Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study

Authors: Tom Achoki, Abaleng Lesego

Published in: International Journal for Equity in Health | Issue 1/2017

Login to get access

Abstract

Background

Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance coverage offers promise in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualized to many African health systems.

Methods

We interviewed 37 key informants drawn from public, private and civil society organizations involved in health service delivery in Botswana. The objective was to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. We thematically synthesized their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage.

Results

Participants suggested that expansion of health insurance would be characterized by increased financial resources for health and catalyze an upsurge in utilization of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realizing the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage.

Conclusion

Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance also comes with many challenges. Decision-makers keen to achieve universal health coverage, must view health financing reform through the holistic lens of the health system and its interactions with the population, in order to anticipate its potential benefits and risks. Failure to embrace this comprehensive approach, would potentially lead to counterproductive results.
Literature
1.
Achoki T, Chansa C. Impact of funding modalities on maternal and child health intervention coverage in Zambia. Health Policy Technol. 2013;2(3):162–7.CrossRef
2.
Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800.CrossRefPubMedCentral
3.
Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):957–79.CrossRefPubMedPubMedCentral
4.
WHO. The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva: World Health Organization; 2010.
5.
IHME. Financing Global Health: 2013 Transition in an Age of Austerity. Seattle, WA: Institute for Health Metrics and Evaluation; 2014.
6.
7.
Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91:602–11.CrossRefPubMedPubMedCentral
8.
Agyepong I, Adjei S. Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy Plan. 2008;23:150–60.CrossRefPubMed
9.
Addae-Korankye A. Challenges of financing health care in Ghana: the case of national health insurance scheme (NHIS). Int J Asian Soc Sci. 2013;3(2):511–22.
10.
Fusheini A. The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation. Int J Health Policy Manag. 2016;5(x):1–10.
11.
12.
Tangcharoensathien V, Patcharanarumol W, Ir P, et al. Health-financing reforms in Southeast Asia: challenges in achieving universal coverage. Lancet. 2011;377:863–73.CrossRefPubMed
13.
Lagomarsino G, Garabrant A, Adyas A, et al. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet. 2012;380:933–43.CrossRefPubMed
14.
Knaul F, Arreola-Ornelas H, Méndez-Carniado O, et al. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet. 2006;368:1828–41.CrossRefPubMed
15.
16.
17.
18.
Callahan S, Pandit-Rajani T, Levey I, Bastelaer T. Botswana Private Health Sector Assessment. Bethesda: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc; 2013.
19.
Ministry of Health, Republic of Botswana. Botswana National Health Accounts for Financial Years 2007/08, 2008/09 and 2009/10. Gaborone, Botswana. Bethesda: Abt Associates Inc.; 2012.
20.
Achoki T, Baruwa E, Callahan S, et al. Advancing Universal Health Coverage in Botswana by Expanding Membership in BPOMAS. Bethesda: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc; 2015.
21.
WHO. Botswana: Country cooperation strategy at a glance. Geneva: World Health Organization; 2014.
22.
de Savigny D, Adam T, editors. Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and Systems Research, World Health Organization; 2009.
23.
Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717–31.PubMedPubMedCentral
24.
WHO. The World Health Report 2000: Health Systems: Improving Performance. Geneva, Switzerland: World Health Organization; 2000.
25.
WHO. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization; 2007.
26.
Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, et al. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692–704.CrossRefPubMed
27.
Obse A, Hailemariam D, Normand C. Knowledge of and preferences for health insurance among formal sector employees in Addis Ababa: a qualitative study. BMC Health Serv Res. 2015;15:318.CrossRefPubMedPubMedCentral
28.
Talampas RG. Review of Experience of Social Health Insurance in Three Asian Countries: China, Thailand, and Vietnam. Makati City: Philippine Institute for Development Studies; 2014. Report No.: DP 2014-46.
29.
Knaul FM, Frenk J. Health insurance in Mexico: achieving universal coverage through structural reform. Health Aff Proj Hope. 2005;24(6):1467–76.CrossRef
30.
Dalinjong PA, Laar AS. The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana. Health Econ Rev. 2012;2(1):13.CrossRefPubMedPubMedCentral
31.
32.
Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240–9.CrossRefPubMed
Metadata
Title
The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study
Authors
Tom Achoki
Abaleng Lesego
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0550-x

Other articles of this Issue 1/2017

International Journal for Equity in Health 1/2017 Go to the issue

Research

Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals

Research

Determinants of village doctors’ job satisfaction under China’s health sector reform: a cross-sectional mixed methods study

Research

Preventative health, diversity, and inclusion: a qualitative study of client experience aboard a mobile health clinic in Boston, Massachusetts

Research

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers’ use of information in decision-making: experience from Cape Town, South Africa

Research

Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models

Research

“I’m not strong enough; I’m not good enough. I can’t do this, I’m failing”: a qualitative study of low-socioeconomic status smokers’ experiences with accessing cessation support and the role for alternative technology-based support