Financing is concerned with how revenue is raised for health systems, pooled together and used to provide health care services.

Research focuses on how best to finance universal health coverage in low and middle-income countries.

In recent years, there has been a growing focus on achieving universal access to health services without the risk of financial catastrophe or impoverishment associated with obtaining care. Few lower income countries have financing systems that are capable of providing a universal health system with many relying heavily on out-of-pocket payments (including user fees) for funding services, and have limited and fragmented pre-payment mechanisms.

Debates about how to expand pre-payment funding mechanisms have concentrated on increasing the coverage of health insurance schemes, especially in sub-Saharan Africa; however, many of these schemes have achieved relatively low population coverage and generated little revenue for health care funding. The potential to increase funding from general tax sources and through improved tax collection mechanisms has been less widely considered.

Graphic overview of our financing research

Research questions

1. How can progressive financing systems be developed in different contexts, particularly through increasing domestic public funding?

In Kenya, South Africa and Nigeria (Lagos State), studies will look at expanding fiscal space (the amount of resources government can sustainably spend on health care), through increasing the effectiveness of tax collection systems. Increasing domestic resources for health care is especially important in countries that rely on donor funding, which can be both unstable and unsustainable in the long run. The studies will use case studies of experiences of improved tax collection based on interviews with key stakeholders and document reviews.

2. What features of benefit package design and purchasing arrangements within health insurance schemes promote health equity and better financial protection for the poor?

A core function of health care financing is purchasing – the process by which funds are allocated to providers to obtain health services on behalf of a population. If designed and undertaken strategically, purchasing can improve health systems performance by promoting quality, efficiency, equity and responsiveness of health service provision. Despite the important role of purchasing in health systems performance, there is limited empirical work on purchasing agreements in low and middle-income countries.

RESYST researchers aim to critically assess the performance of health care purchasers in a range of low and middle-income countries and identify factors influencing that performance. The countries included in the study are: Kenya, India, Nigeria, South Africa, Tanzania, Thailand and Vietnam. The research will examine the relationships between different actors so as to understand the various components of strategic purchasing and the organisational environment within which it operates.