HEALTH-CARE financing is an important function of health-care delivery systems that encompass the generation, allocation, and use of financial resources in the delivery of health-care programmes. Complementary to health-care financing is population health, a field of public health that studies health determinants and uses an interdisciplinary approach to reduce health disparities and improve health outcomes within a nation or amongst a specific group of people. In health-care management, careful consideration must be given to both areas so that desired health targets set by governments can be achieved.

The successful approach

Annually, governments throughout the world, especially those of low- and middle-income countries, are forced to spend on health care in excess of what they can afford and, of course, a major contributing factor to this cost overrun is the way decisions are made concerning allotment of funding to support health-care delivery programmes. The International Monetary Fund outlines that there are 152 developing countries with a population of approximately 6.90 billion. A large percentage of these countries also have health-care financing policies which support widescale public provision of free health care for its populace, a situation which is desirable but not sustainable, as it presents a major budgetary challenge for many nations. Efficient health-care delivery programmes integrate population health data to guide health financing decisions whilst incorporating inputs from stakeholders such as academia and the health-care industry. This results in the development and implementation of health-care policies which are not generic but are effective and efficient in curtailing adverse experiences from health occurrences in a population.

The shared burden

At present, governments worldwide, especially those in developing countries, continue to grapple with the challenge of funding annual health-care bills as well as the need to provide accessible, equitable, and quality health-care services for its populace. Thankfully, at present, numerous international agencies provide financial support to save lives throughout the world, for example, The Global Fund to fight AIDS, Tuberculosis and Malaria Joint United Nations Programme on HIV/AIDS partners with national agencies globally to achieve universal access to HIV prevention, treatment, care, and support. The Pan American Health Organization works with countries throughout the Americas to improve and protect the health of the people. The World Bank provides financial and technical assistance to developing countries around the world to fight poverty, whilst making investments to improve health.

Health data trends and facts

Whilst developed nations are better able to provide resources to support health-care delivery programmes, the greatest challenge where health targets are not achieved is amongst developing and underdeveloped nations which are responsible for 93 per cent of the global burden of disease. In these countries, cardiovascular and infectious diseases such as HIV/AIDS, malaria, and tuberculosis have the highest mortality rates. With reference to the global annual data reported on maternal deaths, 90 per cent occurs in developing and undeveloped countries, further to that, in these countries, parasitic infections, in particular intestinal parasites, such as taenia, toxoplasma, and cryptosporidium, are responsible for food contamination with a prevalence rate of 30-60 per cent.

Back to basics

Throughout the world, distribution of health-care resources amongst different population groups, sectors, or levels of care has always been unequal; notwithstanding, infectious diseases such as tuberculosis are re-emerging at an alarming rate, averaging at approximately 10 million cases per year. Data on ‘lost to follow-up’ of tuberculosis cases shows a universal figure of four per cent in most instances. Centralisation of treatment sites and the inability to afford costs associated with accessing treatment after intense phase are all factors that determines the effectiveness of tuberculous treatment programmes. In addition, The World Health Organization states that most maternal deaths can be avoided if maternal care is decentralised, and it should be so, as nearly two-thirds of the eight million infant deaths that occur each year result largely from poor maternal health and hygiene, inadequate care, and inefficient management of delivery. Nursing services provided at the level of the community averts occurrences such as these and reduces the need for seeking care at the already overburdened secondary care health facilities. Daily migration of secondary health-care professionals from low- and middle-income countries will continue, and in light of such reality, governments and countries who are affected negatively must immediately shift focus to prevention rather than cure, including providing financial support for training of technical community health-care professionals. Similar to maternal care, and in order to reduce incidence of cardiovascular diseases, greater support is required for strategies and programmes which monitor and manage risk factors. Primordial and primary health care initiatives and programmes must be given better financial support to reduce levels of negative outcome from health occurrences.

Focus on the cause over the cure

Carefully crafted and executed health-care financing policies which give priority to factors that determine health outcomes in a population will reduce health disparity and provide better support for health-care programmes, even those aspects of the programme that heavily depend on international funding. As it relates to international funding to support national health-care programmes, the reality is that any change in the international funder policies can spell devastation for nations whose health financing strategies are executed, with the expectation that international funding will always be provided to fill the gap. Harmonising population health data and health-care financing decisions will result in the development and implementation of health-care policies that minimise misuse of resources. Harmonising these areas will also give greater focus to the cause and not just the cure to ensure more positive health outcomes and improved quality of life.

Dr Karlene Atkinson is a public health specialist and lecturer at the Joint Colleges of Medicine, Oral Health and Veterinary Science, University of Technology, Jamaica.