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| Course Code | HSRM 553 |
| Teaching/learning methods | Lectures and group work |
| Assessment methods | Exam questions + group work presentation |
| Credit points | 3 |
| Semester (1 / 2) | Semester 1 |
Course objectives/ Learning outcomes: The aim of the course is to introduce the main concepts and options for health systems financing with a focus on achieving universal coverage and financial risk-protection. The course will enable students to discuss different options of health system financing reforms and to analyse their benefits and disadvantages.
Content: The course provides a structured overview to the main health systems financing functions, including (1) resource mobilization, (2) pooling & allocation to third-party payers, (3) purchasing and payer provider relationships. The advantages and disadvantages of typical health financing mechanisms, such as social health insurance, tax-financed systems, community-based health insurances, and private health insurance will be discussed. Different pathways to achieving (effective) universal coverage of persons, benefits, and costs, in various countries are presented. Furthermore, the course provides an overview of the essential role of payment systems and their incentives for achieving efficiency and transparency in service delivery.
Timetable/Schedule
| Length of course | Block course for 2 weeks |
|---|---|
| Start | Nov 6th |
| End | Nov 15th |
| Venue | SPH combined class (in the School of Medical Sciences building) |
| Lecturer(s) | Reinhard Busse |
| Course coordinator | Reinhard Busse (TUB), Peter Agyei-Baffour (KNUST) |
| Monday | Tuesday | Wednesday (06.11) | Thursday (07.11) | Friday (08.11) | |
|---|---|---|---|---|---|
| 08:00 - 10:00 | | | | Group work: finding information from databases | Social health insurance systems |
| 10:30 - 12:30 | | | | Raising resources, pooling and allocation | Tax financed systems |
| 13:00 - 15:00 | | | Introduction, expectations, course outline | Out-of-pocket: (i) voluntary/private health insurance (ii) community-based health insurance | Group work: advantages/disadvantages of SHI systems vs. tax financed systems |
| 15:30 - 17:30 | | | Frameworks | |
| | Monday (11.11) | Tuesday (12.11) | Wednesday (13.11) | Thursday (14.11) | Friday (15.11) |
|---|---|---|---|---|---|
| 08:00 - 10:00 | | | Payment systems 1: Overview & Primary care | | Summary: Financing for universal coverage |
| 10:30 - 12:30 | | Group work: different pathways to UHC - option | Payment systems 2: Hospitals | Equity in financing | Mid-term exam (30 min) + questions and wrap-up |
| 13:00 - 15:00 | Moving from fragmented systems to universal coverage | Group work: presenting the pathway to UHC | Group work: Advantages and disadvantages of DRG vs. capitation | Financial protection, financial accessibility | |
| 15:30 - 17:30 | PUBLIC LECTURE: Evidence-informed health policy: Which evidence? How to inform? Does it work? | Purchasing | | Guest lecture by Francis Adjei (NHIA): Overview of the three health financing functions in Ghana | |
Lecture/topics/subjects/academic catalogue
| Date | Subject (Time) |
| 04.11.2019 | |
| 05.11.2019 | |
| 06.11.2019 | Introduction, expectations, course outline Frameworks |
| 07.11.2019 | Group Work: Finding information from databases Raising resources, pooling and allocation Out-of-pocket: (i) voluntary private health insurance, (2) community-based health insurance |
| 08.11.2019 | Social health insurance systems Tax financed systems Group work: Advantages/disadvantages of SHI systems vs. tax financed systems |
| 11.11.2019 | Moving from fragmented systems to universal coverage PUBLIC LECTURE: Evidence-informed health policy: Which evidence? How to inform? Does it work? |
| 12.11.2019 | Group work: different pathways to UHC - option Group work: presenting the pathway to UHC Purchasing |
| 13.11.2019 | Payment systems 1: Overview & primary care Payment systems 2: Hospitals Group work: Advantages and disadvantages of DRG vs. capitation |
| 14.11.2019 | Equity in financing Financial protection, financial accessibility Guest lecture by Francis Adjei (NHIA): Overview of the three health financing functions in Ghana |
| 15.11.2019 | Summary: Financing for universal coverage Mid-term exam (30 min) + questions |
| Examination will be based on group presentation (10%) + written mid-term exam (20%) and written final exam (70%). |
|---|
| Fail = below 50% | Grade C = 50%-59% | Grade B = 60%-69% | Grade A = 70% and above |
|---|
