MIDDLE low and middle-income contries which share %95







































Care Systems in Low and Middle-Income Countries

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Last 10-15
years Global Health Organizations towarded focus on the health care systems which
are associated to satisfy population with health care needs. They are
institutions, organizations, and resources. In my final term project I will
especially pay attention to low and middle-income countries health care


to the data on World Health Organization, in low and middle-income contries
which share %95 of child and maternal deaths attendance of unskilled doctor is
%38. It is quite enormous proportion if compare with developed countries.


absence of cost-sharing programs or weak health social institutions, shifting
millions of people below the poverty line every year because of medical


this project I will cover main health care system problems of low and
middle-income countries, and write about responses to those issues. The main
purpose is to detect whether to cover health care payments through taxation or
to increase cost-sharing for certain part of population, whether to improve
standards of health care usage by material supports, whether to extend health care
system through using private sector. Of course there is not unique solution or
system. The conditions and the situation of each country determines its own
best solution to find best health care system. So countries should be careful
when try to implement generalized health care systems.


























we look at the figure above where is shown the
sources of health care financing in China we can observe that only %36 is paid
by household, other %74 is meet by insurances and government supports.




But in the
low-income countries principal problem is that the households are burdened to
pay a big portion of health care payments. It is mostly because of weak
insurance 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).





































biggest financing agents in the lower-middle-income and low-income countries
are households. According to the data of World Health Organization of health
expeniture, %73 of health care spending in Nigeria has been met by individuals
themselves, where governmental


support is
just %24. How to supply financial support in low middle-income countries to
meet population health care demand?


of formally employed part of population, and include them in social insurance
arangements. At least partial subsidization for health care expenditures for
low-income level of population. This conditions will cause free-rider problem.


issue of free rider has been recently discussed in The Philippines and Vietnam.
They have tried to expand material support by encouraging voluntary enrollment
in social health insurance programs whereas some countries like Thailand have
used funds from general taxation.


low and middle-income countries progress toward increasing quality of health
care system will be step by step because of weak tax base. But these countries
should be focused on which financing tools must be used to cover peoples’
health care demand in current economic political situation.

point for better Health System is 1) evolve financial inducement for households
to consume health goods and services 2) encourage producers to provide a high
quality goods and services. These kind of approaches are known as results-based
financing which is set out to motivate providers and to direct the issues of
lack of demand for poor feedback.

Latin America such a financial incentives like conditional cash transfers have
increased  the number of preventive
services users. In Africas’ Rwanda output based aid of primary care providers has
skyrocketed the number of teenagers 
hospital visits for preventive care.




the general overview the implementations of such programs which  targeted to recipients of health care or to
individual 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 goverments
inefficient implementation of these programs is one of the main issues that can
be occur.

Financial ?ncentives could have objectionable results as well. The case
happened in India that cash incentives for women access health care services have
increased the fertility level.

Financial ?ncentives is one of the paths for satisfaction of necessary health
care countries about alternatives of using financial incentive programs to make
clear suggestions.



the low and middle-income countries there are an extensive participation of
private entities. The main attractive point  for private sector in health car system is rising
demand for health care which leads to rise in profits and the insufficiency of
public sector to meet expectations.



the figure above  that was driven from
World Health Organization Data we can see that in lower and middle-income
countries the percentage of health funded privately is higher than paid by
government. ?n some countries limited capacity of public-sector triggered
governments to contract  with private sector
to manage some health care services behalf of the public-sector. The numerous
studies suggest that such contracted private sector has increased service
delivery in some areas.          To
manage contracts government should have capacity. Even that some argues that privatization
of health care system making it profitable “commodity”.

sum up, there can be driven some strategies to improve “poor” countries health
care system. Of course there is not the best technique that can be applied for
all countries because of each countries’ unique socio-economic conditions. The
efficiency of any approach to meet peoples’ health care demand depends on the
system into which the country is intended to apply also its consistency with
country values and ideologies. The best way can be driven from own
experimentation and the experiences of other countries. As health care system
is very complex it should be carefully constructed and planned for a long-term.
















Taskforce on
Innovative International Financing for Health Systems. Constraints to scaling
up and costs. Geneva: World Health Organization, 2009.

World Health
Organization. Universal health coverage (http://www.who.int/universal_health_coverage/un_resolution/en/index.html).

Global health
expenditure database. Geneva: World Health Organization (http://apps.who.int/nha/database/CompositionReportPage.aspx).

High Level
Expert Group. Report on universal health coverage for India: submitted to the
Planning Commission of India. New Delhi: Planning Commission of India, 2011.

systems evidence. Hamilton, ON, Canada: McMaster University (http://www.healthsystemsevidence.org).




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