A surprising amount, actually. A voucher gives its recipient the right to access a specific health service (or health service package) at quality-assured health facilities for free. That same voucher enables the health provider to claim payment for the services they provided to the voucher-holding client. That’s why voucher programmes are often described as a demand-side subsidy with a supply-side effect.
This nifty ‘2-for-1’ characteristic means that vouchers can do a lot of good for all three key principles of universal health coverage: equity, financial protection, and quality of care. On the equity front, targeted enforcement of entitlements to free care ensure that even the most vulnerable can benefit from effective coverage. By largely eliminating out of pocket payments, vouchers also contribute to financial protection, while building the systems needed for social health insurance (SHI).
Across the world, countries at all income levels are aspiring to the goal of universal health coverage (UHC). Hardly a week goes by without a government making an announcement about extending coverage, either in terms of new population groups covered, new services added to a benefit package or people receiving higher levels of financial protection. In fact Mexico (the new chair of the G20) is about to announce that it has reached UHC six months earlier than schedule.
How do we link financing mechanisms to achieve maximum impact?
There is no doubt in my mind that there is real momentum today in the quest for universal health coverage in Africa. Health financing has become a priority topic for discussion at the international and national levels, sometimes even catapulting onto the agenda for campaigning presidential candidates. It has not always been so. One tangible manifestation of this new and timely interest in health financing is the vibrant and growing communities of practice (CoP) spawned by Harmonization for Health in Africa.
Different strategies for raising revenue to cover the informal sector
Panelists representing Ghana, Mali, Indonesia, Rwanda and the World Bank discussed the challenges of raising revenues for covering the informal sector at the JLN workshop session in Mombasa on June 7, 2011. Debated were the relative merits of different strategies for raising revenues such as general taxes, payroll taxes, special earmarked taxes, donor and community contributions.
During the June 7, 2011, JLN workshop session on raising revenue to cover the informal sector it emerged that most countries, in fact, utilize a mix of financing sources, although one source may be more dominant than the others. The financing source may also differ according to the population group(s) being targeted – thus payroll taxes tend to predominate when it concerns the formal sector, while a mix of sources is more relevant to cover the informal sector due to the many complexities of raising sufficient premium income from that sector and the large numbers who may not be able to pay premiums for themselves.