Healthcare Policy And Finance
Expert-defined terms from the Postgraduate Certificate in Health Financing and Budgeting course at LearnUNI. Free to read, free to share, paired with a professional course.
A market condition where individuals with higher health risks are more likely to… #
A market condition where individuals with higher health risks are more likely to enroll in insurance, while healthier individuals opt out, leading to an imbalanced risk pool.
Example #
In a voluntary health insurance scheme, chronic‑ill patients disproportionately enroll, raising average costs.
Practical application #
Designing mandatory enrollment or community rating to mitigate adverse selection.
Challenges #
Political resistance to compulsory participation; administrative costs of enforcement.
The systematic process through which health ministries plan, approve, allocate,… #
The systematic process through which health ministries plan, approve, allocate, and monitor financial resources over a fiscal year.
Example #
A Ministry of Health prepares a three‑year rolling budget, revises allocations mid‑year based on expenditure reports.
Practical application #
Aligning budget cycles with program timelines to ensure funding continuity.
Challenges #
Delays in approval, mismatched timing between program delivery and fund release.
A defined set of health interventions, services, and medicines that a financing… #
A defined set of health interventions, services, and medicines that a financing scheme guarantees to its beneficiaries.
Example #
A national health insurance scheme includes outpatient visits, maternal care, and a list of 200 essential medicines.
Practical application #
Using cost‑effectiveness analysis to prioritize services within the package.
Challenges #
Balancing comprehensiveness with fiscal sustainability; updating the package as technology evolves.
A fixed amount paid to a health provider per enrolled individual for a defined p… #
A fixed amount paid to a health provider per enrolled individual for a defined period, regardless of actual services delivered.
Example #
A primary‑care clinic receives $30 per adult per month to manage preventive and curative care.
Practical application #
Incentivizing providers to focus on preventive services and efficient resource use.
Challenges #
Risk of under‑service; need for robust monitoring of quality and outcomes.
A methodological approach that compares the relative costs and health outcomes o… #
A methodological approach that compares the relative costs and health outcomes of two or more interventions to determine the most efficient use of resources.
Example #
Comparing a new vaccine’s cost per DALY averted with that of an existing vaccine.
Practical application #
Informing inclusion decisions in benefit packages.
Challenges #
Data limitations, valuation of health outcomes, ethical considerations of equity.
A form of economic evaluation that measures health outcomes in terms of both qua… #
A form of economic evaluation that measures health outcomes in terms of both quantity and quality of life, typically using QALYs.
Example #
Assessing a surgical procedure’s cost per QALY gained versus a less invasive alternative.
Practical application #
Guiding reimbursement decisions for high‑cost technologies.
Challenges #
Assigning utility values across cultures; handling uncertainty in long‑term outcomes.
The practice of using revenues from higher‑income or lower‑risk groups to subsid… #
The practice of using revenues from higher‑income or lower‑risk groups to subsidize services for lower‑income or higher‑risk populations.
Example #
Payroll taxes from formal sector workers fund services for informal sector beneficiaries.
Practical application #
Designing tax brackets or contribution rates that achieve equity.
Challenges #
Ensuring transparency; avoiding disincentives for high‑income contributors.
The transfer of authority, responsibility, and resources for health service deli… #
The transfer of authority, responsibility, and resources for health service delivery from central to sub‑national entities.
Example #
Provincial health departments receive direct budget allocations to manage local hospitals.
Practical application #
Tailoring services to regional health needs and improving accountability.
Challenges #
Variable capacity across regions; risk of fragmentation and duplication.
Mechanisms that provide financial resources directly to households or patients,… #
Mechanisms that provide financial resources directly to households or patients, enabling them to purchase health services from providers of choice.
Example #
A maternal health voucher program that reimburses women for antenatal visits.
Practical application #
Empowering patients, stimulating competition among providers.
Challenges #
Ensuring provider quality; preventing fraud and misuse of funds.
Systematic appraisal of the costs and outcomes of health interventions to inform… #
Systematic appraisal of the costs and outcomes of health interventions to inform resource allocation decisions.
Example #
Evaluating the net monetary benefit of a national immunization program.
Practical application #
Prioritizing interventions under limited budgets.
