MIDDLE in Low and Middle-Income Countries Kanan Aliyev

MIDDLE EAST TECHNICAL UNIVERSITY                                     HealthCare Systems in Low and Middle-Income Countries        Kanan Aliyev   1905512       Last 10-15years Global Health Organizations towarded focus on the health care systems whichare associated to satisfy population with health care needs. They areinstitutions, organizations, and resources. In my final term project I willespecially pay attention to low and middle-income countries health caresystems. Accordingto the data on World Health Organization, in low and middle-income contrieswhich share %95 of child and maternal deaths attendance of unskilled doctor is%38. It is quite enormous proportion if compare with developed countries. Theabsence of cost-sharing programs or weak health social institutions, shiftingmillions of people below the poverty line every year because of medicalpayments. Inthis project I will cover main health care system problems of low andmiddle-income countries, and write about responses to those issues.

The mainpurpose is to detect whether to cover health care payments through taxation orto increase cost-sharing for certain part of population, whether to improvestandards of health care usage by material supports, whether to extend health caresystem through using private sector. Of course there is not unique solution orsystem. The conditions and the situation of each country determines its ownbest solution to find best health care system. So countries should be carefulwhen try to implement generalized health care systems.

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                         Ifwe look at the figure above where is shown thesources of health care financing in China we can observe that only %36 is paidby household, other %74 is meet by insurances and government supports.   But in thelow-income countries principal problem is that the households are burdened topay a big portion of health care payments. It is mostly because of weakinsurance institutions and lack of governmental financial supports.

Approximately %50 of health care expenditure are out-of-pocket of households(for comparison in high-income countries this value is about %14).                                    Thebiggest financing agents in the lower-middle-income and low-income countriesare households. According to the data of World Health Organization of healthexpeniture, %73 of health care spending in Nigeria has been met by individualsthemselves, where governmental support isjust %24. How to supply financial support in low middle-income countries tomeet population health care demand? Taxationof formally employed part of population, and include them in social insurancearangements.

At least partial subsidization for health care expenditures forlow-income level of population. This conditions will cause free-rider problem. Theissue of free rider has been recently discussed in The Philippines and Vietnam.They have tried to expand material support by encouraging voluntary enrollmentin social health insurance programs whereas some countries like Thailand haveused funds from general taxation. Inlow and middle-income countries progress toward increasing quality of healthcare system will be step by step because of weak tax base. But these countriesshould be focused on which financing tools must be used to cover peoples’health care demand in current economic political situation.

Anotherpoint for better Health System is 1) evolve financial inducement for householdsto consume health goods and services 2) encourage producers to provide a highquality goods and services. These kind of approaches are known as results-basedfinancing which is set out to motivate providers and to direct the issues oflack of demand for poor feedback.InLatin America such a financial incentives like conditional cash transfers haveincreased  the number of preventiveservices users. In Africas’ Rwanda output based aid of primary care providers hasskyrocketed the number of teenagers hospital visits for preventive care.   Inthe general overview the implementations of such programs which  targeted to recipients of health care or toindividual health care workers through conditinal cash transfers or vouchers has triggered some achievements in the short-run.

But it is hard to observe those successes in other countries as well. The govermentsinefficient implementation of these programs is one of the main issues that canbe occur.TheFinancial ?ncentives could have objectionable results as well. The casehappened in India that cash incentives for women access health care services haveincreased the fertility level.

TheFinancial ?ncentives is one of the paths for satisfaction of necessary healthcare countries about alternatives of using financial incentive programs to makeclear suggestions.  ?nthe low and middle-income countries there are an extensive participation ofprivate entities. The main attractive point  for private sector in health car system is risingdemand for health care which leads to rise in profits and the insufficiency ofpublic sector to meet expectations.  Fromthe figure above  that was driven fromWorld Health Organization Data we can see that in lower and middle-incomecountries the percentage of health funded privately is higher than paid bygovernment. ?n some countries limited capacity of public-sector triggeredgovernments to contract  with private sectorto manage some health care services behalf of the public-sector. The numerousstudies suggest that such contracted private sector has increased servicedelivery in some areas.          Tomanage contracts government should have capacity.

Even that some argues that privatizationof health care system making it profitable “commodity”.Tosum up, there can be driven some strategies to improve “poor” countries healthcare system. Of course there is not the best technique that can be applied forall countries because of each countries’ unique socio-economic conditions. Theefficiency of any approach to meet peoples’ health care demand depends on thesystem into which the country is intended to apply also its consistency withcountry values and ideologies.

The best way can be driven from ownexperimentation and the experiences of other countries. As health care systemis very complex it should be carefully constructed and planned for a long-term.              REFERENCES·        Taskforce onInnovative International Financing for Health Systems. Constraints to scalingup and costs. Geneva: World Health Organization, 2009.

·        World HealthOrganization. Universal health coverage (http://www.who.int/universal_health_coverage/un_resolution/en/index.html).·        Global healthexpenditure database. Geneva: World Health Organization (http://apps.

who.int/nha/database/CompositionReportPage.aspx).·        High LevelExpert Group. Report on universal health coverage for India: submitted to thePlanning Commission of India.

New Delhi: Planning Commission of India, 2011.·        Healthsystems evidence. Hamilton, ON, Canada: McMaster University (http://www.healthsystemsevidence.org).

  

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