This volume presents the results of research which represent a significant contribution to the knowledge of equity in the finance and delivery of health care in ten countries. It compares the experience of nine European countries and the US using a consistent methodology to draw out comparable results from ten very different health care systems. Such an approach facilitates not only a greater understanding of the performance of the health care systems of other countries but also the identification of the lessons that can be learnt from international comparisons. In recent years it has been recognized that many health and health care problems are similar across many countries and their solution can be usefuly informed by the abandonment both of isolation and the belief that an individual country's problems are unique. The contents of this book demonstrate that given efficient research teams, research funding can produce both significant new knowledge of direct relevance to the reform of health care systems world-wide, and also collaborative, mutually informative work between Europeans and others living outside the EEC.

Reforming Health Care Systems brings together the work of leading economic scholars on the reform and development of the United Kingdom's National Health Service and the implications of this process for health care systems worldwide.It addresses important issues such as the financing of medical care, assessments of health care effectiveness, the need for rationing resources and the wider determinants of health in society. The contributors to this stimulating, thought-provoking volume discuss a breadth of topics and approaches. Placing the UK's health service in an international context, the authors also examine economic understandings of the health care market, the place of contracts and competition, capital and labour markets for health, health care funding and equity in the rationing of health care. Students, researchers and policy makers will welcome Reforming Health Care Systems for challenging established views and beliefs in order to examine fundamental issues concerned with health care, how it should be delivered and how it should be financed.

'Reforming China s Rural Health System' examines the performance and workings of China s rural health system leading up to the reforms of the 2000s, outlines the reforms, and presents some early evidence on their impacts. The authors outline ideas for building on these reforms to further strengthen China s rural health system, covering health financing and health insurance, service delivery, and public health. The authors conclude by using the experiences of the Organisation for Economic Co-operation and Development countries to gaze into China s future, asking not only what China s health system might look like, but also how China might get there from where it is today. 'Reforming China s Rural Health System' will be of interest to health care policy makers, public health officials, university researchers, and others working to improve rural health and health service delivery in China and in other countries especially those in East and South Asia."

Vietnam s successes in the health sector are remarkable. Between 2000 and 2005, Vietnam achieved reductions in mortality rates for all ages, while some of its neighbors saw little change or even increases. To date, its infant and under-five mortality rates are comparable to those of countries with substantially higher per capita incomes. According to the data assembled in 'Health Financing and Delivery in Vietnam', the country continues to perform strongly in the sector, but its health care system is facing new challenges, as do those of other countries. By international standards, for example, a large percentage of Vietnamese households make out-of-pocket health care payments that exceed a reasonable fraction of their income. The country has been expanding the breadth of health insurance coverage, but questions remain on how to further expand coverage, how to decrease health care costs, and how to increase the overall quality of care. 'Health Financing and Delivery in Vietnam' reviews the country s successes and the challenges it faces, and suggests some options for further reforming the country s health system. These include the issue of stewardship what different parts of government (for example, the Health Ministry and the health insurer) should be doing at each level of government, and what different levels of government (for example, the central government and the provincial government) ought to be doing. 'Health Financing and Delivery in Vietnam' will be of interest to readers working in the areas of public health and social analysis and policy."

Have gaps in health outcomes between the poor and better off grown? Are they larger in one country than another? Are health sector subsidies more equally distributed in some countries than others? Are health care payments more progressive in one health care financing system than another? What are catastrophic payments and how can they be measured? How far do health care payments impoverish households? Answering questions such as these requires quantitative analysis. This in turn depends on a clear understanding of how to measure key variables in the analysis, such as health outcomes, health expenditures, need, and living standards. It also requires set quantitative methods for measuring inequality and inequity, progressivity, catastrophic expenditures, poverty impact, and so on. This book provides an overview of the key issues that arise in the measurement of health variables and living standards, outlines and explains essential tools and methods for distributional analysis, and, using worked examples, shows how these tools and methods can be applied in the health sector. The book seeks to provide the reader with both a solid grasp of the principles underpinning distributional analysis, while at the same time offering hands-on guidance on how to move from principles to practice.

This volume presents eleven case studies that document how well or poorly health, nutrition, and population programs have reached disadvantaged groups in the countries of Africa, Asia, and Latin America where they were undertaken. The studies were commissioned by the Reaching the Poor Program, undertaken by the Word Bank in cooperation with the Bill and Melinda Gates Foundation and the Dutch and Swedish governments, in an effort to find better ways of ensuring that health, nutrition, and population programs benefit the neediest. These case studies, reinforced by other material gathered by the Reaching the Poor Program, indicate clearly that health programs do not have to be inequitable. Although most health, nutrition, and population services achieve much lower coverage among disadvantaged groups than among the better-off, many significant and instructive exceptions exist. These show that the poor can be reached much more effectively than at present and point to potentially promising strategies for doing so.

This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines.