Examines hospital financing in Canada, England France, Germany, the Netherlands, Sweden and the United States.

This report examines the recent experience of the United States and six of its international peers - Canada, France, Germany, the Netherlands, Sweden, and the United Kingdom - with recent trends in the way hospital services are paid for, and the effects of new technologies and recent and ongoing reforms on the use and costs of hospital services. The United States stands out among its internationsl peers as having the highest level of hospital costs since 1980, but also for pioneering financing mechanisms - especially prospective payment systems - that have led hospitals to reduce the hospital resources used to care for individual patients. Other countries have had greater control over total hospital spending at a central level. Decentralizing hospital financing, creating incentives for competition within the hospital system, and basing a greater amounts of a hospital's revenues on the needs of the population it serves are the goals of reform, while also giving consumers more choice in where and from whom they get their health care.

This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.

Examines hospital financing in Canada, England France, Germany, the Netherlands, Sweden and the United States.

This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks (e.g., following the collapse ofthe Soviet Union). In doing so, this report seeks to expand the evidence base on "good performance" in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam.

Any analysis of health financing issues has to begin with sound estimates of the level and flow of resources in a health system, including total levels of spending, the sources of health expenditures, the uses of funds in terms of services purchased, and in terms of who purchases them. The analysis should also aim at understanding how these resource flows are correlated with health system outcomes, including those of improving health, reducing health inequalities, and reducing the incidence of catastrophic health expenditure. National Health Accounts (NHA) provide a framework to collect, compile, and analyze such data on all types of health spending in a country—and so create a robust evidence base for policy making. Although NHA data delineate the key financial metrics of a health system, the collection of these data have not been institutionalized in most developing countries. The root problems are often the same: insufficient resources to collect, collate, analyze and produce information on spending; poor development of health and other information systems; low levels of local capacity to interpret information to meet policy needs; and inadequate demand for data within countries. Furthermore, in many low- and middle-income countries, NHA activities have been conducted as ad hoc, donor-driven initiatives. Since 2008, the World Bank has been coordinating a global initiative to identify bottlenecks to the institutionalization of NHA, and to learn lessons in countries at different stages on the journey towards this institutionalization. The focus has been less on the production of NHA and more on its relevance as a tool to enable policy makers develop and implement evidence-based decisions, and better measure the impact of health reforms, especially those related to health financing. This report has been developed through a consultative process, involving experts and policy makers from more than fifty low-, middle- and high-income countries, large and small, in all corners of the world, development partners and World Bank staff globally. The report represents a synthesis of lessons learned from country experiences and is intended to serve as a strategic guide to countries and their development partners as they design and implement their strategy to develop nationally relevant and internationally comparable data, collected in a routine and cost-effective manner.