Literature (required/additional readings)
Frameworks
Essential reading
Kutzin, J. (2013). “Health financing for universal coverage and health system performance: concepts and implications for policy.” Bulletin of the World Health Organization 91(8). pp. 602-611, available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3738310/pdf/BLT.12.113985.pdf
Chapter 1 in: Mossialos, Elias (Hg.) (2003): Funding health care. Options for Europe. Buckingham: Open Univ. Press (European Observatory on Health Care Systems series), available at: www.euro.who.int/__data/assets/pdf_file/0003/98310/E74485.pdf
Lagomarsino, Gina; Garabrant, Alice; Adyas, Atikah; Muga, Richard; Otoo, Nathaniel (2012): Moving towards universal health coverage. Health insurance reforms in nine developing countries in Africa and Asia. In: The Lancet 380 (9845), S. 933–943. DOI: 10.1016/S0140-6736(12)61147-7, available at: www.sciencedirect.com/science/article/pii/S0140673612611477
Raising resources, pooling and allocation
Kutzin, J.; Yip, W.; Cashin, C. (2016):
Alternative Financing Strategies for Universal Health Coverage.
In: World Scientific Handbook of Global Health Economics and Public Policy, S. 267–309. Available at: www.worldscientific.com/doi/abs/10.1142/9789813140493_0005.
Chapters 3 and 4 in: McIntyre, D., Kutzin, J. (2016). Health financing country diagnostic: a foundation for national strategy development.. Health Financing Guidance No. 1, World Health Organization, Geneva, available at: apps.who.int/iris/bitstream/handle/10665/204283/9789241510110_eng.pdf;jsessionid=E693DB173EA74FB4A76483FA87C0D3E3
Social health insurance systems
Chapter 3 in: Saltman RB, Busse R, Figueras J: Social health insurance systems in western Europe. Berkshire: European observatory on health systems and policies, Open University Press; 2004, available at: www.who.int/health_financing/documents/shi_w_europe.pdf
Carrin, Guy. "Social health insurance in developing countries: a continuing challenge." International social security review 55.2 (2002): 57-69, available at: onlinelibrary.wiley.com/doi/abs/10.1111/1468-246X.00124
Olugbenga, Ebenezer Olatunji. "Workable Social Health Insurance Systems in Sub-Saharan Africa: Insights from Four Countries." Africa Development 42.1 (2017): 147-175, available at: www.ajol.info/index.php/ad/article/viewFile/163629/153106
Barnighausen, T., & Sauerborn, R. (2002). One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries? Soc Sci Med, 54(10), 1559-1587.
Tax financed systems
WHO (2004): Tax-Based Financing for Health Systems: Options and Experiences, World Health Organization (WHO), Geneva. Available at: www.who.int/health_financing/taxed_based_financing_dp_04_4.pdf
Reeves, Aaron, et al. "Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries." The Lancet 386.9990 (2015): 274-280, available at: www.sciencedirect.com/science/article/pii/S0140673615605748
Cashin, C., Sparkes, S., Bloom, D. (2017). Earmarking for health: from theory to practice. Health Financing Working Paper No. 5, World Health Organization, Geneva , available at: apps.who.int/iris/bitstream/handle/10665/255004/9789241512206-eng.pdf;jsessionid=0019A781F30997988B38E90856825BB7
Private health insurance systems and community-based health insurance:
Carrin, G., Waelkens, M. P., & Criel, B. (2005). Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health, 10(8), 799-811, available at: onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-3156.2005.01455.x
Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z.; Abou Samra, Clara Abou; Ahmad, Ali et al. (2018): Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review. In: International journal for equity in health 17 (1), S. 13. DOI: 10.1186/s12939-018-0721-4, available at: equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0721-4
Chapter 2 in: Sagan, Anna; Thomson, Sarah (2016): Voluntary health in insurance in Europe. Role and regulation. Copenhagen, Copenhagen: World Health Organization Regional Office for Europe; European Observatory on Health Systems and Policies (Observatory studies series, 43), www.euro.who.int/__data/assets/pdf_file/0005/310838/Voluntary-health-insurance-Europe-role-regulation.pdf
Moving from fragmented systems to universal coverage:
Chapter 2 in: Cotlear, Daniel; Nagpal, Somil; Smith, Owen; Tandon, Ajay; Cortez, Rafael (2015): Going universal. How 24 developing countries are implementing universal health coverage reforms from the bottom up. Washington, DC: World Bank Group. Online available at: openknowledge.worldbank.org/handle/10986/22011.
