
|
|
Date of Project:1998-
Key Contact: Peter Berman
Sponsors: USAID/Kenya, Danish International Development Agency (DANIDA)
Collaborators: Department of Planning, Ministry of Health
Main Activities:
The purpose of this activity was to provide technical support to USAID/Kenya and the Government
of Kenya (GOK) to develop a set of national health accounts (NHA). Specifically, this NHA
initiative conducted the following activities:
1. Produced a set of NHA accounts and final report for Kenya, describing the sources and uses of
health care expenditures, which is a basic requirement for managing the allocation of health
sector resources, developing policies, and assessing the impact of policy interventions.
Information was disaggregated to illustrate the flow of funds from sources to financing agents.
Additional information was presented on the uses of expenditures according to provider type,
function and region.
2. Ensured that the NHA process is useful and sustainable in Kenya by:
- supporting a local NHA technical team composed of a cross-ministerial team in the GOK to
conduct the work; and,
- training the technical team and other collaborating partners in the
methodology (data collection, processing, and analysis), use of software, construction of
national health accounts matrices, and in the application of NHA results (e.g. secondary analyses,
policy implications, health sector reform strategies);
3. Disseminated NHA findings to Kenyan policy makers to promote national-level discussions of the
policy implications from the results of the NHA data and any associated analyses that have been
done and the conclusions drawn.
4. Provided technical advice on institutionalization of the NHA activity.
5. Coordinated the activities undertaken by the Kenya technical team with those of the larger
East and Southern Africa regional NHA initiative. The Kenyan technical team contributed their
country experiences to the content of the workshops and benefitted from the technical assistance
provided through its participation.
Key Results/Main Findings:
Related Publications:
Hospital Autonomy in Kenya: The Experience of Kenyatta
National Hospital
David H. Collins, Grace Njeru and Julius Meme, June 1996
Kenya: Non-Governmental Health Care Provision
Peter Berman, Kasirim Nwuke, Kara Hanson, Muthoni Kariuki, Karanja Mbugua,
Sam Ongayo and Tom Omurwa, April 1995
Conference Report -- Private and Non-Governmental Providers:
Partners for Public Health in Nairobi, Kenya, November 28, 1994 -
December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya and Joseph
Rittmann
Conference Report Summaries: Private Providers Contributions
to Public Health in Four African Countries, Nairobi, Kenya, November 28,
1994 - December 1, 1994
Gerald Hursh-Cesar, Peter Berman, Kara Hanson, Ravi Rannan-Eliya, Joseph Rittmann
and Kristen Purdy
|
back to the top
|
Kosovo
Date of Project:
Key Contact:
Sponsors:
Main Activities:
Main Results:
Related Publications:
|
back to the top
|
Malaysia
Date of Project: 2001-present
Key Contact: Peter Berman
Sponsors: UNDP/Govt. of Malaysia
Collaborators: Ministry of Health
Main Activities: Technical assistance in the development of National Health Accounts in Malaysia
Key Results: Project ongoing
Related Publications: |
back to the top
|
|
Date of Project: 1998-2000
Key Contact: Thomas Bossert
Sponsors: USAID/LAC Health Sector Reform Initiative
Collaborators: Ministry of Health
Main Activities:Health Reform Policy Process Applied Research Study
Applied Research on policy process of health reform of the Social Security System. This
research evaluates stakeholders, institutions and role of "change team" in producing the health
reforms. This study is part of a regional study of three countries: Chile, Colombia, Mexico.
Key Results:
The failure to develop a full multi-institutional like-minded "change team" with horizontal
and vertical linkages to other key actors has resulted in frustrated attempts at reform in
Mexico.
