Unmet Health Needs of Two Billion : Is Community Financing a Solution?
2001
Hsiao, William C.
One of the most urgent and vexing problem around the world is how to finance and provide health care for the more than two billion peasants and ghetto dwellers in low- and middle-income countries. Part I of this paper develops a conceptual framework for community financing and uses it to clarify and classify the variety of community financing schemes. This section of the papers discusses the impact of community financing schemes on outcomes and compares them to several African countries. Part II uses the conceptual framework developed above to explain why some community financing schemes in Asia have been successful and why some have failed. The review points to a number of measure that governments could take to strengthen such community financing. They include subsidizing the premiums of the poor, providing technical assistance to improve scheme management capacity, and forging links with formal health care networks. Satisfaction with the scheme was often related to the nature of direct community involvement in their design and management. A critical factor was the matching willingness and ability to pay with the expectation of benefits to be received at some later time. The review also highlighted several areas of government actions that appear to have a negative impact on the function of community financing schemes. Top-down interference with scheme design and management appeared to have a particularly negative impact on their function and sustainability.
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