Forms of Health Service Financing and Their Effect on the Provision of Care

SUMMARY The successful implementation of primary health care is dependent on financing systems that reflect the wider social, economic and political perspectives on which the concept rests. Particular forms of financing health care will affect its provision, organisation and utilisation. The question of what PHC will cost should properly be answered by: ‘what we can reasonably expect to have is what it will cost’. RESUMEN Formas de financiamiento de los servicios de salud y sus efectos en el suministro de atención La implementación exitosa de la atención primaria de salud, depende de sistemas financieros que reflejen las amplias perspectivas sociales, económicas y políticas, sobre las cuales se basa. Las formas concretas del financiamiento de la atención primaria de salud, afectarán su suministro, organización y utilización. La respuesta adecuada al problema de! costo de la atención primaria de salud debería ser: ‘costará lo que razonablemente esperemos lograr’. RESUMES Formule de financement de l'assistance médicale et ses effets sur les provisions Le succès de l'assistance médicale primaire dépend essentiellement de systèmes financiers qui reflètent les plus grandes perspectives sociales, économiques et politiques sur lesquelles le concept demeure. Certaines formes de financement de l'assistance médicale affecteraient ses provisions, son organisation et utilisation. La question du coût de l'assistance médicale primaire devrait simplement trouver réponse par: ‘Ce que nous pouvons raisonnablement attendre d'obtenir est ce qu'il nous coûtera.

Selective primary health care: Old wine in new bottles

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24149/1/0000406.pd

SOME STRENGTHS AND WEAKNESSES OF TRADITIONAL ACADEMIC ANTHRO-SOCIOLOGICAL RESEARCH

ABSTRACTAnalysis of this monograph, and the research project from which it stems offers the basis for a discussion of some strengths and weaknesses of traditional academic anthro-sociological research. Such strengths are to be found in (small scale) studies of community value systems. The weaknesses arise when such studies are conducted either in isolation from wider national frame works or -as in this case -inserted into them almost at random. The volume contains many conceptual and technical errors. These fall, especially, in three categories: 1. ethnicity taken as a unique determinant of social consciousness; 2. conceptual and technical confusion over the nature of health service development and utilization; and, 3. failure to recognize (much less analyze) the fact of the Ethiopian revolution and its likely effects on the people and issues under discussion. Most of the specific recommendations of the research project are found to be ill conceived and often in gross error. Finally, the monograph demonstrates the difficulty of understanding the processes of social change through analyses based primary on small communities divorced from -or improperly located within -their wider social context. This difficulty is especially clearly demonstrated in this study as it was carried out at a special moment of dynamic revolutionary history, which moment the monograph's authors appear not to have noticed

A reappraisal of the "brain drain"--With special reference to the medical profession

The "brain drain" problem is not so much a question of the numbers who migrate as the distortion in training systems and economic structures that their mobility implies. The persistence of the problem reflects the ineffectiveness of the policies so far implemented to reduce it. This ineffectiveness stems largely from the inadequacy of the standard neoclassical framework of analysis, which also misrepresents the effects of the "brain drain". The fundamental inadequacy of this analysis derives from the fact that it deals with the response of individuals to a number of variables without taking account of the structure within which individual decisions are made and of the relevant interdependencies and dynamic effects. The most important aspect of this structure is the existence of an international market in professional skills into which the educated elite of the Third World is more or less integrated, to the benefit of their salary levels and, in a process of institutional determination of salaries, those of all who can plausibly claim "compatibility" with them. The condition of integration into this international market is the possession of internationally negotiable qualifications and international negotiability implies, to a varying degree, lack of relation to local needs.The question of international (medical) migration is of interest not so much in itself, but because of what it reveals about the nature of particular (health care) systems and the socio-political structures in which they operate. If everything else were to stay much the same the reduction of (medical) emigration would probably make no difference at all to the welfare of most of the population of the Third World. In the same vein, the solution to the problem raised by these international movements are not to be found within the movements themselves but in necessary changes within the framework of specific national (health care) systems and, of course, the social, political and class structures in which they exist.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23611/1/0000573.pd

Health Care Financing In Indonesia

ABSTRAK This paper describes health care financing and expenditures in Indonesia, a developing country spending around $US 9.50 per capita anually for health care (2.6$ US 2.70 percapita anually for health care, another 30% averaged $US 8.35 each, and then upper 9$ US 31.90. The Government is reviewing various "social financing\u27 mechanism with a view to expanding health insurance coverage bath for those in formal wage employment and the bulk of the population which remains either on the land or is part of the \u27informal\u27 sector. Steps are also being taken to increase the efficient use of resources by, among other things, making greater use of evaluation techniques and economic metodologies. Such efforts are coupled with more decentralized authority being given to the provinces and districts. Particulary important to future health efforts is the further expansion of community-based activities, especially in the form of the Posyandu (integrated health post)

Cross-national study of health systems : by . Transaction, New Brunswick, NJ, 1980. 253 pp. [UK pound]15.95

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24096/1/0000353.pd