Related Publications:
Enhancing the Political
Feasibility of Health Reform: A Comparative Analysis of Chile, Colombia,
and Mexico
Alejandra González-Rossetti and Thomas Bossert, June 2000
English
Spanish
Enhancing
the Political Feasibility of Health Reform: The Mexico Case
Alejandra González-Rossetti and Olivia Mogollon, June 2000
|
back to the top
|
Morocco
Date of Project:
Key Contact:
Sponsors:
Main Activities:
Main Results:
Related Publications:
Exploratory Study of Social Capital and Social Programs in Morocco
Thomas Bossert, Diana Bowser, Volkan Cakir, Andrew Mitchell, Final DRAFT May 2003
Proposal for Decentralization of Health System in Morocco
Thomas
Bossert, March 2001 |
back to the top
|
Nicaragua
Date of Project:
Key Contact:
Sponsors:
Main Activities:
Main Results:
Related Publications:
Building Social Capital through Human Capital Development Programs in
Rural Nicaragua: An Evaluation of MSH Management and Leadership Programs in Waslala and
Pantasma
Nancy
Brune, Thomas Bossert, Diana Bowser, August 2005
English
Spanish
Construyendo Capital Social a través de Programas de Desarrollo de Capital Humano en Áreas Rurales de Nicaragua Una evaluación del Programa de Gerencia y Liderazgo en Waslala y Pantasma
Nancy Brune, Thomas Bossert, Diana Bowser, Freddy Solis, Agosto 2005
Social Capital and Health in Nicaraguan Communities
Thomas Bossert, Nancy Brune, Diana Bowser, Freddy Solis, December 2003 Capital Social y Salud en Comunidades de Nicaragua
Thomas Bossert, Nancy Brune, Diana Bowser, Freddy Solis, Diciembre 2003
Studies of Decentralization of the
Health System in Nicaragua: Final Report
Thomas Bossert, Diana Bowser, Leonor Corea, September 2001
English
Spanish
|
back to the top
|
Nigeria
HIV/AIDS and Health Expenditures in Nigeria
|
back to the top
|
|
Date of Project:1995-2000
Key Contact: Paul Campbell
Sponsors: DDM/USAID Mission
Collaborators: Jagiellonian University Foundation for Public Health
Main Activities:
The Consortium's activities have centered on policy and management issues in the areas which
the Polish Ministry of Health has structured health sector reform. These areas focus on the
decentralization of the central government controlling the entire scope of health care and the
creation of sixteen regional insurance funds, having these new regional funds contract with both
public and private providers, and providing market-like incentives for improving health care.
The Consortium is facilitating their implementation by:
- Being involved with the policy-making processWorking with local governments to develop and test models of health delivery
- Increasing managerial capacity
Key Results
The projects, workshops, trainings and other activities conducted by the Consortium since it's
inception in late 1995, have produced the following results:
- Completion of Poland's first application of market research methods
(focus groups and patient surveys)
at the health facility level.
- Facilitated the rapid spread of the practice of provider contracts across the country
through conferences and training programs
- Developed and implemented new approaches for quality monitoring of
gmina-managed
outpatient services
- Assisted with the establishment of the nation's first truly private non-profit hospital
of the post-communist period
- Completed a successful city-wide experiment with public relations related to health
sector reform
- Assisted Krakow city officials with the design and implementation of significant reforms
leading to a documented increase in consumer satisfaction levels
Related Publications
Unpredictable Politics:
Policy Process of Health Reform in Poland
Thomas Bossert and Cesary Wlodarczyk, January 2000
Public Relations and
Health Sector Reform: The Experience in Poland
Paul Campbell, Andrzej Rys, and Witoslaw Stepien, June 2000
Privatization and Payments
: Lessons for Poland from Chile and Colombia
Tom Bossert, March 2000
The Impact of Economic
and Demographic Factors on Government Health Expenditure in Poland
Mukesh Chawla, Dorota Kawiorska, and G. Chellaraj
Provision of Ambulatory
Health Services in Poland: A Case Study from Krakow
Mukesh Chawla, Peter Berman, Adam Windak, and Marzena Kulis
Quality of Outpatient Services,
Krakow Gmina
Ann G. Lawthers and Bogdan S. Rózanski, May 1998
Health Care Options for Polish Municipalities:
The Implications of International Experience
Marc Roberts and Thomas Bossert
Notes on Health Sector Reform in Poland
Peter Berman, Andrzej Rys, Thomas Bossert, and Paul Campbell
Innovations in Provider Payment
Systems in Transitional Economies: Experience in Suwalki, Poland
Mukesh Chawla, Peter Berman, and Dariusz Dudarewicz, May 1998
National Health Insurance in Poland: A Coach without Horses?