Challenges #
Selecting appropriate discount rates; capturing non‑monetary benefits.
The set of conditions that determine who may access a particular health financin… #
The set of conditions that determine who may access a particular health financing scheme or service.
Example #
Residents aged 65 and above qualify for a subsidized chronic disease management program.
Practical application #
Targeting resources to intended populations while minimizing leakage.
Challenges #
Administrative burden of verification; potential exclusion errors.
Indirect effects of health interventions that affect third parties not directly… #
Indirect effects of health interventions that affect third parties not directly involved in the transaction.
Example #
Vaccinating children reduces disease transmission to the broader community.
Practical application #
Justifying public investment in preventive measures.
Challenges #
Quantifying external benefits; integrating them into cost‑effectiveness calculations.
The capacity of a government to allocate additional resources for health without… #
The capacity of a government to allocate additional resources for health without jeopardizing fiscal sustainability.
Example #
A country expands its fiscal space by improving tax collection efficiency and reallocating existing budget lines.
Practical application #
Planning long‑term health investments and scaling up programs.
Challenges #
Competing priorities, macro‑economic volatility, debt constraints.
The difference between the financial resources required to achieve health object… #
The difference between the financial resources required to achieve health objectives and the resources actually available.
Example #
An HIV program estimates a $200 million gap to meet 2025 targets.
Practical application #
Mobilizing additional domestic or external funding, redesigning cost structures.
Challenges #
Accurate gap estimation; donor dependency risk.
The allocation of fiscal responsibilities and revenue‑raising powers to lower le… #
The allocation of fiscal responsibilities and revenue‑raising powers to lower levels of government.
Example #
Municipalities receive a share of national health taxes to fund local clinics.
Practical application #
Aligning revenue sources with expenditure responsibilities.
Challenges #
Ensuring equitable distribution; preventing fiscal imbalances.
A predetermined payment amount for a specific service, regardless of the actual… #
A predetermined payment amount for a specific service, regardless of the actual cost incurred by the provider.
Example #
A flat fee of $150 for a standard cesarean delivery.
Practical application #
Simplifying billing and containing costs.
Challenges #
May not reflect regional cost variations; potential under‑compensation.
A systematic process that evaluates the potential health effects of a policy, pr… #
A systematic process that evaluates the potential health effects of a policy, program, or project in non‑health sectors.
Example #
Assessing the health implications of a new urban transport plan.
Practical application #
Integrating health considerations into all‑of‑government decision‑making.
Challenges #
Data availability; inter‑agency coordination.
A contractual arrangement where individuals or groups pay regular contributions… #
A contractual arrangement where individuals or groups pay regular contributions (premiums) to obtain coverage for a defined set of health services.
Example #
A national compulsory health insurance scheme funded through payroll taxes.
Practical application #
Spreading financial risk and improving access to care.
Challenges #
Adverse selection, ensuring affordability, managing moral hazard.
A multidisciplinary evaluation of the clinical effectiveness, cost‑effectiveness… #
A multidisciplinary evaluation of the clinical effectiveness, cost‑effectiveness, and broader impact of health technologies.
Example #
An HTA determines whether a new oncology drug should be listed on the national formulary.
Practical application #
Informing coverage decisions and price negotiations.
Challenges #
Limited local data; time‑intensive appraisal processes.
The amount paid by an individual or employer to maintain health insurance covera… #
The amount paid by an individual or employer to maintain health insurance coverage over a specified period.
Example #
Employees contribute 5 % of their monthly salary to the national health insurance fund.
Practical application #
Calculating sustainable contribution levels based on demographic risk profiles.
Challenges #
Balancing affordability with financial adequacy; adjusting for inflation.
Monetary flows from higher to lower levels of government intended to support the… #
Monetary flows from higher to lower levels of government intended to support the provision of public services, including health.
Example #
Central government allocates a health grant to provinces based on per‑capita need.
Practical application #
Reducing regional disparities in health financing.
Challenges #
Conditionality, monitoring usage, political negotiations over formulas.
Quantitative measures used to assess the efficiency, effectiveness, and impact o… #
Quantitative measures used to assess the efficiency, effectiveness, and impact of health financing and service delivery.
Example #
Percentage of health facilities receiving timely budget disbursements.
