Added value and possible areas of cooperation. Serge Heijnen Executive Secretary. Carrin et al. 2008 Key health financing options at different stages of the evolution towards universal coverage. Tax-based financing Social health insurance Mix of tax-based and social health insurance.
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Added value and possible areas of cooperation
Carrin et al. 2008
Key health financing options at different
stages of the evolution towards universal coverage
Social health insurance
Mix of tax-based and
social health insurance
Mixes of community -, cooperative -
and enterprise-based health insurance and other private insurance. Social health insurance- type coverage for specific groups and limited tax-based financing
“The responses of many health systems so far have been generally considered inadequate and naive. Inadequate, insofar as they not only fail to anticipate, but also to respond appropriately – too often with too little, too late, or too much in the wrong place. Naive, insofar as a system’s failure requires a system’s solution – not a temporary remedy.”WHO World Health Report, 2008
“A system to a large extent causes its own behaviour. Once we see the relationships between structure and behaviour, we can begin to understand how systems work, what make them produce poor results, and how to shift them into better behaviour patterns. System structure is the source of system behaviour. System behaviour reveals itself as a series of events over time”.
Health financing function
Actors and process: policy formulation and implementation
Sufficient, equitable, efficient revenue collection
Efficiency, equity in purchasing / provision
Health financing norms
Universal Coverage (UC): adequate health services coverage of the whole population (the breadth, depth and height of coverage)
Adapted from Carrin, et al. 2008
Systems thinking in health places high value on understanding context and looking for connections between the parts, actors and processes of the system.
Systems thinking requires a deliberate and continuous approach to anticipate rather than to react, and to identify upstream points of leverage.
High leverage points are usually governance and information systems, but they receive least attention!
Learning workshops / networks on universal coverage can definately be a good point of entry not only for exchanging information about health systems’ status, structure or technical pathway towards universal coverage. It allows meaningful discussions about context, actors and their behaviour which caused a policy or measure to succeed or fail.
What is the added value of the Dutch experience?
I would argue that the added value of the Dutch experience to countries that are exploring options to extend coverage lies particularly in:
Gradually strengthening the public stewardship role and information systems in health within a context of 1) dominant private care provision and financing – both for profit and not-for-profit and 2) a historically very weak role of the government in the health sector.
Our health system only works below sea-level. Successes are more difficult to copy than mistakes.
So, in line with the recommendations of the WRR, I would argue for development aid to:
Invest more in “the brains of health systems”: individuals, institutions and infrastructures, next to offering direct care or insurance products / solutions.