Peter Berman, April 1998
Enrollment Procedures
and Self-selection By Patients: Evidence From A Family Practice in Krakow,
Poland
Mukesh Chawla, Tomasz Tomasik, Marzena Kulis, Adam Windak, and Deirdre
A. Rogers, April 1998
Poland Health Policy: Democracy and Governance At Local Levels
In International Perspective
Thomas Bossert
Financing Health Services in Poland:
New Evidence on Private Expenditures
Mukesh Chawla, Peter Berman, and Dorota Kawiorska
Enrollment Procedures and
Self-Selection By Patients: Evidence From A Family Practice in Krakow, Poland
Mukesh Chawla, Tomasz Tomasik, Marzena Kulis, Adam Windak, and Deirdre A. Rogers
Economics of A Family Practice in
Krakow
Mukesh Chawla, Tomaz Tomasik, Marzena Kulis, and Adam Windak, July 199769. Physician Contracting in Suwalki
Dariusz Dudarewicz and Mukesh Chawla, February 1997 |
back to the top
|
Thailand
Date of Project:1998
Key Contact: Winnie Yip
Sponsors: USAID
Collaborators: Chulongkorn University in Thailand
Main Activities:
The objective of the MAR/Provider Payment Project in Thailand is to examine
the impact of capitation payment on system performance. In particular, the
study aims to answer the following three questions:
- What is the impact of capitation payment on resource allocation between
primary and secondary/tertiary services?
- What is the impact of capitation on organizational and/or internal
management changes adopted to increase efficient provision of services (or
risk selection)?
- What is the impact of capitation on networking building and contracting
practices between primary and tertiary care providers, and between public
and private providers, and their implications on market structure and market
competition?
The study will empirically examine the experience
of the Social Security Scheme, which is a social insurance scheme that
covers employees of enterprises. The scheme pays contract hospitals by
capitation and covers general and specialist outpatient care,
hospitalization, drugs and prescriptions, ambulance and transportation
services, and ancillary services. This study is one component of the provider payment
study which includes 3 countries, the other two are Argentina and Nicaragua.
Key Results:
Findings from the study are expected to generate useful lessons for the host
country, such as reforming provider payment of other insurance schemes, e.g.
the Civil Servant Scheme and the health card scheme; building a more primary
care-based health system; and understanding the market process of
public/private competition. |
back to the top
|
Turkey
Developing National Health Accounts in Turkey |
back to the top
|
Zambia
Date of Project:1999-2001
Key Contact: Thomas Bossert
Sponsors: PHR Major Applied Research Project and USAID/Lusaka
Collaborators: Ministry of Health and Abt Associates (in ZIHP Project)
Main Activities:
Applied Research on decentralization of health system. Zambia has an innovative recent
decentralization to district levels of the Ministry of Health. The study is an analysis of the
degree of decentralization and its impact on system performance using the "Decision Space"
Methodology developed by DDM Project and modified by the PHR Applied Research team. It will be
compared to the LAC regional study of four countries: Chile, Bolivia, Colombia, and Nicaragua.
Key Results:
It is too soon to have any significant results from the study.
