The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.
Compare various dimensions of country reform efforts using our interactive tool.
| Program | Service delivery system | Public providers | Non-state providers | Service delivery system |
|---|---|---|---|---|
| Vietnam: Compulsory and Voluntary Health Insurance Schemes |
|
980 | 85 |
Beneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers. Read full sectionBeneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers. The health public care network is organized under state administrative units: central, provincial, district, commune and village level, with the MoH at the central level. In the public sector, there are 980 hospitals (39 central, 331 provincial and 610 district hospitals) and 11,544 primary health centers. Communes Health Centers (CHCs) provide primary health care services, including consultation, outbreak prevention and surveillance, treatment of common diseases, maternal and child health care, family planning, hygiene, and health promotion. Although CHCs are widespread, they are underutilized. On average, a CHC serves just 7,000 people. Hospitals, on the other hand, exhibit high occupancy rates, often exceeding 100%. This trend may reflect perceptions in quality of care, or may represent the strong bias in reimbursements towards higher-level facilities and inpatient care. Across Vietnam, there are approximately 35,000 private clinics and 85 private hospitals, accounting for 8.7 % of the total number of hospitals nationwide, with 5,800 beds, accounting for 3.8% of the total number of hospital beds nationwide. VSS has begun contracting with private providers, but they still represent a small portion of care provided under the national insurance program. Of private providers registered with VSS, general practitioner clinics represent the largest groups. VSS reimburses approved facilities, which include all public facilities and some contracted private facilities. Enrollees may also use non-contracted facilities, including providers abroad, but reimbursement in this case is to the patient, who pays the facility directly and subsequently files a claim, and is limited to the costs incurred on average by public facilities in Vietnam. Compulsory and Voluntary Health Insurance SchemesService delivery system Types of Providers Empanelled: Both Public & Non-state
Number of public providers: 980
Number of non-state providers: 85 Beneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers. The health public care network is organized under state administrative units: central, provincial, district, commune and village level, with the MoH at the central level. In the public sector, there are 980 hospitals (39 central, 331 provincial and 610 district hospitals) and 11,544 primary health centers. Communes Health Centers (CHCs) provide primary health care services, including consultation, outbreak prevention and surveillance, treatment of common diseases, maternal and child health care, family planning, hygiene, and health promotion. Although CHCs are widespread, they are underutilized. On average, a CHC serves just 7,000 people. Hospitals, on the other hand, exhibit high occupancy rates, often exceeding 100%. This trend may reflect perceptions in quality of care, or may represent the strong bias in reimbursements towards higher-level facilities and inpatient care. Across Vietnam, there are approximately 35,000 private clinics and 85 private hospitals, accounting for 8.7 % of the total number of hospitals nationwide, with 5,800 beds, accounting for 3.8% of the total number of hospital beds nationwide. VSS has begun contracting with private providers, but they still represent a small portion of care provided under the national insurance program. Of private providers registered with VSS, general practitioner clinics represent the largest groups. VSS reimburses approved facilities, which include all public facilities and some contracted private facilities. Enrollees may also use non-contracted facilities, including providers abroad, but reimbursement in this case is to the patient, who pays the facility directly and subsequently files a claim, and is limited to the costs incurred on average by public facilities in Vietnam. |
| Kyrgyz Republic: Mandatory Health Insurance Fund (MHIF) |
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The reforms restructured the health delivery system to form a completely new PHC sector and introduced retraining mechanisms for physicians in order to establish a cadre of autonomous primary care providers across the country. From 2000 to 2003 alone, the share of primary care expenditures in total health spending increased from 17% to 31%. Read full sectionThe reforms restructured the health delivery system to form a completely new PHC sector and introduced retraining mechanisms for physicians in order to establish a cadre of autonomous primary care providers across the country. From 2000 to 2003 alone, the share of primary care expenditures in total health spending increased from 17% to 31%. Enrollees are free to choose a family group practice for their primary care and they can switch once per year during the annual registration period. In large urban settings, practices that offer higher quality services will attract a larger number of patients, leading to higher capitation payments for the practice. Rural areas, however, have too few providers in order to create this type of quality incentive. After the primary care reforms created the undergraduate, postgraduate, and continuing education curricula, the number of primary care physicians rose significantly from 5.8 per 1,000 population in 2001 to 8.2 per 1,000 population in 2005. Furthermore, by the end of 2004, 75 percent of primary care physicians and nurses had been retrained as family physicians and family medicine nurses. Kyrgyzstan has three types of primary care providers. First, the core of the old rural health