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SWM518 HealthCare Financing in Low And Middle Income Countries and Achieving UHC Assessment Answer

SWM518  Health Economics and Finance

Topics for individual oral presentation and essay

For your essay (3rd Assignment), you are required to write an essay between 2500 (minimum) – 3000 (maximum) words on the topic

You are expected to cite and relate your perspectives to references such as research papers, government reports, published articles, and so on. Country level statistics gained from publicly available database is highly recommended as further support. Simple statistical analysis using publicly available data set is appreciated, but not necessary.

Topic 1 Role of private health insurance in health care financing

Unlike most OECD countries with universal public insurance, Australia has 50% of the population holding private health insurance (PHI) and at the same time PHI spending accounts for only 8-11% of total health expenditures (like most OECD countries with universal public insurance!). Discuss the underlying reasons and potential approaches to optimize, if necessary, the functioning of PHI in the Australian context.

Topic 2 Australia health system trade-off between efficiency and equity

The Australian healthcare system is unique in its design with a complex system of public and private partnerships in the financing and provision of healthcare services. Discuss the history, current and possible future healthcare system’s design in the context of the classic trade-off between equity and efficiency.

Topic 3 Medical tourism and its implications in demand and supply of health care in a country

Medical tourism is growing phenomenon in some countries like Thailand and India. It brings opportunities as well as challenges in terms of demand and supply of health care. In particular, it burdens existing health systems of a country in terms of extra workload for the health workforces. At the same time, it creates opportunities to earn more revenues for the country. Discuss these issues using a country of example.

Topic 4 Healthcare financing in low- and middle-income countries and achieving universal health coverage (UHC)

In low resource countries, the health financing dependence on external aid (unpredictable, fragmented and subjected to politics) poses great challenges in assuring all citizens access to preventive, curative and rehabilitative services at an affordable cost. Discuss health financing alternatives using a comparative health systems analysis.


Topic- Healthcare financing in low- and middle-income countries and achieving universal health coverage (UHC)


Every year there are incidences of the growing health consequences. The figures show that around one million children suffer from tuberculosis and thirteen million people are diagnosed with cancer. Non-communicable disease is also the leading cause of health consequences including diabetes, arthritis, cardiovascular diseases. There are various health challenges the world is facing. These range from epidemics of vaccination-preventable diseases such as diphtheria and measles, growing reports of medication-resistant pathogens, higher rates of diabetes, heart diseases and physical inactivity to environmental and global warming health consequences, and numerous humanitarian crises. Different countries have their policies and preventive strategies that are for the beneficent effect on health consequences. The low and medium-income countries are usually posed with the challenges of tackling health matters for curative, preventive and rehabilitative matters. World health organization has proposed a five-year strategic plan that aims to address this threats this assessment aims at comparing the healthcare financing, function, and organization of the health care system of different low and middle-income countries. Also, it deals with universal health coverage and comparative health systems. 

Healthcare financing

It is important to understand the nature of the association between socioeconomic status and diseases in middle- and low-income nations and to understand the basic factors and associated mechanisms for the development of contextually relevant health improvement strategies.

Middle-income countries and their healthcare financing

India is among the middle-income countries and has a developing health care system. Many developing policies are made to overcome the disease burden. The organization of the Indian health care involves inpatient care from focused treatment to advanced care with links to referral facilities, secondary care from insight-oriented strategic procurement to output-oriented, in government hospitals from user fees & reimbursement to secure prescription medications, medical and emergency medical services for all, infrastructure and human resource management from a conventional approach to a focused approach to targeting underserved communities, to coordinate primary care delivery and care services for middle and upper classes from marginal initiatives to on-scale guaranteed interventions. Collaboration with other industries is promoted to tackle wider public health determinants, connectivity with healthcare systems for policy efficacy in national health initiatives, in turn, lead to the improvement of quality healthcare systems and facilities and AYUSH is walk-alone to two-dimensional corporatization.. A free public-sector patient care, complemented by strategic acquisitions of secondary care hospital stay and tertiary care facilities both from the public and non-governmental sectors to fill crucial gaps, would be the key strategy to ensure health services. The plan foresees as a short-term step the systematic procurement of secondary and tertiary care services. Federal funding promotes health care service via a variety of generalized grant programs (for example, primary health centres and maternal and reproductive health services) and insurance schemes. 

Specific management of medical or other services offered to people, however, is a small part of the job description of DHHS. The state, federal, and local authority public health system comprised of economic resources (e.g., laboratories), data systems, and procurement (the staff for public health). Equivalently sized and efficiently trained staffs are an important element of the framework for public health. The ability of the government sector to produce those important drugs and vaccinations is also crucial for the long-term health stability of the country and to address those needs including the prevalence of health challenges. These government institutions need expenditure, adequate HR initiatives, and management initiatives to make them similar in the developing world to the performance metrics.