Practical application #
Guiding performance‑based financing and accountability mechanisms.
Challenges #
Selecting relevant indicators; data quality and timeliness.
An approach that captures all costs associated with a health intervention over i… #
An approach that captures all costs associated with a health intervention over its entire lifespan, from acquisition to disposal.
Example #
Calculating the total cost of a medical imaging equipment, including purchase, maintenance, training, and decommissioning.
Practical application #
Supporting procurement decisions and budgeting for capital assets.
Challenges #
Forecasting future costs; incorporating uncertainty.
Government strategies concerning revenue generation, public expenditure, and deb… #
Government strategies concerning revenue generation, public expenditure, and debt management that affect overall economic stability and health sector funding.
Example #
A fiscal consolidation plan reduces health spending as a share of GDP, prompting advocacy for protection of essential services.
Practical application #
Aligning health financing with broader economic goals.
Challenges #
Balancing austerity with health equity; political pressures.
Setting the price of a health service equal to the additional cost incurred by p… #
Setting the price of a health service equal to the additional cost incurred by providing one more unit of that service.
Example #
Charging patients the marginal cost of an additional laboratory test.
Practical application #
Encouraging efficient use of scarce resources.
Challenges #
Determining accurate marginal costs; potential price volatility.
A personal account into which individuals can deposit pre‑tax income to pay for… #
A personal account into which individuals can deposit pre‑tax income to pay for qualified medical expenses.
Example #
An employee contributes $2,000 annually to an MSA used for out‑of‑pocket drug purchases.
Practical application #
Promoting consumer responsibility and cost awareness.
Challenges #
Risk of under‑utilization of needed care; inequitable savings capacity.
The combination of multiple financing sources #
such as taxes, social health insurance, private insurance, and out‑of‑pocket payments—to fund health services.
Example #
A health system relies 40 % on general taxation, 30 % on payroll contributions, 20 % on private insurance, and 10 % on out‑of‑pocket.
Practical application #
Diversifying revenue streams to enhance resilience.
Challenges #
Coordination among sources; avoiding duplication and gaps.
Payments made directly by households to health providers at the point of service… #
Payments made directly by households to health providers at the point of service, not reimbursed by any third‑party payer.
Example #
A patient pays $50 for a clinic visit without insurance coverage.
Practical application #
Monitoring OOP levels to assess progress toward universal health coverage.
Challenges #
Catastrophic spending, inequitable access, discouraging care‑seeking.
A financing mechanism that links disbursements to the achievement of predefined… #
A financing mechanism that links disbursements to the achievement of predefined performance targets.
Example #
A district receives additional funds if immunization coverage exceeds 90 %.
Practical application #
Motivating providers to improve quality and efficiency.
Challenges #
Designing reliable verification systems; risk of data manipulation.
Financing health services based on the size of the population served rather than… #
Financing health services based on the size of the population served rather than on services rendered.
Example #
A regional health authority receives $200 per resident annually to fund primary care.
Practical application #
Encouraging preventive care and cost control.
Challenges #
Adjusting for demographic variations; preventing under‑service.
A tax structure in which the tax rate increases as the taxable base (e #
g., income) rises, resulting in a larger share of revenue from higher‑income groups.
Example #
Income tax rates of 10 % for low earners, 30 % for high earners.
Practical application #
Generating resources for health while reducing inequality.
Challenges #
Tax avoidance, political opposition, administrative complexity.
A collaborative arrangement between government and private sector entities to de… #
A collaborative arrangement between government and private sector entities to design, finance, build, and/or operate health facilities or services.
Example #
A private firm constructs a hospital and operates it under a 20‑year lease with the government.
Practical application #
Leveraging private capital and expertise to expand infrastructure.
Challenges #
Risk allocation, ensuring affordable tariffs, maintaining public accountability.
A statistical method used to modify payments to health insurers or providers bas… #
A statistical method used to modify payments to health insurers or providers based on the health risk profile of their enrolled populations.
Example #
Insurers with a higher proportion of chronic disease patients receive additional funds.
Practical application #
Reducing incentives for risk selection and promoting equity.
Challenges #
Accurate risk modeling; data privacy concerns.
The aggregation of financial contributions from many individuals to spread the f… #
The aggregation of financial contributions from many individuals to spread the financial risk of health expenditures across the pool.
