Overview

Improving health outcomes and protecting households against the financial consequences of ill health are top priorities to reduce poverty and sustain growth. However, poor individuals often forgo care when it is needed because they cannot afford to pay user fees. They also report worse health outcomes, which can keep them trapped in poverty. How health care is financed thus influences who has to pay how much for care (financial risk protection), how much of the health funds are spent on different forms of health care, how equitably health revenues are collected from public and private sources and distributed (equity in finance), and how effectively health care costs are managed (efficiency). The World Bank has implemented health financing activities in 68 countries during FY03 12. Health financing interventions are found in about 40 percent of the Bank s Health, Nutrition, and Population portfolio. Most projects include interventions on revenue collection from public sources. Almost half of the projects support public health insurance and automatic coverage. More recently, results-based financing operations became more prominent. The International Finance Corporation delivered a small program in health financing. This is the first evaluation by the Independent Evaluation Group of the World Bank Group s support to countries trying to address health financing issues. The evaluation recognizes that reforms in health financing alone are insufficient and that additional investments are needed to ensure the supply of health care. But health financing decisions are necessary to influence the provision and use of health care and ensure financial protection. Four evaluation questions are addressed: What is the evidence that Bank Group support to revenue collection for health leads to improved equity in health financing and service use, financial protection, and efficiency? What is the evidence that Bank and IFC support to pooling health funds and risks leads to improved equity in health financing and service use, financial protection, and efficiency? What is the evidence that Bank Group support to purchasing leads to improved equity in health financing and service use, financial protection, and efficiency? What are the factors in successful Bank Group support to health financing reforms?

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