More money for health - More health for the money

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  ■■  No country has yet been able to guarantee everyone immediate access to all the services that might maintain or improve their health. They all face resource constraints of one type or another, although these are most critical in low-income countries.
  
• ■■  Every country could raise additional domestic funds for health or diversify their funding sources if they wished to.
  
• ■■  Options include governments giving higher priority to health in their budget allocations, collecting taxes or insurance contributions more efficiently and raising additional funds through various types of innovative financing.
  
• ■■  Taxes on harmful products such as tobacco and alcohol are one such option. They reduce consumption, improve health and increase the resources governments can spend on health.
  
• ■■  Even with these innovations, increased donor flows will be necessary for most of the poorest countries for a considerable period of time. Donor countries can also raise more funds to channel to poorer countries in innovative ways, but they should also do more to meet their stated international commitments for official development assistance (ODA) and to provide more predictable and long-term aid flows.
• More money for health   
  
  
  • ■■  All countries can do something, many of them a great deal, to improve the efficiency of their health systems, thereby releasing resources that could be used to cover more people, more services and/or more of the costs.
    
  • ■■  Some of these actions would aim to improve efficiency in a particular area of the health system, such as medicines. Others would address the incentives inherent in the health financing system; in particular, how services are bought and providers paid.
    
  • ■■  All countries can look to improve efficiency by taking a more strategic approach when providing or buying health services, e.g. decide which services to purchase based on information on the health needs of the population and link payments to providers on their performance and to information on service costs, quality and impact.
    
  • ■■  All provider payment mechanisms have strengths and weaknesses, but particular care should be taken with fee-for-service payments, which offer incentives to over-service those people who can pay or who are covered from pooled funds, and to underservice those who cannot pay.
    
  • ■■  Reducing fragmentation in the flow and pooling of funds for health and in service delivery will also increase efficiency.
    
  • ■■  There is no convincing evidence that private-sector health facilities are more, or less, efficient than government facilities. It depends on the setting.
    
  • ■■  By setting rules and ensuring they are followed, effective governance is the key to improving efficiency and equity.
    
  • ■■  Donors can also contribute by helping to develop domestic financing institutions and by reducing the fragmented way their funds are delivered and countries are asked to report on their use. They could also reduce duplication at the global level. 
    More health for the money