Example #
A national health insurance fund pools payroll contributions from all formal workers.
Practical application #
Protecting individuals from catastrophic health costs.
Challenges #
Maintaining solvency; ensuring contributions reflect risk diversity.
A scheme where workers and employers contribute a fixed percentage of wages to a… #
A scheme where workers and employers contribute a fixed percentage of wages to a health insurance fund that provides universal coverage.
Example #
Germany’s statutory health insurance system funded by a 14.6 % contribution split between employee and employer.
Practical application #
Achieving near‑universal coverage through employment‑linked financing.
Challenges #
Covering informal sector workers; managing cost inflation.
Budgeting approach that allocates funds according to the origin of financing (e #
g., tax, donor, insurance) rather than by programmatic need.
Example #
Separate budget lines for donor‑funded HIV programs and tax‑funded maternal health services.
Practical application #
Facilitating donor reporting and compliance.
Challenges #
Fragmentation, reduced flexibility for cross‑cutting initiatives.
The process of actively deciding which health services to buy, from whom, and at… #
The process of actively deciding which health services to buy, from whom, and at what price, based on evidence of effectiveness and efficiency.
Example #
An agency contracts private labs only if they meet turnaround‑time standards and cost thresholds.
Practical application #
Aligning incentives with health system goals.
Challenges #
Data requirements, negotiating power imbalances, monitoring compliance.
Funding mechanisms aimed at enhancing the capacity, quality, and availability of… #
Funding mechanisms aimed at enhancing the capacity, quality, and availability of health service providers and facilities.
Example #
Government allocates capital grants to upgrade rural health centers with solar power.
Practical application #
Reducing geographic disparities and improving service readiness.
Challenges #
Long implementation timelines, maintenance sustainability.
A health financing model where public funds collected through general taxation a… #
A health financing model where public funds collected through general taxation are used to provide health services to the entire population, often at no point‑of‑service charge.
Example #
The United Kingdom’s National Health Service (NHS) is primarily funded through income and value‑added taxes.
Practical application #
Ensuring equity and simplifying administration.
Challenges #
Vulnerability to fiscal shocks; political pressure on tax rates.
Financial assistance provided to specific population groups based on income, geo… #
Financial assistance provided to specific population groups based on income, geography, or health status to improve access to services.
Example #
Low‑income families receive vouchers covering 80 % of transportation costs to health facilities.
Practical application #
Reducing financial barriers for vulnerable groups.
Challenges #
Identifying eligible beneficiaries; risk of exclusion errors.
A strategic approach that simultaneously seeks to improve health outcomes, enhan… #
A strategic approach that simultaneously seeks to improve health outcomes, enhance patient experience, and reduce per‑capita health expenditures.
Example #
A health system implements integrated care pathways to lower readmission rates while boosting satisfaction scores.
Practical application #
Guiding policy reforms and performance measurement.
Challenges #
Balancing competing objectives; data integration across domains.
The commitment that all individuals receive the health services they need withou… #
The commitment that all individuals receive the health services they need without suffering financial hardship.
Example #
A country adopts a UHC law guaranteeing a basic benefits package financed through a mix of taxes and insurance.
Practical application #
Setting national health financing targets (e.g., coverage of 80 % of the population).
Challenges #
Mobilizing sufficient resources; ensuring equitable service quality.
An insurance benefit structure that sets patient cost‑sharing levels based on th… #
An insurance benefit structure that sets patient cost‑sharing levels based on the clinical value of services, encouraging use of high‑value care and discouraging low‑value interventions.
Example #
No copayment for statins for patients with cardiovascular risk, higher copayment for non‑essential supplements.
Practical application #
Improving health outcomes while controlling costs.
Challenges #
Defining “value” across diverse conditions; administrative complexity.
The consolidation of multiple levels of health care (e #
g., primary, secondary, tertiary) under a single organizational or financial entity.
Example #
A health authority owns both community clinics and a regional hospital, sharing budgets and data systems.
Practical application #
Facilitating coordinated care pathways and resource sharing.
Challenges #
Potential monopoly power; regulatory oversight.
