top of page
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

Screen Shot 2018-08-12 at 1.24.09 AM.png
Screen Shot 2018-08-12 at 1.24.02 AM.png
Screen Shot 2018-08-12 at 1.23.57 AM.png
Screen Shot 2018-08-12 at 1.23.52 AM.png
crossref
doi
open access

Published: 15 April 2024

A Comparison of Healthcare Funding Systems between Low- /Medium-Income and High-Income Countries: Equity, Equality, and Fairness in the Rationing of Healthcare Resources

Henry Omoregie Egharevba

National Institute for Pharmaceutical Research and Development, Abuja

journal of social and political sciences
pdf download

Download Full-Text Pdf

doi

10.31014/aior.1994.07.02.315

Pages: 23-31

Keywords: Health Funding Systems, Healthcare, Inequities, Inequalities, Rationing, Cost-Effectiveness Analysis, Malaria, Cardiovascular Disease, Nigeria, United States

Abstract

Access to healthcare is a social right and its demand is universal. However, health resources are limited and have to be rationed justifiably which borders on societal values and the efficiency of the healthcare system. A more efficient health system will promote more equitable access to health care based on the principle of universal health coverage (UHC) advocated by the World Health Organisation. The efficiency of any health system depends on the structure of its funding or financing system. Evidence has shown that there is a strong correlation between country’s income and total health expenditure. This also affects the health financing systems of countries. This discourse exposes the challenge of health inequities/inequalities and its correlation with health funding systems in low-income countries and upper-middle/high-income countries using Nigeria and the United States as reference countries. It also attempts to discuss the feasibility of attaining more equitable access to healthcare in a manner that promotes health equity and equality through economic evaluations of interventions in diseases of high socioeconomic burden and major health outcome concerns.

References

  1. Adegoke, A.A. et al. (2017) ‘Improving human resource for health in rural Northern Nigeria’, Human Resource for Health, 15(32), pp. 1–8. doi: https://doi.org/10.1186/s12960-017-0205-4.

  2. Adelakun, E.O. (2022) ‘The Implications of Health Financing for Health Access and Equity in Nigeria’, Healthcare Access. IntechOpen, 2022. pp. 1-16. doi: http://dx.doi.org/10.5772/intechopen.98565. Accessed: 25 May 2023.

  3. Angell, B.et al. (2022) ‘Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study’, Lancet, 399(10330), pp. 1117–1129. doi: https://doi.org/10.1016/S0140-6736(21)02722-7

  4. Avanceña, A.L.V. et al. (2022) ‘Achieving malaria testing and treatment targets for children under five in Mozambique: a cost-effectiveness analysis’, Malaria Journal, 21, (320). https://doi.org/10.1186/s12936-022-04354-9

  5. Ayogu, E.E.et al. (2021) ‘Direct Medical Cost of Treatment of uncomplicated malaria after the Adoption of Artemisinin-Based Combination Therapy in Nigeria’, Journal of Applied Pharmaceutical Science, 11(09), pp. 029-034.

  6. Azodoh, N.R. and Obitube KF. (2022) ‘Human Resource for Health Gaps in Nigeria: Stakeholders’ Policy Considerations Towards Accelerating Universal Health Coverage in Nigeria’, Research Square, pp. 1-12. doi: https://doi.org/10.21203/rs.3.rs-2041684/v1

  7. Center for Disease Control and Prevention [CDC] (2023a) Heart Disease. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Available at: https://www.cdc.gov/heartdisease/index.htmAccessed 7 June 2023.

  8. Centers for Disease Control and Prevention [CDC] (2023b) What is health equity?Available at: https://www.cdc.gov/healthequity/whatis/index.html#:~:text=Across%20the%20country%2C%20people%20in,compared%20to%20their%20White%20counterparts. Accessed 28 May 2023.

  9. Centre for the Study of the Economies of Africa (2012). A Cost-Effectiveness Analysis of Long-Lasting Insecticidal Nets and Indoor Residual Spraying Programs in Jigawa state, Nigeria. Policy Brief, 1(6), pp. 1-4.

  10. Cheng, J., Malone, A. and Thorndike, A.N. (2023) ‘Importance of Nutrition Security to CVD Prevention Efforts in the USA’, Current Atherosclerosis Report, 25, pp. 219–230. doi: https://doi.org/10.1007/s11883-023-01097-z

  11. Conteh, L.et al. (2021) ‘Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review’, Value Health (Elsevier). 24(8), pp. 1213–1222.

  12. Donaldson, L.J. and Rutter, P.D. (2018) Donaldsons’ Essential Public Health. Boca Raton Florida: CRC Press Taylor and Francis Group.

  13. Ejughemre, U.J.et al. (2015) ‘Healthcare financing in Nigeria: A systematic review assessing the evidence of the impact of health insurance on primary health care delivery’, Journal of Hospital Administration, 4(1), pp. 1-8.

  14. Ezenduka, C.C., Falleiros, D.R. and Godman, B.B. (2017) ‘Evaluating the Treatment Costs for Uncomplicated Malaria at a Public Healthcare Facility in Nigeria and the Implications’, PharmacoEconomics – open. 1(3), pp. 185–194. doi: https://doi.org/10.1007/s41669-017-0021-8

  15. Eze-Nliam, C.M.et al. (2015) ‘Cost-effectiveness Assessment of Cardiac Interventions: Determining a Socially Acceptable Cost Threshold’, Interventional cardiology, 6(1), pp. 45–55. doi: https://doi.org/10.2217/ica.13.81

  16. Gunda, R. and Chimbari, M.J. (2017) ‘Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review’, (BMC) Cost effectiveness and resource allocation. 15(1), pp. 1-13. doi: https://doi.org/10.1186/s12962-017-0072-9

  17. Institute for Health Metrics and Evaluation (2023) Nigeria. Available at: https://www.healthdata.org/nigeriaAccessed 25 May 2023.

