As World Bank Group President Jim Yong Kim said during a recent speech at Washington’s Howard University, the battle against the Ebola epidemic is also a fight against inequality. Those fortunate enough to be born in countries with functional health care systems receive better treatment. But as a recent IEG evaluation found, it’s not just poor countries that struggle to develop health systems that efficiently make use of available resources and provide quality care in an equitable way to the entire population.

Our evaluation of World Bank Group Support to Health Financing points to health financing as a key policy instrument in meeting this challenge. The way countries finance health care influences how well the service delivery system performs, including how equitable and efficient it is. Countries decide how to mobilize revenues from public and private sources for financing health care, how to pool revenues and protect populations against financial risk, and how to purchase services wisely from health care providers.

An integrated approach

In many countries, millions of people suffer because they can’t get needed care or the price they must pay for it pushes them into poverty. The World Bank Group recognizes that improving the well-being of a nation’s people and protecting them against the financial consequences of ill health are top priorities to reduce poverty, share economic prosperity, and sustain long-term growth.

In its first evaluation of the Bank Group’s support to countries grappling with health financing issues, IEG found that efforts to improve resource mobilization, pooling, and purchasing for health are more effective and institutionally sustainable when they are coordinated and linked to broader public sector reforms.  

Elements of an integrated approach include compulsory and less-fragmented pooling in insurance and national health systems as well as strategic purchasing that examines potential adverse effects in a broader public sector context. Where Bank support to purchasing was combined with other health financing functions and linked to the public finance context rather than limited to narrowly defined payment methods, it has been relatively effective.

Health care available to all

Recently, results-based financing (RBF) has become more popular. It typically involves a cash payment or nonmonetary transfer made to a government, manager, provider, payer, or consumer of health services after predefined results have been verified. Availability of care increased where countries moved from line-item budgets to activity- or performance-based payments.

But without measures to reduce user fees and improve risk pooling, RBF is unlikely to lead to greater equity in access to health care services and protection from financial hardship caused by illness.

The evaluation makes five recommendations: support government commitment and build technical and information capacity, address health financing as a cross-cutting issue at the country level, focus on health financing as a core comparative advantage, integrate all health financing functions, and strengthen monitoring and evaluation in the Bank Group’s projects.

The opportunity and means for transformational change exists now for development practitioners to help their clients find ways to finance health care systems that offer quality services to all citizens.

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