Good practices in health financing: Lessons from reforms in low- and middle-income countries

Editors(s): Gottret P, Schieber GJ, and Waters HR
Publisher: The World Bank
Publication date: 2008
Number of pages: 530 p
Language: English


“…..With health at the center of global development policy, the international community and developing countries are focused on scaling up health systems, in line with the Millennium Development Goals (MDGs). As a result, both global aid and individual country health reform plans are geared to improving health outcomes, securing financial protection against impoverishment, and ensuring longterm, sustainable financing to support these gains. However, with the scaling up of aid, both donors and countries have come to realize that more money alone cannot buy health improvements or prevent impoverishment due to catastrophic medical bills.

Well-targeted health spending is critical for success—including international donor aid to help in achieving sustainable results in the long term. These concerns have triggered a major debate over the need to define “results” and assemble appropriate data for decision making, monitoring, and evaluation. Central to this endeavor is the need for an analytically sound evidence base on national health financing policies that have “performed well” in terms of improving health outcomes and financial protection. Unfortunately, for want of solid evidence to inform policy makers, the policy debate is often driven by ideological, one-size fits-all solutions.

This book attempts to partially fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have demonstrated “good performance” in expanding their populations’ health insurance coverage—to both improve health status and protect against catastrophic medical expenses. Good performance also includes average or better-than-average population health outcomes relative to resources devoted to health and to national income and educational levels.

Among the low- and middle-income countries that are in the process of achieving high levels of population coverage and financial protection, nine were selected as examples of good performance by an expert steering committee representing all six World Bank Regions.

They are Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. Each country case is analyzed using a standardized taxonomy that captures the key health and non health sector–specific factors affecting the performance of its health financing….’