Ricardo Bitran | Universidad de Chile (original) (raw)

Papers by Ricardo Bitran

In 2016, the Flagship Program for improving health systems performance and equity, a partnership ... more In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.

This paper analyzes the rationale for, and costs associated with, the control and elimination of ... more This paper analyzes the rationale for, and costs associated with, the control and elimination of neglected tropical diseases (NTDs) in Latin America and the Caribbean. It also estimates the magnitude of potential health gains. The results suggest that lymphatic filiariasis, onchocerciasis, and trachoma can be feasibly and affordably eliminated by 2020, at a total cost of US$128 million. Control of other NTDs could produce important reductions in prevalence and incidence, along with other social and economic benefits. In particular, controlling soil-transmitted helminths (roundworm and hookworm, for example) would produce total costs of $41 million between now and 2020.

BackgroundDonor funding for HIV programs has flattened out in recent years, which limits the abil... more BackgroundDonor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization.MethodsPotential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors.ResultsFour non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be r...

In response to shortages in public budgets for government health services, many developing countr... more In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Z...

This paper focuses on recent and significant health reform implemented in 2005, known as Universa... more This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system...

The fight against HIV and AIDS has long been at the center of many programs in lower-income count... more The fight against HIV and AIDS has long been at the center of many programs in lower-income countries and international donor funding for health. More recently, particularly with the advent of the Sustainable Development Goals (SDGs), health practitioners, policy makers, and funders are emphasizing an integrated approach to health services, with a focus on universal access within each country to a set of critical health services as part of a minimum health benefits package (MHBP). However, programming and planning for HIV and universal health coverage (UHC) have often been handled separately. This study has taken on this challenge, conducting research and analysis for three countries (Cote d’Ivoire, Kenya, and Tanzania) and in Nasarawa State in Nigeria. It quantifies each one’s current costs and financial needs for UHC and HIV and then creates projections looking to the 2030 deadline. The study generated concrete findings related to the resources needed to meet the goals, the curren...

In response to shortages in public budgets for government health services, many developing countr... more In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Z...

The aim of the report is to review existing approaches and available policy options to improve ac... more The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to q...

World Bank Working Papers

Health Systems & Reform, 2016

In 2016, the Flagship Program for improving health systems performance and equity, a partnership ... more In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.

This paper analyzes the rationale for, and costs associated with, the control and elimination of ... more This paper analyzes the rationale for, and costs associated with, the control and elimination of neglected tropical diseases (NTDs) in Latin America and the Caribbean. It also estimates the magnitude of potential health gains. The results suggest that lymphatic filiariasis, onchocerciasis, and trachoma can be feasibly and affordably eliminated by 2020, at a total cost of US$128 million. Control of other NTDs could produce important reductions in prevalence and incidence, along with other social and economic benefits. In particular, controlling soil-transmitted helminths (roundworm and hookworm, for example) would produce total costs of $41 million between now and 2020.

BackgroundDonor funding for HIV programs has flattened out in recent years, which limits the abil... more BackgroundDonor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization.MethodsPotential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors.ResultsFour non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be r...

In response to shortages in public budgets for government health services, many developing countr... more In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Z...

This paper focuses on recent and significant health reform implemented in 2005, known as Universa... more This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system...

The fight against HIV and AIDS has long been at the center of many programs in lower-income count... more The fight against HIV and AIDS has long been at the center of many programs in lower-income countries and international donor funding for health. More recently, particularly with the advent of the Sustainable Development Goals (SDGs), health practitioners, policy makers, and funders are emphasizing an integrated approach to health services, with a focus on universal access within each country to a set of critical health services as part of a minimum health benefits package (MHBP). However, programming and planning for HIV and universal health coverage (UHC) have often been handled separately. This study has taken on this challenge, conducting research and analysis for three countries (Cote d’Ivoire, Kenya, and Tanzania) and in Nasarawa State in Nigeria. It quantifies each one’s current costs and financial needs for UHC and HIV and then creates projections looking to the 2030 deadline. The study generated concrete findings related to the resources needed to meet the goals, the curren...

In response to shortages in public budgets for government health services, many developing countr... more In response to shortages in public budgets for government health services, many developing countries around the world, have adopted formal, or informal systems of user fees for health care. In most countries, user fee proceeds seldom represent more than 15 percent of total costs in hospitals, and health centers, but they tend to account for a significant share of the resources required to pay for non-personnel costs. The problem with user fees is that the lack of provisions to confer partial, or full waivers to the poor, often results in inequity in access to medical care. The dilemma, then, is how to make a much needed system of user fees, compatible with the goal of preserving equitable access to services. Different countries have tried different approaches. Those which have carefully designed, and implemented waiver systems (e.g., Thailand and Indonesia) have had much greater success in terms of benefits incidence, than countries that have improvised such systems (Ghana, Kenya, Z...

The aim of the report is to review existing approaches and available policy options to improve ac... more The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to q...

World Bank Working Papers

Health Systems & Reform, 2016