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The role of institutional design and organizational practice for health financing performance and universal coverage


  • Mathauer, Inke
  • Carrin, Guy


Many low- and middle income countries heavily rely on out-of-pocket health care expenditure. The challenge for these countries is how to modify their health financing system in order to achieve universal coverage. This paper proposes an analytical framework for undertaking a systematic review of a health financing system and its performance on the basis of which to identify adequate changes to enhance the move towards universal coverage. The distinctive characteristic of this framework is the focus on institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators. Inadequate performance can be caused by six types of bottlenecks in institutional design and organizational practice. Accordingly, six types of improvement measures are proposed to address these bottlenecks. The institutional design and organizational practice of a health financing system can be actively developed, modified or strengthened. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.

Suggested Citation

  • Mathauer, Inke & Carrin, Guy, 2011. "The role of institutional design and organizational practice for health financing performance and universal coverage," Health Policy, Elsevier, vol. 99(3), pages 183-192, March.
  • Handle: RePEc:eee:hepoli:v:99:y:2011:i:3:p:183-192

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    References listed on IDEAS

    1. North, Douglass C., 1989. "Institutions and economic growth: An historical introduction," World Development, Elsevier, vol. 17(9), pages 1319-1332, September.
    2. North, Douglass C, 1994. "Economic Performance through Time," American Economic Review, American Economic Association, vol. 84(3), pages 359-368, June.
    3. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
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    Cited by:

    1. Deepak Kumar Behera & Umakant Dash, 2020. "Is health expenditure effective for achieving healthcare goals? Empirical evidence from South-East Asia Region," Asia-Pacific Journal of Regional Science, Springer, vol. 4(2), pages 593-618, June.
    2. Ridde, Valéry & Kouanda, Seni & Yameogo, Maurice & Kadio, Kadidiatou & Bado, Aristide, 2013. "Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso," Evaluation and Program Planning, Elsevier, vol. 36(1), pages 145-152.
    3. Behera, Deepak Kumar & Dash, Umakant, 2019. "Prioritization of government expenditure on health in India: A fiscal space perspective," Socio-Economic Planning Sciences, Elsevier, vol. 68(C).
    4. V. Ridde & I. Agier & A. Jahn & O. Mueller & J. Tiendrebéogo & M. Yé & M. De Allegri, 2015. "The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 55-64, January.
    5. Andreea-Oana IACOBUTA, 2012. "Several issues affecting sustainability of healthcare financing in Romania," Anale. Seria Stiinte Economice. Timisoara, Faculty of Economics, Tibiscus University in Timisoara, vol. 0, pages 537-544, May.
    6. Raj Panda & Pradeep Guin & Kumar Gaurav, 2020. "Governance in Public Purchasing of Tertiary-Level Health Care: Lessons From Madhya Pradesh, India," SAGE Open, , vol. 10(3), pages 21582440209, July.
    7. Fadi El‐Jardali & Racha Fadlallah & Aref Daouk & Rana Rizk & Nour Hemadi & Ola El Kebbi & Aida Farha & Elie A. Akl, 2019. "Barriers and facilitators to implementation of essential health benefits package within primary health care settings in low‐income and middle‐income countries: A systematic review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 15-41, January.
    8. Deepak Kumar BEHERA & Umakant DASH, 2017. "Impact of GDP and tax revenue on health care financing: An empirical investigation from Indian states," Theoretical and Applied Economics, Asociatia Generala a Economistilor din Romania - AGER, vol. 0(2(611), S), pages 249-262, Summer.


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