Health financing for universal coverage

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Pay-for-performance debate: not seeing the forest for the trees

WHO/N. Ansari

A new commentary on pay-for-performance (P4P) has been published in the Journal Health Systems & Reform. It argues that it is crucial to pay greater attention to the “forest” - that is, overall health system reforms and how provider payment arrangements interact with these to influence health outcomes, as opposed to looking almost solely and more narrowly at the “trees” - that is, the details and impact of a P4P mechanism divorced from the underlying health system. P4P is a strategic purchasing tool, helping to translate stated priorities into services and making an explicit link between budgets, information and services.

Aligning PFM and health financing

3 March 2017 – Progress towards UHC requires sustainable public financing that is channelled through strong and responsive public financial management (PFM) systems. PFM improvements generally benefit the health sector. However, specific health sector challenges require flexibility to enable effective implementation of health financing policies. This document lays out areas where PFM systems are crucial for the effective implementation of health financing policy in support of UHC and offers guidance for improving alignment. It is meant to facilitate productive dialog between health and finance authorities to enable a coordinated reform approach.

New publication on expanding fiscal space to support UHC in LMICs

Calculator and stethoscope on top of printed diagram
Shutterstock/Chompoo Suriyo

December 2016 – Fiscal space is a very important concept for health financing reform to support universal health coverage. This paper is the first comprehensive review of studies from more than 40 low- and middle-income countries to explore how the concept of fiscal space is applied and used. Analysis explores results of country-level projections of fiscal space and assesses the main methods used to project fiscal space for health. This review complements the programme of work under the Collaborative Agenda on Fiscal Space, Public Financial Management and Health Financing.

Spending targets for health: no magic number

September 2016 - Absolute levels of public funding are critical to UHC progress; however, health systems vary significantly in what they achieve for a given level of spending. In a new analysis of core health service coverage rates relative to public spending on health, in 83 low and middle income countries, variation is particularly evident at levels below PPP$ 40 per capita (public). Whilst a range of non-health system factors influence a country’s performance, this analysis demonstrates the importance of focusing not only on raising more revenues for health, but also on ensuring available funds are spent efficiently.

Alternative financing strategies for universal health coverage

Health financing reforms are at the core of strategies to move towards universal health coverage (UHC). There is not one solution to every context, and this chapter synthesizes theory, lessons and financing reforms. It highlights the pitfalls on the path to UHC, and financial protection to the informal sector that comprises the majority of the population.

All documents and publications on the WHO health financing policy website are listed here sorted by document type for easy access. Please choose a category below to access the documents. The list is updated continually.