Financing
Health care financing in complex emergencies: a background issues paper on cost-sharing.
Arguments for and against cost sharing in developing countries
Authors:
T. Poletti
Publisher:
London School of Hygiene and Tropical Medicine , 2003
There is considerable interest in the introduction of cost-sharing as an element of health care financing in emergency and post-emergency situations, but many questions remain. This paper from the London School of Hygiene and Tropical Medicine provides an understanding of health care financing issues, and the arguments for and against cost-sharing in developing countries and complex emergencies. Written for a workshop the document explores health care financing in complex emergencies in order to define the issues, develop a conceptual framework, and delineate the operational research that is required to develop a more considered and empirical approach to health care financing.
The document considers various issues including when cost-sharing schemes should be introduced, the effects of cost-sharing on efficiency and the implications of cost-sharing for the control of infectious diseases. The author concludes that given that donor policy currently promotes cost-sharing in complex emergencies, despite the outstanding questions outlined above, a strong case can be made that donors should fund operational research on this issue. It is only via the commissioning of such research that a more considered and empirically based approach to cost-sharing in complex emergencies can be developed. The document warns that initial results of NGO experience with user fees in complex emergencies has raised serious concerns regarding the impact of user fees on equity, health status, efficiency, and their ability to raise significant revenue from war-affected populations. Policymakers and implementation agencies should thus reengage in a debate about the use of cost-sharing mechanisms in complex emergencies.