system, Feldsher-Obstetric Ambulatory Points (FAPs) are facilities in the most remote reaches of the country that offer basic services such as neonatal care, immunizations, and health education. As of 2006 there were 875 FAPs across Kyrgyzstan, each serving between 500 and 2,000 people. Second, Family Group Practices (FGPs) are the major providers of primary care in Kyrgyzstan. FGPs are normally made up of three to five doctors. They can be freestanding and autonomous entities or units within large hospital polyclinics. Finally, Family Medicine Centers (FMCs) are large outpatient facilities staffed by varying numbers of specialists, often 10 to 20 health care professionals in addition to their affiliated FGPs. Their service offerings range from primary care to specialized care, including instrumental diagnostics. In 2006, approximately 93% of FAPs and 96% of FGPs were part of Family Medicine Centers. Secondary care is provided by hospitals at the oblast level (generally one oblast merged hospital in each oblast), and by territorial hospitals in rayons and cities (51 hospitals nationally). The main difference between these two types of hospitals lies in the variety and complexity of conditions that they can handle. Tertiary care that provides highly specialized services is conducted in eight central-level hospitals. In terms of legal organization, most health care organizations tend to be public. The exceptions are optic, dental, urologic, and gynecological services, which tend to be private facilities and are mostly concentrated in the capital city of Bishkek. Mandatory Health Insurance Fund (MHIF)Service delivery system Types of Providers Empanelled: Both Public & Non-state
Number of public providers:
Number of non-state providers: The reforms restructured the health delivery system to form a completely new PHC sector and introduced retraining mechanisms for physicians in order to establish a cadre of autonomous primary care providers across the country. From 2000 to 2003 alone, the share of primary care expenditures in total health spending increased from 17% to 31%. Enrollees are free to choose a family group practice for their primary care and they can switch once per year during the annual registration period. In large urban settings, practices that offer higher quality services will attract a larger number of patients, leading to higher capitation payments for the practice. Rural areas, however, have too few providers in order to create this type of quality incentive. After the primary care reforms created the undergraduate, postgraduate, and continuing education curricula, the number of primary care physicians rose significantly from 5.8 per 1,000 population in 2001 to 8.2 per 1,000 population in 2005. Furthermore, by the end of 2004, 75 percent of primary care physicians and nurses had been retrained as family physicians and family medicine nurses. Kyrgyzstan has three types of primary care providers. First, the core of the old rural health system, Feldsher-Obstetric Ambulatory Points (FAPs) are facilities in the most remote reaches of the country that offer basic services such as neonatal care, immunizations, and health education. As of 2006 there were 875 FAPs across Kyrgyzstan, each serving between 500 and 2,000 people. Second, Family Group Practices (FGPs) are the major providers of primary care in Kyrgyzstan. FGPs are normally made up of three to five doctors. They can be freestanding and autonomous entities or units within large hospital polyclinics. Finally, Family Medicine Centers (FMCs) are large outpatient facilities staffed by varying numbers of specialists, often 10 to 20 health care professionals in addition to their affiliated FGPs. Their service offerings range from primary care to specialized care, including instrumental diagnostics. In 2006, approximately 93% of FAPs and 96% of FGPs were part of Family Medicine Centers. Secondary care is provided by hospitals at the oblast level (generally one oblast merged hospital in each oblast), and by territorial hospitals in rayons and cities (51 hospitals nationally). The main difference between these two types of hospitals lies in the variety and complexity of conditions that they can handle. Tertiary care that provides highly specialized services is conducted in eight central-level hospitals. In terms of legal organization, most health care organizations tend to be public. The exceptions are optic, dental, urologic, and gynecological services, which tend to be private facilities and are mostly concentrated in the capital city of Bishkek. |
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| Ghana: National Health Insurance Scheme (NHIS) |
|
1368 | 966 |
In order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS. Read full sectionIn order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS. At present all public facilities have been given a provisional accreditation and 800 private providers (many of them pharmacies and ‘chemical shops’) have been accredited by the NHIA. National Health Insurance Regulations (LI 1809, Regulation 19 (1)) state that the first point of attendance for accessing health care under the NHIS should be a primary healthcare facility. This includes CHPS, health centers, district hospitals, polyclinics, quasi public hospitals, private hospitals, clinics and maternity homes. Where the only facility is a Regional Hospital, it will also be considered a primary healthcare facility. In emergencies, any accredited healthcare facility may be utilized. National Health Insurance Scheme (NHIS)Service delivery system Types of Providers Empanelled: Both Public & Non-state
Number of public providers: 1368
