Role of Communities in Resource Mobilization and Risk Sharing : A Synthesis Report

Preker, Alexander S. ; Carrrin, Guy ; Dror, David M. ; Jakab, Melitta ; Hsiao, William ; Arhin, Dyna

World Bank, Washington, Dc

关键词: HEALTH SYSTEMS DEVELOPMENT & REFORM;    HEALTH CARE;    HEALTH FINANCE;    HEALTH FINANCING;    RURAL HEALTH CARE;   

RP-ID  :  28893

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Most community finance schemes haveevolved in the context of severe economic constraints,political instability, and lack of good governance. Usuallygovernment taxation capacity is weak, formal mechanisms ofsocial protection for vulnerable populations absent, andgovernment oversight of the informal health sector lacking.In this context of extreme public sector failure, communityinvolvement in financing health care provides a criticalthough insufficient first step in the long march towardimproved access to health care by the poor and socialprotection against the cost of illness. It should beregarded as a complement to-not as a substitute for-stronggovernment involvement in health care financing and riskmanagement related to the cost of illness. Based on anextensive survey of the literature, the main strengths ofcommunity financing schemes are the extent of outreachpenetration achieved through community participation, theircontribution to financial protection against illness, andincrease in access to health care by low-income rural andinformal sector workers. Their main weaknesses are the lowvolume of revenues that can be mobilized from poorcommunities, the frequent exclusion of the very poorest fromparticipation in such schemes without some form of subsidy,the small size of the risk pool, the limited managementcapacity that exists in rural and low-income contexts, andtheir isolation from the more comprehensive benefits thatare often available through more formal health financingmechanisms and provider networks.The authors conclude byproposing concrete public policy measures that governmentscan introduce to strengthen and improve the effectiveness ofcommunity involvement in health care financing. Thisincludes: (a) increased and well-targeted subsidies to payfor the premiums of low-income populations; (b) use ofinsurance to protect against expenditure fluctuations anduse of reinsurance to enlarge the effective size of smallrisk pools; (c) use of effective prevention and casemanagement techniques to limit expenditure fluctuations; (d)technical support to strengthen the management capacity oflocal schemes; and (e) establishment and strengthening oflinks with the formal financing and provider networks.