Related Publications:
Decentralization of health systems in Ghana, Zambia, Uganda
and the Philippines: a comparative analysis of decision space
Thomas Bossert and Joel Beauvais, March 2002
Decentralization
of the Health System in Zambia
Thomas J. Bossert, Mukosha Bona Chitah, Maryse Simonet, Ladslous
Mwansa, Maureen Daura, Musa Mabandhala, Diana Bowser, Joseph Sevilla,
Joel Beauvais, Gloria Silondwa, and Munalinga Simatele, December
2000
Decentralization of Health Systems:
Decision Space, Innovation and Performance
Tom Bossert, March 1997
Proceedings of Zambia
National Conference on Public/Private Partnership for Health, Siavonga,
Zambia, June 8-11, 1995
Kasirim Nwuke and Abraham Bekele
Zambia: Non-Governmental
Health Care Provision
Peter Berman, Kasirim Nwuke, Ravindra Rannan-Eliya and Allast Mwanza,
January 12, 1995 |
back to the top
|
LAC NHA Network
Bolivia, Ecuador, and Guatemala were countries we worked with directly. Mexico was a
regional resource center. Nicaragua, Dominican Republic, and El Salvador were directly supported
by PAHO. Peru joined with their own resources.
Date of Project: 1997-
Key Contact: Peter Berman
Sponsors:
USAID, Latin America and Caribbean Equitable Access Initiative through the Partnerships
for Health Reform Project and the Pan American Health Organization
Collaborators.
Main Activities:
Using the National Health Accounts methodology developed by IHSP through the Data for Decision
Making Project, each country team participated in a regional network to develop their own
national health accounts study and to allow comparative analysis and learning across countries in the region. The country team conducted data collection
and analysis. The PHR project and PAHO organized three regional network meetings for training,
exchange of preliminary and final results, and policy discussions. Technical assistance was
provided to each country in addition to the workshops through country visits of experts and
through participation in national workshops to review results. |
back to the top
|
|
Zimbabwe
Kenya
India
Indonesia
Ghana
Date of Project: 1995-
Key Contact: Peter Berman
Sponsors:
USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through
the Data for Decision Making Project Collaborators
Main Activities:
Based on a common methodology (Chawla et al report on Methodological Guidelines), a national
research team carried out a study of the objectives, implementation, and results of efforts to
make public hospitals more autonomous. The study assessed the degree of autonomy intended and
achieved across several different dimensions. The effects of autonomy effort were also analysed
in terms of the financial condition of the institition and changes in technical efficiency,
quality of care, equity in use, and community perceptions.
Key Results:
These case-studies suggest that success with autonomy in public sector
hospitals in developing countries has been limited, and there have been few gains in terms of
efficiency, quality of care, and public accountability. We have drawn on the lessons learned from
these studies to advance several testable hypotheses regarding the conceptualization and
implementation of hospital autonomy. In general, we have argued that it is as much the confused
and erroneous ideas of autonomy, as the poor implementation of the autonomy measures, that have
been responsible for the relative lack of success of the autonomy initiative. However, an
important caveat is in order. Given the limited sample size of this study, and the fact that in
many of the countries hospital autonomy is a relatively new concept, the findings of our research
must be viewed as preliminary. In our opinion, therefore, further inquiry into the issue of
autonomy in public sector hospitals is a research imperative.
A report comparing the results of all five country case studies was produced,
(DDM No-32.2. Recent Experiences with Hospital Autonomy in Developing Countries -- What Can We Learn?) and a set of implementation guidelines for future hospital autonomy efforts was developed.
Results were reviewed and discussed at two regional workshops: Zimbabwe and Senegal
|
back to the top
|
|
Zimbabwe
Senegal
Bolivia
Sri Lanka
Cote D'Ivoire
Date of Project: 1995-
Key Contact: Peter Berman
Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through the Data
for Decision Making Project Collaborators
Main Activities:
Based on a common methodology (Chawla et al report on Methodological Guidelines), a national
research team studied the contributions of different sources of finance to total national health
expenditures in the country and how this has changed over time and in response to new health
finance policy initiatives such as user charges and health insurance.