A program that issues vouchers to eligible individuals, allowing them to obtain… #
A program that issues vouchers to eligible individuals, allowing them to obtain specific health services from accredited providers, with the provider reimbursed by the scheme administrator.
Example #
A maternal health voucher covering antenatal visits, delivery, and post‑natal care.
Practical application #
Expanding access while preserving patient choice.
Challenges #
Monitoring provider compliance; preventing voucher fraud.
A capitation model where payment amounts are adjusted for demographic and health… #
A capitation model where payment amounts are adjusted for demographic and health‑status characteristics of the enrolled population.
Example #
Higher per‑person rates for districts with a larger elderly population.
Practical application #
Aligning funding with expected service utilization.
Challenges #
Accurate risk data; potential incentives for “cream‑skimming.”
A budgeting approach that starts from a “zero base” each cycle, requiring justif… #
A budgeting approach that starts from a “zero base” each cycle, requiring justification for every line item rather than adjusting previous budgets.
Example #
Health ministries must submit detailed cost justifications for each program, even if unchanged.
Practical application #
Identifying inefficiencies and reallocating resources to high‑impact areas.
Challenges #
Time‑intensive preparation; resistance from entrenched departments.
An accounting method that records revenues when earned and expenses when incurre… #
An accounting method that records revenues when earned and expenses when incurred, regardless of cash movement.
Example #
Recognizing a government health grant as revenue when the commitment is signed, not when funds are transferred.
Practical application #
Providing a more accurate picture of financial obligations and resource availability.
Challenges #
Complexity of implementation; need for robust information systems.
Example #
A health grant formula that gives a base amount per 1,000 residents plus an additional weight for high‑mortality districts.
Practical application #
Promoting transparent and equitable financing across regions.
Challenges #
Data reliability; political negotiations over weightings.
Systematic examination of financial records and operations to ensure accuracy, l… #
Systematic examination of financial records and operations to ensure accuracy, legality, and efficiency of health spending.
Example #
An external audit of a national health insurance fund identifies misallocated procurement funds.
Practical application #
Detecting fraud, enhancing accountability, and informing corrective actions.
Challenges #
Capacity constraints; potential resistance from audited entities.
A technique that evaluates how the benefits of public spending are distributed a… #
A technique that evaluates how the benefits of public spending are distributed across different income groups.
Example #
BIA shows that 70 % of a maternal health program’s benefits accrue to the top quintile, indicating pro‑rich bias.
Practical application #
Guiding policy adjustments to improve progressivity.
Challenges #
Data on household consumption; methodological complexity.
Budgeting that records only cash inflows and outflows, ignoring accruals and non… #
Budgeting that records only cash inflows and outflows, ignoring accruals and non‑cash transactions.
Example #
A health department records the disbursement of donor cash grants without recognizing future obligations.
Practical application #
Simpler cash management for short‑term operations.
Challenges #
May underestimate true financial commitments; limited insight for long‑term planning.
A fixed amount paid by the patient at the point of service, in addition to the a… #
A fixed amount paid by the patient at the point of service, in addition to the amount covered by the insurer or government.
Example #
A $10 co‑payment for each outpatient visit under a national insurance scheme.
Practical application #
Discouraging unnecessary utilization and generating revenue.
Challenges #
Potential barrier for low‑income patients; risk of delayed care.
Setting fees for services such that total revenues equal the cost of providing t… #
Setting fees for services such that total revenues equal the cost of providing those services, without profit margin.
Example #
A public hospital charges patients the exact cost of a surgical procedure, calculated annually.
Practical application #
Ensuring financial sustainability of fee‑based services.
Challenges #
Accurate cost data; may not cover capital investment needs.
Any arrangement where the patient bears a portion of the cost of health services… #
Any arrangement where the patient bears a portion of the cost of health services, typically through co‑payments, deductibles, or coinsurance.
Example #
An insurance plan requires a 20 % coinsurance for specialist visits.
Practical application #
Reducing moral hazard and generating additional revenue.
Challenges #
Equity concerns; potential to deter needed care.
The amount a patient must pay out‑of‑pocket before an insurer begins to cover su… #
The amount a patient must pay out‑of‑pocket before an insurer begins to cover subsequent expenses.
Example #
A health plan has a $500 annual deductible for inpatient services.
