ThinkWell, Rue du Mont-Blanc 15, 1201 Geneva, Switzerland.
ThinkWell, Nairobi, Kenya.
Bull World Health Organ. 2020 Feb 1;98(2):126-131. doi: 10.2471/BLT.19.239442. Epub 2019 Dec 12.
As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved.
随着中低收入国家着手进行卫生融资改革以实现全民健康覆盖，人们对更具战略性地向医疗保健提供者分配集合资金重新产生了兴趣。为了使采购更具战略性，各国正在测试不同的提供者支付方法。因此，他们需要有关来自不同购买者的资金流向医疗保健提供者的综合数据，以就支付方法做出决策。跟踪资金流向是包括卫生账户体系和公共支出跟踪调查在内的几种卫生资源跟踪工具的重点。本研究以肯尼亚为例，探讨这些卫生资源跟踪工具是否生成了用于告知战略采购改革的信息类型。我们对肯尼亚三个县的定性评估表明，不同的公共购买者，即县卫生局和国家医疗保险机构，通过各种支付方式向公共设施付款。其中一些资金是实物支付，而另一些是财政转移。资金流动的性质以及设施保留和使用资金的财务自主权在各县和护理级别之间存在很大差异。政府经常开展不同的卫生资源跟踪活动，以为卫生政策和规划提供信息。然而，由于这些活动最初并非旨在提供此类见解，因此仍然缺乏有关公共设施资金流向的综合数据的良好来源。因此，我们认为可以改进这些方法以跟踪此类信息，从而改善战略采购。我们还提供了如何实现这种增强的建议。