  18. Jalali, F.S., Bikineh, P. and Delavari, S. (2021) ‘Strategies for reducing out of pocket payments in the health system: a scoping review’, Cost effectiveness and resource allocation: C/E, 19(47), pp. 1-22. doi: https://doi.org/10.1186/s12962-021-00301-8

  19. Kum, Z.T. Allocation of Public Domestic Resources for Health in Nigeria - Is Primary Healthcare not forgotten in the allocation of domestic health resources? M.Sc Public Health Thesis, KIT (The Royal Tropical Institute) Amsterdam, The Netherlands; 2020. Available at: https://bibalex.org/baifa/Attachment/Documents/ylOc8ecqGj_20210727173007962.pdfAccessed: 28 May 2023.

  20. McCreanor, V.et al. (2018) ‘A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment’, F1000Research, 7(77), pp. 1-19. doi: https://doi.org/10.12688/f1000research.13616.2

  21. McIntyre, D. Learning from Experience: Health care financing in low- and middle-income countries. Geneva, Global Forum for Health Research; 2007. Available at: https://www.files.ethz.ch/isn/48554/2007-06%20Health%20care%20financing.pdfAccessed: 20 May 2023.

  22. Murray, C.J.L.et al. (2020) ‘Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019’, The Lancet, 396(10258), pp. 1204–1222. doi: https://dx.doi.org/10.1016/S0140-6736(20)30925-9

  23. National Health Act (2014). Federal Government of Nigeira Official Gazette (Government Notice No 208), Act. No 8, 101(145), pp. A139-172. Available at: https://www.ilo.org/dyn/natlex/docs/ELECTRONIC/104157/126947/F-693610255/NGA104157.pdfAccessed 9 June 2023.

  24. National Health Insurance Authority Act (2022). Federal Government of Nigeria Official Gazette, Act No 17, 109(95) pp. A625-A652.

  25. National Health Insurance Scheme (2012) Operational Guidelines (revised October 2012). Nigeria: National Health Insurance Scheme. ISBN 978 2397 24 5.

  26. Nigeria Solidarity Support Fund (2022) Supporting Vulnerable Groups. Available at: https://nigeriasolidarityfund.ng/vulnerable-groups/#:~:text=Children%2C%20adolescent%20girls%2C%20women%2C,of%20the%20impacts%20of%20emergencies. Accessed: 26 May 2023.

  27. Oyibo, P.G. (2011) ‘Out-of-pocket payment for health services: constraints and implications for government employees in Abakaliki, Ebonyi state, South east Nigeria’, African Health Sciences, 11(3), pp. 481-485.

  28. Pan American Health Organization (PAHO) Leading causes of mortality and health loss at regional, subregional, and country levels in the Region of the Americas, 2000-2019. ENLACE data portal; 2021. Available at: https://www.paho.org/en/enlace/leading-causes-death-and-disability#:~:text=The%20causes%20of%20DALYs%20with,%2C%20and%20falls%20(7%25). Accessed 25 May 2023.

  29. Smith, L. et al. (2019) ‘Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk’, BMC Public Health, 19, 1234. doi: https://doi.org/10.1186/s12889-019-7573-8

  30. The World Bank. Nigeria Poverty Assessment 2022 - A Better Future for All Nigerians. Washington DC, World Bank Publications, The World Bank Group; 2022a. Available at: https://documents1.worldbank.org/curated/en/099730003152232753/pdf/P17630107476630fa09c990da780535511c.pdfAccessed 25 May 2023.

  31. The World Bank. Rural population – Nigeria. 2022b. Available at: https://data.worldbank.org/indicator/SP.RUR.TOTL?locations=NGAccessed 28 May 2023.

  32. The World Bank. Out-of-pocket expenditure (% of current health expenditure). 2023. Available at: https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZSAccessed 25 May 2023.

  33. Umukoro, N. (2012) ‘Governance and public health care in Nigeria. Journal of Health Management, 14(4), pp. 381-395. doi: https://dx.doi.org/10.1177/0972063412468970

  34. Uneke, C. et al. (2007) ‘The Nigeria health sector and human resource challenges’, The Internet Journal of Health, 8(1), pp. 1-5.

  35. World Health Organisation. WHA 58.33 - Sustainable health financing, universal coverage and social health insurance. Geneva; 2005. Available at: https://cdn.who.int/media/docs/default-source/health-financing/sustainable-health-financing-universal-coverage-and-social-health-insurance.pdf?sfvrsn=f8358323_3Accessed 25 May 2023.

  36. World Health Organisation. The role of government in health development. Geneva; 2006. Available at: https://applications.emro.who.int/docs/em_rc53_tech.disc.1_en.pdfAccessed: 23 May 2023.

  37. World Health Organisation. World malaria report 2022. Geneva; 2022. Available at: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022Accessed: 25 May 2023.

  38. World Health Organisation. NHA indicators - Nigeria. Geneva; 2023. Available at: https://apps.who.int/nha/database/ViewData/Indicators/en Accessed: 25 May 2023.

bottom of page