Practical application #
Sharing risk and limiting insurer exposure to low‑cost claims.
Challenges #
Financial burden for low‑income households; may delay care seeking.
A situation where a health system’s budget heavily relies on foreign aid, making… #
A situation where a health system’s budget heavily relies on foreign aid, making it vulnerable to donor policy changes and funding fluctuations.
Example #
45 % of a country’s immunization budget comes from bilateral donors.
Practical application #
Planning for transition strategies and increasing domestic revenue.
Challenges #
Maintaining program continuity; negotiating donor exit.
The increase in a country’s production of goods and services, which can expand t… #
The increase in a country’s production of goods and services, which can expand the fiscal space available for health financing.
Example #
A 4 % annual GDP growth enables a 2 % increase in health budget allocations.
Practical application #
Linking health financing reforms to macro‑economic planning.
Challenges #
Growth may be uneven; health spending may not automatically rise with GDP.
A systematic approach that compares the costs and outcomes of alternative health… #
A systematic approach that compares the costs and outcomes of alternative health interventions to inform resource allocation.
Example #
Evaluating the net monetary benefit of scaling up antiretroviral therapy.
Practical application #
Prioritizing interventions under constrained budgets.
Challenges #
Data gaps; translating results into policy decisions.
A quantitative or qualitative benchmark that determines who qualifies for a heal… #
A quantitative or qualitative benchmark that determines who qualifies for a health financing benefit.
Example #
Households earning less than $2 per day are eligible for a free primary‑care card.
Practical application #
Targeting subsidies to those most in need.
Challenges #
Accurate income verification; risk of exclusion errors.
The potential for changes in currency values to affect the real purchasing power… #
The potential for changes in currency values to affect the real purchasing power of health budgets, especially when financing is sourced internationally.
Example #
A devaluation of the local currency reduces the value of a US‑dollar‑denominated vaccine grant.
Practical application #
Hedging strategies or converting funds to local currency promptly.
Challenges #
Limited financial instruments; forecasting accuracy.
Payments made to service foreign‑origin debt, which can limit the amount of fisc… #
Payments made to service foreign‑origin debt, which can limit the amount of fiscal space available for health spending.
Example #
A country allocates 1.5 % of GDP to external debt service, reducing resources for the health sector.
Practical application #
Debt restructuring to free up funds for health investments.
Challenges #
Negotiating with creditors; maintaining creditworthiness.
The process of assigning revenue‑raising and expenditure responsibilities to low… #
The process of assigning revenue‑raising and expenditure responsibilities to lower levels of government.
Example #
Provinces gain authority to levy property taxes to fund local health clinics.
Practical application #
Aligning financing with service delivery responsibilities.
Challenges #
Capacity disparities; ensuring equitable resource distribution.
Example #
A tax increase on sugary drinks earmarked for nutrition programs.
Practical application #
Using fiscal tools to promote public health objectives.
Challenges #
Balancing economic growth with health priorities; political feasibility.
The ability of a government to maintain its current level of health spending wit… #
The ability of a government to maintain its current level of health spending without compromising future fiscal stability.
Example #
A health budget that grows at a rate no higher than the projected increase in tax revenues.
Practical application #
Setting long‑term financing targets and monitoring debt levels.
Challenges #
Unexpected economic shocks; competing budgetary demands.
A payment system where providers receive a predetermined amount for a specific s… #
A payment system where providers receive a predetermined amount for a specific service, irrespective of the actual cost incurred.
Example #
A standard fee of $120 for an uncomplicated hysterectomy.
Practical application #
Controlling provider incentives for over‑utilization.
Challenges #
May not reflect regional cost variations; potential under‑payment.
Example #
A multinational firm invests $50 million in a private diagnostic center.
Practical application #
Expanding service capacity and technology transfer.
Challenges #
Regulatory oversight; ensuring alignment with national health goals.
Government income derived from broad‑based taxes (e #
g., income, VAT) that is not earmarked for specific sectors.
Example #
60 % of a country’s health budget comes from general revenue.
Practical application #
Providing flexibility for cross‑cutting health initiatives.
Challenges #
Vulnerability to macro‑economic fluctuations; competition with other sectors for allocation.