Purchasing:
Robinson, R., E. Jakubowski, et al. (2005). Organization of purchasing in Europe. Purchasing to improve health systems performance. J. Figueras, R. Robinson and E. Jakubowski, available at: www.euro.who.int/__data/assets/pdf_file/0004/98428/E86300.pdf
Figueras, J., R. Robinson, et al. (2005). Purchasing to improve health systems performance: drawing the lessons. Purchasing to improve health systems performance. J. Figueras, R. Robinson and E. Jakubowski, available at: www.euro.who.int/__data/assets/pdf_file/0004/98428/E86300.pdf
Introduction Chapter in: Preker, Alexander S., Xingzhu Liu, and Edit V. Velenyi, eds. Public ends, private means: strategic purchasing of health services. The World Bank, 2007, available at: openknowledge.worldbank.org/bitstream/handle/10986/6683/399790PAPER0Pu101OFFICIAL0USE0ONLY1.pdf
Payment systems 1: Overview
Ellis, R. P. & Miller, M. M. 2009. Provider Payment Methods and Incentives. In: CARRIN, G. (ed.) Health systems policy, finance, and organization. Amsterdam: Elsevier Academic Press
Quinn, Kevin. "The 8 basic payment methods in health care." Annals of internal medicine 163.4 (2015): 300-306, available at:
Group work: Advantages and disadvantages of DRG vs. capitation
Payment systems 2: Paying hospitals
Quentin, W., D. Scheller-Kreinsen, M. Blumel, A. Geissler and R. Busse (2013). "Hospital payment based based on diagnosis-related groups differs in Europe and holds lessons for the United States." Health Aff (Millwood) 32(4): 713-723, available at: www.healthaffairs.org/doi/10.1377/hlthaff.2012.0876
Mathauer I, Wittenbecher F (2013): Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries. Bulletin of the World Health Organization 2013;91:746-756A. doi: dx.doi.org/10.2471/BLT.12.115931
Financial protection, financial accessibility:
Chapter 2: Tracking universal health coverage: 2017 global monitoring report. World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2017, available at: apps.who.int/iris/bitstream/handle/10665/259817/9789241513555-eng.pdf;jsessionid=37CBF860DBB98AFA7FF01F33BF77D623
Wagstaff, Adam; Flores, Gabriela; Hsu, Justine; Smitz, Marc-François; Chepynoga, Kateryna; Buisman, Leander R. et al. (2018): Progress on catastrophic health spending in 133 countries. A retrospective observational study. In: The Lancet Global Health 6 (2), S. e169-e179. DOI: 10.1016/S2214-109X(17)30429-1, available at: www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30429-1/fulltext
Equity in financing:
Mills, Anne, et al. "Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage." The Lancet 380.9837 (2012): 126-133, available at: researchonline.lshtm.ac.uk/21118/1/Equity%20in%20financing%20and%20use_GREEN%20AAM.pdf
Asante A, Price J, Hayen A, Jan S, Wiseman V (2016) Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses. PLoS ONE 11(4): e0152866., available at: doi.org/10.1371/journal.pone.0152866
