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Improving Health Sector Performance

Institutions, Motivations and Incentives - The Cambodia Dialogue

Hossein Jalilian and Vicheth Sen

Publication Year: 2011

There is growing international evidence that the effectiveness of health services stems primarily from the extent to which the incentives facing providers and consumers are aligned with "better health" objectives. Efficiency in health service provision requires that providers and consumers have incentives to use healthcare resources in ways that generate the maximum health gains. Equity in at least one sense requires that consumers requiring the same care are treated equally, irrespective of their ability to pay. Efficiency in the use of health services requires that consumers are knowledgeable about the services on offer and which are most appropriate to their needs. Although these principles are enshrined in the design of every health system in the world, they have proven extremely difficult to apply in practice. Healthcare providers have financial obligations to their families as well as professional obligations to their patients. Health service consumers generally lack information about both their health and health services so that they under-consume or over-consume healthcare. The papers in this volume are selected from an international conference organized by the CDRI, Cambodia, that tried to deal with some of these issues. With participation of international and local experts, it aimed at collecting major experiences and innovative solutions from inside and outside the country to improve health sector performance, with particular focus on institutions, motivations and incentives.

Published by: ISEAS–Yusof Ishak Institute

Title Page, Copyright

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Table of Contents

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pp. ix-x

This volume comprises chapters based on a collection of papers presented at a two-day international conference on “Improving Health Sector Performance: Institutions, Motivations and Incentives” in Phnom Penh from 26–27 April 2010. The event was co-organized by the...

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pp. xi-xii

The chapters in this volume come from papers presented at an international conference organized by the Cambodia Development Resource Institute in April 2010. With participation from local and international experts, the conference aimed at collecting major experiences...

List of Contributors

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pp. xiii-xvi

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pp. xvii-xx

There is growing international evidence that the effectiveness of health services stems primarily from the extent to which the incentives facing providers and consumers are aligned with “better health” objectives. Efficiency in health service provision requires that providers and consumers...

Part I: Overview

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1. What Incentives Are Effective in Improving Deployment of Health Workers in Primary Health Care in Asia and the Pacific?

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pp. 3-18

Improving access to primary health care is important for prevention, early detection, and management of health conditions and also contributes to more efficient utilization of resources in a health system. However, workforce shortages and high staff turnover rates can be a major barrier...

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2. Reforming Provider Behaviour Through Incentives: Challenges and Reflections from the U.K. Experience

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pp. 19-42

Before exploring theories of motivation, trust, incentives and regulation, it is important to clarify a number of fundamental terms in health policy. These terms are often used by policymakers and academics in an inappropriate manner which confuses policy debate. Following this, the...

Part II: Organizational Arrangements: Purchasing Health Services

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3. The Transition to Semi-Autonomous Management of District Health Services in Cambodia: Assessing Purchasing Arrangements, Transaction Costs and Operational Efficiencies of Special Operating Agencies

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pp. 45-75

Under the theme, “health sector institutions”, this chapter focuses on new arrangements for the management of health districts in Cambodia, called Special Operating Agencies (SOAs). SOAs are a form of internal contracting recently initiated as part of the government’s wider public sector...

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4. Vouchers as Demand-Side Financing Instruments for Health Care: A Review of the Bangladesh Maternal Voucher Scheme and Implications for Incentives for Human Resource Management

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pp. 76-100

The challenge of reaching the health related Millennium Development Goals has led to the search for new mechanisms of channelling resources to demonstrate the efficacy of pilot interventions for future scaling up and to benefit needy groups. Demand-side financing (DSF) mechanisms...

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5. Social Health Insurance in Cambodia: An Analysis of the Health Care Delivery Mechanism

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pp. 101-135

This chapter is based on a research paper that aimed to analyse various mechanisms of health care delivery, both in theory and in practice, in order to suggest appropriate mechanisms for a social health insurance (hereafter SHI) scheme. The main question addressed by the chapter...

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6. Purchasing Health Services in New Zealand

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pp. 136-148

New Zealand and Cambodia are both situated on the rim of the western Pacific Ocean. Beyond this, they appear to share few common features. Cambodia is a developing country with a GDP per capita of under US$600 and a population of more than fourteen million. New Zealand has...

Part III: Optimal Health Workers Contracts

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7. A Civil Service That Performs: Primary Health Care in Curitiba, Brazil

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pp. 151-183

“Curitiba is a city of 1.9 million people. It is the capital of Paraná, one of Brazil’s more developed states, located in the south of the country, and one of Brazil’s wealthiest cities. Curitiba is known for its urban innovations and the quality of its life. It has an innovative rapid-transport bus...

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8. Increasing Uptake of Reproductive Health Services Using Innovative Financing Models: Experiences of Marie Stopes International

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pp. 184-201

Marie Stopes International (MSI) is globally recognized as one of the leading family planning organizations. The organization uses demand-side financing to improve access to family planning, sexually transmitted infection (STI) services, and safe motherhood services, using a range...

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9. Understanding Rural Health Service in Cambodia: Results of a Discrete Choice Experiment

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pp. 202-247

In Cambodia, health centres and health posts, mainly located in rural areas and providing the minimum package of activities (MPA), are the first point of patient contact. These facilities are staffed by nurses and midwives and do not normally include doctors, except in the case...

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10. Contracting Health Workers to Underserved Areas: Indonesian Approaches to a Distributional Challenge

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pp. 248-261

Indonesia is an archipelago of some 17,000 islands spread over 1.9 million sq km, with a total population of 230 million. Administratively, it is divided into thirty-three provinces and some 500 districts. These in turn are divided into subdistricts. Per capita GDP is US$3,310, placing the...

Part IV: Managing Doctors and Nurses

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11. How Managers Manage In Cambodia's Public Health Sector

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pp. 265-303

This chapter reports the results of a study of managers in the Cambodian health sector and the performance of their organizations. The study was conducted in 2009 after the government introduced wide-ranging changes in the way health services were organized and managed. These changes...

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12. The Impact of Management Training and Education on the Performance of Health Care Providers: What Do We Know?

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pp. 304-327

Health care systems around the world are faced with a large array of challenges that include: a call for greater accountability, better results, improved performance, greater efficiency, and improved access to services. To meet these challenges, countries are engaged in health sector...

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13. Incentive Systems in Public Health Care Organizations in Italy

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pp. 328-349

The design and management of incentive schemes for managers and employees is an important research area in the fields of human resource management, organizational control, and organizational sociology. Research on this topic has addressed issues such as which incentive...

Part V: Health Service Consumer Behaviour

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14. Factors Influencing Health-Seeking Behaviour in Siem Reap: A Qualitative Analysis

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pp. 353-364

Following more than thirty years of civil war, the genocidal regime of the Khmer Rouge, and global isolation, Cambodia has made a notable movement forward in political, economic, and social development. However, it remains one of the poorest countries in the region, with...

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15. Villagers’ Evaluation of a Community-Based Health Insurance Scheme in Thmar Pouk, Cambodia

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pp. 365-384

Community-based health insurance (CBHI), also known as health insurance for the informal sector or microinsurance, is “a voluntary health insurance scheme organized at the level of the community” (Carrin et al. 2005). The population coverage, services offered, regulation, management...

Appendix: Health Equity Funds Implemented by URC and Supported by USAID

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pp. 387-419


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pp. 421-430

E-ISBN-13: 9789814311854
Print-ISBN-13: 9789814345521

Page Count: 430
Publication Year: 2011

Edition: 1