Direct Payment Schemes for People with Disabilities: A New and Innovative Policy Approach to Providing Services to Disabled People in Ireland

[Excerpt] This research project commenced initially in August 2002 and was initiated by the Disability Cluster Group – a network of local disability groups and service-providers, facilitated by the Bray Partnership. The Disability Cluster Group established a Disability Research Steering Committee for the project which, in turn, employed 80:20 Educating and Acting for a Better World – a non-governmental development education organisation – to undertake the research. The core objective of the work is to explore and move forward the agenda relating to direct payments in the East Coast Area Health Board (ECAHB). This is primarily a piece of qualitative research focusing on the many elements that make up a direct payment scheme from a number of stakeholder perspectives. In terms of the cross-border comparative element of the research, 10% of the total number of direct payments users in NI were interviewed. Given low overall numbers of direct payments service users, this figure is too limited for any significant statistical analysis. Instead, they serve to highlight some of the issues, experiences and challenges associated with introducing direct payments for a number of people with disabilities in Northern Ireland and allows for a range of conclusions to be drawn out

Community-based health insurance and social protection policy

Of all the risks facing poor households, health risks pose the greatest threat to their lives and livelihoods. A health shock adds health expenditures to the burden of the poor precisely at the time when they can afford it the least.One of the ways that poor communities manage health risks, in combination with publicly financed health care services, are community-based health insurance schemes (CBHIs). These are small scale, voluntary health insurance programs, organized and managed in a participatory manner. They are designed to be simple and affordable, and to draw on resources of social solidarity and cohesion to overcome problems of small risk pools, moral hazard, fraud, exclusion and cost-escalation. Less than 10 percent of the informal sector population in the developing nations has health coverage from a CBHI, but the number of such schemes is growing rapidly. On average, CBHIs recover between a quarter to a half of health service costs. As a social protection device, they have been shown to be effective in reducing out-of-pocket payments of their members, and in improving access to health services. Many schemes do fail. Problems, such as weak management, poor quality government health services, and the limited resources that local population can mobilize to finance health care, can impede success.Health Economics&Finance,Health Monitoring&Evaluation,Poverty Assessment,Safety Nets and Transfers,Insurance&Risk Mitigation