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Getting
Health Reform Right: A Guide to Improving Performance and Equity
by Marc Roberts, William Hsiao,
Peter Berman and Michael Reich
"New Book Demonstrates Lessons and Challenges of Redesigning
Health Care Systems in Different Countries" (click
here
to read book description.)
"Flagship
Course Draws International Group of Senior-level Health Care Policymakers"
(click
here
to read article.)
Course
Background
The Flagship Course on Health Sector Reform and Sustainable
Financing is a joint offering of the Harvard School of Public Health
and the World Bank Institute, and has been redesigned following
it's initial offering in 1997. The Flagship Course introduces a
practical and comprehensive framework for understanding health systems
and their performance and a structured approach to developing health
system reform policies to improve that performance. Specific course
modules examine the theoretical and empirical basis for reform strategies
in such diverse areas as health financing, payment systems, organizational
change, regulation, and population and provider behavior, making
extensive use of case materials from countries in all regions and
at all levels of development. The course will also examine the issue
of gender and health and looks at gender gaps in service delivery
and how it affects health outcomes.
The Flagship Course continues to contribute to the World Bank Institute's
broader Flagship program, which involves partner institutions throughout
the world. Since its inception, this program has reached more than
4,700 participants from 56 countries, with more than 80 percent
of training provided by Flagship regional partner institutes in
developing countries.
Learning
Objectives
The principal goal of the Flagship Course is to provide intensive,
state-of-the-art knowledge and training on options for health sector
development, including lessons learned and best practices from country
experience. The Flagship course is targeted to mid-career, senior-level
decision-makers and managers who are actively involved in planning
or directing; government-initiated health sector reforms; compulsory
social health insurance programs; private-voluntary or private sector
initiatives, and developing country training programs in health
sector reform and sustainable financing. Enrollment is also open
to staff from the World Bank and donor agencies. The course is dedicated
to the development of national capacities through dissemination
of knowledge and training. Country teams of 3-4 members are strongly
encouraged to apply as the aim of the course is to build the capacity
of a critical mass who could become agents of change in their country.
The Course will enable participants to:
- Speak
a "common language" about dimensions of health sector reform and
achieve deeper understanding of heath finance issues and sustainable
financing options;
- Situate
their health systems within a taxonomy of health systems according
to structural, financial, and functional characteristics;
- Assess
how well their national health systems perform according to explicit
criteria including health status, financial protection, patient
satisfaction, efficiency, and sustainability.
- Determine
alternate paths their national health systems could take, and
why it would be desirable to pursue some paths over others;
- Understand
how to move their national health system from its current state
to a desired future state; and
- erstand
how to select and apply tools and procedures to make desired changes
and to assess their effects.
Flagship
Core Course
Development and revision of the learning materials is a continuous
process with additional materials including new country case studies
being prepared for future courses.
The Core Course includes the following major topics:
- Analyzing
Health Sector Performance
Ethics, politics and economics all influence how health systems
work and how they are judged. This section introduces a framework
of ultimate and intermediate health system outcomes, explores
their philosophical and analytical bases, and shows how to apply
them in a systematic diagnosis of health system problems, causes,
and solutions. It also provides an understanding of how markets
in general operate and what they can achieve, and how markets
for health care and health insurance differ from other markets.
- Health
Sector Reform, Poverty Alleviation and Priority Health Interventions
The Millenium Development Goals call for special attention to
poverty and specific priority health outcomes. The course examines
how these goals can influence strategies for health reform and
how health reform can be designed better to achieve these goals.
The linkage between health reform and the PRSP process and new
disease control priorities will be discussed.
- Strategies
for Financing and Paying for Health Care
The sources of funds to pay for health care include taxes, obligatory
insurance, voluntary insurance and out-of-pocket payment. Different
sources have different implications for health system goals, which
depend also on how resources are pooled and channeled through
funding institutions. Government has a crucial role both in raising
funds through taxes and social security, and in regulating public
and private insurance. The course examines the four main types
of financing strategies- the pros and cons of each, and the conditions
necessary to implement each of them.
- Designing
Benefit Packages and Targeting Beneficiaries
There are several criteria for choosing which health services
to offer or finance. Course participants will learn to analyze
this important decision with emphasis on cost-effectiveness of
interventions. It covers the composition and costing of a package
of services, in relation to health status, demand and capacity
to pay, as well as the criteria and mechanisms for targeting publicly
subsidized care to particular groups of beneficiaries.
- Paying,
Contracting, and Regulating Providers
How providers of health care are remunerated affects who produces
what, how much it costs, and who benefits, because different payment
mechanisms have distinct economic incentives and consequences
for performance. Remuneration often involves contracting in advance
for services: course sessions will discuss the corresponding requirements,
models and experience relevant to the regulation of provider efficacy,
safety and quality of care.
- Organizational
Strategies in Ambulatory Health Care
The organization of health care delivery is a major determinant
of health outcomes, their distribution, and their costs. This
section will introduce organization as a key health system "control
knob" and discuss ambulatory care reforms in middle and high-income
countries, providing an overview of issues to consider when designing
ambulatory health care reforms.
- Hospital
Reform Strategies
This section will review hospital organizational reform based
on a recent set of international case studies. Key organizational
differences between budgetary units, autonomous hospitals, and
corporatised public hospitals will be discussed, and each modality
and reform alternative will be illustrated with examples.
- Organizational
Reform and Management of Public Providers
Toward improving performance, health sector policy makers are
applying a variety of organizational and management reforms, including
introducing new types of health care organization. Reform strategies
often seek to maintain (predominantly) public financing as well
as public ownership while simultaneously "mimicking" best practices
from the private sector - such as more performance oriented organizational
and management structures, stronger incentives and exposure to
increased market pressures. The objective of this section is to
explain the reasons behind these new organizational reforms, and
to focus on options, instruments and tools for reform, especially
of public hospitals.
- Decentralization:
Sharing Resources and Responsibilities
In the effort to improve equity, efficiency, quality and responsiveness
to local conditions, many health systems have experimented with
various forms of decentralization. This module will examine the
different options for sharing of funds, authority and responsibility
with sub-national levels of ministries and with other governmental
units. The emphasis will be on the fiscal, policy and managerial
requirements and the risk of such effort.
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