Number of non-state providers: 966 In order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS. At present all public facilities have been given a provisional accreditation and 800 private providers (many of them pharmacies and ‘chemical shops’) have been accredited by the NHIA. National Health Insurance Regulations (LI 1809, Regulation 19 (1)) state that the first point of attendance for accessing health care under the NHIS should be a primary healthcare facility. This includes CHPS, health centers, district hospitals, polyclinics, quasi public hospitals, private hospitals, clinics and maternity homes. Where the only facility is a Regional Hospital, it will also be considered a primary healthcare facility. In emergencies, any accredited healthcare facility may be utilized. |
| Philippines: PhilHealth |
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The service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers. Read full sectionThe service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers. In order to achieve accreditation, all in-network hospitals and day-surgery centers must be licensed by the Department of Health. The network includes hospitals, day surgery centers, maternity care clinics, midwife-operated clinics, freestanding dialysis centers, physician clinics, dentists doing procedures in hospitals and day surgeries, government-run health centers for primary care benefits, TB DOTS and malaria, and private TB-DOTS clinics. Non-hospitals and day-surgery centers are not required to be licensed by the DOH; however, all facilities are evaluated by an accreditation team from PhilHealth. PhilHealthService delivery system Types of Providers Empanelled: Both Public & Non-state
Number of public providers:
Number of non-state providers: The service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers. In order to achieve accreditation, all in-network hospitals and day-surgery centers must be licensed by the Department of Health. The network includes hospitals, day surgery centers, maternity care clinics, midwife-operated clinics, freestanding dialysis centers, physician clinics, dentists doing procedures in hospitals and day surgeries, government-run health centers for primary care benefits, TB DOTS and malaria, and private TB-DOTS clinics. Non-hospitals and day-surgery centers are not required to be licensed by the DOH; however, all facilities are evaluated by an accreditation team from PhilHealth. |
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| India: Rajiv Aarogyasri |
|
98 | 244 |
The Aarogyasri network includes 244 private and 98 public hospitals, all of which must meet specific structural, procedural and pricing requirements. Individuals seeking care approach their nearest in-network health facility, where Aarogya Mithras guide them through the system. If a patient needs further care, they will be given a referral card to the appropriate network hospital(s). Beneficiaries may also seek care and receive referrals at health camps held by in-network hospitals. Read full sectionThe Aarogyasri network includes 244 private and 98 public hospitals, all of which must meet specific structural, procedural and pricing requirements. Individuals seeking care approach their nearest in-network health facility, where Aarogya Mithras guide them through the system. If a patient needs further care, they will be given a referral card to the appropriate network hospital(s). Beneficiaries may also seek care and receive referrals at health camps held by in-network hospitals. As of January 2010, there were a total of 342 hospitals in the network. The principal reason Aarogyasri Trust decided to work with private providers was the lack of resources in the public system. The government has been unable to attract the needed specialists to public facilities, while the private sector has rapidly expanded high quality healthcare services. A hospital or nursing home in Andhra Pradesh is eligible to be a part of the Aarogyasri network of care, established for indoor medical care and treatment of disease and injuries. The hospital should comply with the following minimum criteria:
All hospitals that qualify to be in-network must sign a memorandum of understanding with the insurance company. This Memorandum is subject to the approval of the Trust. A provision is made in the Memorandum for non-compliance/default; all such matters are looked into by the Trust. From the perspective of beneficiaries, the path to seeking care is made as simple as possible, as indicated in Figure 1.
Rajiv AarogyasriService delivery system Types of Providers Empanelled: Both Public & Non-state
Number of public providers: 98
Number of non-state providers: 244 The Aarogyasri network includes 244 private and 98 public hospitals, all of which must meet specific structural, procedural and pricing requirements. Individuals seeking care approach their nearest in-network health facility, where Aarogya Mithras guide them through the system. If a patient needs further care, they will be given a referral card to the appropriate network hospital(s). Beneficiaries may also seek care and receive referrals at health camps held by in-network hospitals. As of January 2010, there were a total of 342 hospitals in the network. The principal reason Aarogyasri Trust decided to work with private providers was the lack of resources in the public system. The government has been unable to attract the needed specialists to public facilities, while the private sector has rapidly expanded high quality healthcare services. A hospital or nursing home in Andhra Pradesh is eligible to be a part of the Aarogyasri network of care, established for indoor medical care and treatment of disease and injuries. The hospital should comply with the following minimum criteria:
All hospitals that qualify to be in-network must sign a memorandum of understanding with the insurance company. This Memorandum is subject to the approval of the Trust. A provision is made in the Memorandum for non-compliance/default; all such matters are looked into by the Trust. From the perspective of beneficiaries, the path to seeking care is made as simple as possible, as indicated in Figure 1.
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