Systematic recording, classification, and analysis of financial transactions rel… #
Systematic recording, classification, and analysis of financial transactions related to health services and programs.
Example #
Implementing a health accounts framework that tracks expenditures by function (e.g., curative, preventive).
Practical application #
Enhancing transparency, facilitating budgeting, and supporting audits.
Challenges #
Data integration across ministries; capacity for detailed cost tracking.
All monetary resources spent on health services, public health functions, and he… #
All monetary resources spent on health services, public health functions, and health system administration.
Example #
National health expenditure reached 7 % of GDP in 2022.
Practical application #
Benchmarking against international standards and tracking trends.
Challenges #
Disaggregating data by source and function; addressing informal payments.
The shift from external aid dependence to greater reliance on domestic revenue s… #
The shift from external aid dependence to greater reliance on domestic revenue streams for health system funding.
Example #
A country plans to replace a donor‑funded HIV program with a national insurance contribution.
Practical application #
Developing sustainable financing policies and capacity building.
Challenges #
Ensuring continuity of services; political commitment.
Financial support provided by the government to lower the cost of health insuran… #
Financial support provided by the government to lower the cost of health insurance premiums for low‑income households.
Example #
A 50 % subsidy on monthly premiums for families below the poverty line.
Practical application #
Expanding coverage while maintaining affordability.
Challenges #
Targeting accuracy; fiscal impact on government budgets.
A structured process that predicts the health effects of a proposed policy, prog… #
A structured process that predicts the health effects of a proposed policy, program, or project in non‑health sectors.
Example #
Conducting an HIA for a new industrial zone to assess potential respiratory disease risks.
Practical application #
Informing decision‑makers and mitigating adverse health outcomes.
Challenges #
Limited inter‑agency data sharing; integrating findings into final decisions.
A measurable variable that reflects the health status of a population or the eff… #
A measurable variable that reflects the health status of a population or the effectiveness of a health intervention.
Example #
Under‑5 mortality rate per 1,000 live births.
Practical application #
Monitoring progress toward health targets and evaluating programs.
Challenges #
Data reliability; timeliness of reporting.
The extent to which health resources are used to maximize health outcomes withou… #
The extent to which health resources are used to maximize health outcomes without waste.
Example #
Reducing average length of stay in hospitals while maintaining quality of care.
Practical application #
Implementing performance‑based financing and process improvements.
Challenges #
Measuring efficiency accurately; resistance to change.
A multidisciplinary evaluation of the clinical, economic, ethical, and social im… #
A multidisciplinary evaluation of the clinical, economic, ethical, and social implications of health technologies.
Example #
HTA of a novel gene‑editing therapy informs price negotiations.
Practical application #
Guiding coverage decisions and pricing strategies.
Challenges #
Limited local data; long appraisal timelines.
Allocation of financial resources to recruit, train, and retain health personnel #
Allocation of financial resources to recruit, train, and retain health personnel.
Example #
A government earmarks 15 % of the health budget for nursing scholarships.
Practical application #
Addressing shortages and improving service quality.
Challenges #
Balancing remuneration with fiscal constraints; brain drain.
An approach that integrates health considerations into policymaking across all s… #
An approach that integrates health considerations into policymaking across all sectors to improve population health and health equity.
Example #
Including health impact criteria in urban planning decisions.
Practical application #
Coordinated budgeting and joint implementation mechanisms.
Challenges #
Institutional silos; measuring health co‑benefits.
A research instrument that gathers information from households about health serv… #
A research instrument that gathers information from households about health service utilization, financing, and outcomes.
Example #
A Demographic and Health Survey captures out‑of‑pocket spending on childbirth.
Practical application #
Informing policy design and monitoring financial protection.
Challenges #
Recall bias; sampling representativeness.
A financing mechanism where contributions are proportionate to an individual’s e… #
A financing mechanism where contributions are proportionate to an individual’s earnings.
Example #
Employees contribute 3 % of their monthly salary to the national health insurance fund.
Practical application #
Aligning financing with ability‑to‑pay principles.
Challenges #
Capturing informal sector earnings; enforcement.
Modifying monetary values to reflect changes in the price level over time, ensur… #
Modifying monetary values to reflect changes in the price level over time, ensuring comparability of financial data.
Example #
Adjusting a five‑year health