Low-income countries and their healthcare financing

The association between economic status (ES)–a combined historical and cultural predictor in one's experience and comparative economic and social position based on the incidence and mortality of wages, education, employment, and CVDs is reported among a greater number of people in low-income countries the health system encompasses the (government-run) state sector as well as the private sector. Medical services are categorized into a core, secondary and tertiary care by way of health care facilities situated in and operated by government health authorities. As a consequence, the regional authorities are the medical workforce's primary bosses, while the National Health Ministry is accountable for policymaking and implementation. The Amendment of South Africa ensures access to medical facilities for every citizen. 

However, anyone can obtain private and public health services, based on the capacity of a person to pay, with access to government health services. The private medical sector provides basic facilities through private surgical procedures professionals or hospitals that are also situated in urban areas. In 2012, the healthcare system absorbed around 8.0% of the gross domestic income of the world.Most patients have access to medical services through the District Health System of the government sector, which is also the preferred health care process of the government in a primary healthcare strategy. Smoking, excessive drinking, and obesity are some of the common denominators among people living in poverty, not out of increased use, because of lack of employment, less physical activity, nutritious diet, and care or diagnosis. Several recent medical documents categorize nations into categories based on their gross national income (GNI) for every capita in 2010 based on USD (lower-income: average income of $2,000: $1,100–$12,545; higher-income: $13,246). 


The high income, middle-income nations have less medical pressure as compared to the low-income states this is largely due to higher services and medical amenities. Economic security within a community has been stated to allow for greater health and well-being. Proper treatment and heart disease health care services minimize the adverse effects and deteriorations suffered by patients. Middle-income economies, though, have less financial stability. 

The functioning and structure of the healthcare organizations in such countries is not well organized due to a lack of monetary resources. The correlation among economic status (SES)–a composite anthropological and economic indicator in one's professional experience and relative social and economic role dependent on earnings, schooling, profession, and chronic disease occurrence and death is observed among a larger number of population in the countries with low income. Smoking, excessive alcohol consumption and diabetes are some of the common factors among poor not because of more use but may be due to lack of jobs, less physical exercise, healthy nutrition, and care or treatment. Many recent global health documents classify countries into levels based on their per capita gross national income (GNI) based on USD in 2010 (low income: $2.000 middle income: $1.100–$12.545; high income: $13.246). The term upper-middle-income country is now beginning to appear in economic and health literature, referring to one of four categories in the updated classification synthesis.

The phrase social determinants of health are often used to define the economic system's health effects on people living in a specific community. Health social determinants (including health care system) are mainly responsible for health inequalities between countries within them. Historical research has demonstrated a significant impact on the health of economic development and social organization. It has been stated that economic stability within a population permits greater health and wellbeing. Proper provision of healthcare and healthcare facilities for the diseases reduce the harmful effects and deteriorations experienced by patients suffering from different diseases. 

However, the middle-income countries average population among these countries has lower insurance rates. Insurance enables a healthcare receiver to undergo treatment on government and insurance agencies cost. However, low-income countries have a very low number of healthcare insurance holders.

The structure of public healthcare among the developed nations is systematic and responsive. They use the latest scientific technology to treat patients. The high-income nations such as the United States and Australia uses medical alarms for regulating and monitoring the condition of patients suffering from cardiovascular diseases. They have better supervision and surveillance system in comparison to the middle, and low-income nations. Availability of healthcare resources such as medication is sufficient in the high-income countries but the low-income countries are significantly deprived of healthcare resources in the public healthcare units. The public healthcare system of countries such as Australia is significantly responsive toward the health of the patients. They have a general practitioner that refers the patients to specialists under the cost of public health. However, the middle income and low-income countries have fewer services and facilities which force them to undergo treatment in a private healthcare system.  

Among these nations, the average population has lower insurance premiums. Insurance allows a recipient of health care to be treated at the cost of government and medical coverage agencies. Compared to middle and low-income countries, they get a better supervisory and monitoring system.

The middle-income countries provide government support and sufficient funds are required in the population health units. These facilities in the developed and middle-income countries have led to the prevalence and management of chronic disease, like cancer. The middle and low-income countries need to have more efficient and preventive strategies for lowering the burden of chronic diseases.

Universal health coverage

In many high and middle-income countries healthcare system is provided by many different organizations but most of the facilities are operated and owned by the private sectors. Though it covers all the national standards but does not have coverage for universal health.