Key Results:
These case-studies suggest that although governments often make decisions about individual
resource mobilization methods, such as user fees or the level of general revenue financing, they
rarely think in terms of a strategy of health financing that considers the overall mix of
methods, their interaction with one another, and their linkages with other components of the
health care system. Therefore, the success of even individual methods has been
limited in terms of contributions to resources, efficiency, equity and quality of care, even if
they have been well thought out and implemented. At the same time, a common weakness has been a
tendency on the part of most governments to ignore the role of household spending at private
providers in financing health services. On the more positive side, our studies show that where it
has been possible, private and community initiatives have succeeded in raising funding in the
health sector.
A comparative analysis of the five country studies was prepared, (DDM No. 31.2. Experiences with Resource Mobilization Strategies in Five Developing Countries: What Can We Learn?) Results were review and discussed at two regional workshops: Zimbabwe and Senegal |
back to the top
|
Managed Care
Zimbabwe
Date of Project:1998-2000
Key Contact: Paul Campbell
Sponsors: U.S. Agency for International Development/ DDM
Collaborators: Cimas Medical Aid Society
Main Activities:
The managed care project in Zimbabwe has been in operation for
just over a year. The team has consisted of Karen Quigley, Arlen Collins
and Claudia Corra, as well as Paul Campbell.
We have worked with Cimas, one of the two largest medical aid
societies operating in Zimbabwe, as well as the National Association of
Medical Aid Societies (NAMAS). Cimas serves the private sector and covers
4-5 hundred thousand lives. (Less than a million of Zimbabwe's 12
million total population is covered by private insurance).
Zimbabwe is under great economic stress. The medical aid
societies are fighting for their economic lives as revenue is constricted
and costs spiral out of control in large part due to foreign currency
problems. Medical aid society failure will only intensify Zimbabwe's
current health care crisis.
Key Results:
Economic pressures are forcing the medical aid societies to
re-engineer their relationships with providers. Our technical assistance
focuses upon these relationships. Under our guidance Cimas has hired the
first ever (in Zimbabwe) medical director, and begun to alter the way it
interacts with doctors and consumers. Co-payments have been introduced.
A new program to strengthen the role of primary care providers is about to
be initiated.
We have provided a series of workshops in Zimbabwe on managed care
for providers. Next October we will offer a seminar for small medical aid
societies. We will also produce a Guidebook on managed care that can be
used after our departure. No doubt we will have greatly facilitated the
transition in Zimbabwe to managed care, but the rapid adoption of managed
care concepts and tools will be primarily caused by the adverse
economic conditions rather than our project. |
back to the top
|
CEE Network
Poland
Czech Republic
Hungary
Romania
Out of Pocket Payments and Informal Payments for Health in Middle Income European Countries |
back to the top
|
|
Kenya
Zambia
Date of Project: 1993-
Key Contact: Peter Berman
Sponsors: USAID, Health and Human Resources Analysis for Africa (HHRAA) Project through
the Data for Decision Making Project
Collaborators:
Main Activities:
Based on a common methodology (DDM No. 9. Berman and Hanson methodology for private sector assessment), a
national research team studied the numbers and composition of the private health care provider
sector. The assessment included developing a typology of private health care providers, including
hospitals, ambulatory care providers, and informal and traditional practicioners. Estimates were
developed of the shares in national health expenditures accounted for by private providers and of
the volume and types of services delivered and how they were distributed in the population
according to urban and rural areas and socio-economic distribution.
Key Results:
The results of the country case studies were combined with related work in Tanzania and Senegal
and disseminated at a regional conference in Nairobi.
(DDM No. 21.1. Conference Report Summaries: Private Providers Contributions to Public Health in Four African
Countries, Nairobi, Kenya, November 28, 1994 - December 1, 1994.) |
back to the top
|
|