The ethical issue rises due to the lack of moral human rights in the healthcare system the health care from the universal point of view is only for those who can afford it. The medical services are providing care to the citizens by a multi-payer system in which both the private health insurance and the patients pay for the patient's care. Also, in many countries, there is provision for the single-payer health system in which the tax revenues contribute to the largest amount of the medical care and the government becomes the sole payer for the care providers. Those who provide medical care and manage the healthcare system feel that ensuring the value, availability and cost of healthcare is an ethical issue they need to intervene in continually.

It has been found that an expensive cost of the universal health care system is a drawback for the system. Free universal and affordable health care is the basic human right for individuals as it eliminates the inequalities.

The medical system in many countries does not allow this and it becomes an ethical issue for the doctors and patients too. Patients having fewer wages and incomes can't get access to healthcare when in need; also, the doctors can not treat patients without fees and medical costs. The next issue is the accessibility to the health care in patient’s survey a lot of international and national patients complain about the health care accessibility in a migrant country like the United States.They say they face material hardship and affordability of the healthcare is very poor. Also, those who could afford it had problems in shortfalls of patient engagement, chronic care management, care coordination problems and this leads to poor mental and physical health.

Medicare-for-All is among the best known Public health care forms offered in developed countries. The proposed scenario would be funded by way of taxation and all citizens would be protected. There would no doubt be taxes, co-payments or deductibles through this scheme. Residents can have full rights to essential healthcare services and they will be free to choose their providers. In contrast to this 69% of the citizens worldwide do not have any kind of health insurance this leads to their non-accessibility to the health care and rates of maternal mortality, infant mortality and patients of chronic diseases have been increased.Based on the survey conducted it has been evaluated that 90% of the citizens want that policy leaders should make policies that give priority to universal healthcare so that everyone gets their basic human rights.

Healthcare financing alternatives 

To avoid the high dependency on local taxes and foreign aid, countries may also embark on payroll taxes, private health insurance funds and any other possible source that can lead to sustenance. To develop such techniques, it is required that the government develops sufficient strategies to avoid mismanagement and corruption. However, the specific method applied depends on individual country capabilities to develop the various strategies of revenue collection "Countries must invest at least 1% more of GDP on primary health care to eliminate glaring coverage gaps,". Contrary to this, the new strategies could remain ineffective leading to wastage of the country’s resources. The political atmosphere of the country should be regulated in the aspect of enhancing the strategies of acquiring and managing the various resources the process also requires implementation through policies to ensure that negative influences are eliminated accordingly. 

According to the World Health Organization, purchasing health services remain one of the most important methods of enhancing the effectiveness of health facilities the principle has found application and effectiveness in the various countries which have adopted the practice for the period the process has been in use. Yet, for the middle and low-income countries, the process embarks on a gradual growth until the systems become functional for the particular country although there are financial challenges associated with such practices; the countries strive to cater to some of these needs but that capable benefit much. 

For increased effectiveness of purchases, reforms necessary remains essential in ensuring that the various developments accrue to the necessary practices. The design developed for these practices should accrue to the various countries’ needs to avoid the instances of unworkable processes leading to issues with the government.

In addition to the local private insurance methods, foreign aids may adopt such a strategy to avoid the complexities of operating under governmental institutions. The compelling challenges with the governmentally operated systems are the political issues introduced and prevent the processes from sufficient operations. The locally available insurance types also provide better services to the various patients while the health needs arise. although there is the importance of adopting such programs regulation should be enhanced to ensure that the platforms do not go against the various requirements in the specific country. The external service providers have found these systems provide more effective especially when catering for the health needs of the needy. 

In most countries, the services are provided in the form of non-governmental organizations which run independently in the various countries. These have indicated the effectiveness and positive response from those who receive the services. Subsidizing medications cots is also a favourable strategy for public health. It will act as the pillar of the healthcare and the four key schemes will be supported by eight pillars from sectors such as information, human resource, financing, and regulation. Public funding also will be the main source of funding for both the demand and also the supply of these drugs.


The challenges associated with inadequate healthcare facilities for low and medium-income countries can rarely acquire an exhaustive solution. 

This issue seems even to affect all the efforts from the external funders in enhancing the suitability of the medical processes. Intensification of the problems becomes prevalent when strategies to solve the various issues end up in the hands of inexperienced personnel who lack both the management and technical skills required for effective operations. It remains critical for the various countries to ensure that the institution's considerations are essential for the successful outcome of the various organizations. For complete effectiveness, it is also required that the various authorities inform the public of the healthcare plans in readiness to determine the various societal needs based on the feedback provided. Although the government may embark on some control, it should give room for the private sector to determine the various needs in the attempt to solve any prevalent issues. 

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