Papers by James C Knowles
even to receive a 100% return on their money), while only 22% of civil servants are "more willing... more even to receive a 100% return on their money), while only 22% of civil servants are "more willing to defer gratification" (i.e., accept a 20% return on their money for waiting one year).
This note reports on the analysis of data for Harare residents from the 2015 National Health Acco... more This note reports on the analysis of data for Harare residents from the 2015 National Health Accounts (NHA) Household Survey. The purpose of the analysis is to obtain information that will be useful for developing an actuarial analysis of a possible health care prepayment scheme in the City of Harare. The analysis is discussed by broad topic in five sections: 1. Outpatient curative care, 2. Inpatient Care, 3. Maternity care, 4. Health insurance and 5. Catastrophic health care costs.
This report was prepared with financial assistance from the Commission of the European Communitie... more This report was prepared with financial assistance from the Commission of the European Communities. The views expressed are those of the Consultants and do not necessarily represent any official view of the Commission or the Government of this country. TABLE OF CONTENTS .
The 2002 Public Sector Management and Finance Law (PSMFL) mandates output-based budgeting for rec... more The 2002 Public Sector Management and Finance Law (PSMFL) mandates output-based budgeting for recurrent budgets in all sectors, including the health sector. Currently, health sector budgets remain input-based, although the TA is working with MOH to develop a feasible approach to implementing the PSMFL in the health sector. For organizations such as the MOH or aimag health departments that do not provide services directly, recurrent budgets are based on the number of staff, with staff-based norms used to budget other items. Hospitals receive a recurrent budget based on the number of "approved" beds (which may in some cases differ from their actual number of beds). The amount of money budgeted per bed depends on the level and type of hospital. Higherlevel hospitals tend to receive more funding per bed than lower-level hospitals. Unfortunately, the bed norms do not provide any information about the kinds of activities or outputs that are being "purchased." The approved budget only describes the inputs being "purchased" (for example, personnel, drugs, and utilities). With input-based budgeting, there is no direct link between a hospital's budget and the level of services (outputs) it provides. In theory, a hospital would obtain the same budget regardless of the level or quality of services it provides. However, hospitals try to keep their beds fully occupied so that there will be no reduction in the number of approved beds and so that they can more easily justify adding additional beds to increase their budgets. 1 In this sense only, there is an indirect link between the hospital's budget and its output. Under the current input-based budgeting system, a public hospital has an incentive to provide additional outpatient visits only inasmuch as they lead to additional inpatient admissions and therefore help to keep the hospital's bed occupancy rate at a high level. There is obviously no incentive for the hospital to substitute more costeffective care, such as outpatient care, day surgery, long-term nursing care or home-based care for relatively expensive hospital inpatient care. The fact that some hospital financing is provided from the Health Insurance Fund (HIF) and that the HIF reimburses hospitals on the basis of outputs (for example, inpatient admissions, outpatient visits, and diagnostic procedures) ought to provide a direct link between hospital budgets and hospital outputs. However, the institutional arrangements currently used to implement HIF reimbursement 1 Tertiary hospitals may also try to keep their beds fully occupied so that they can more easily justify turning away complex cases using the excuse that they have no free beds.
Quantitative estimates of benefits and costs were provided, based on the estimated impact of the ... more Quantitative estimates of benefits and costs were provided, based on the estimated impact of the project's small community-level pilot designed to prevent serious complications of diabetes and hypertension. However, the reported benefits from this source were 100 times larger than they should have been, based on the assumptions used.
Component A is the project's health financing component. Its specific objective is to improve the... more Component A is the project's health financing component. Its specific objective is to improve the capacity of the Ministry of Health to develop and implement health financing policy. Three key health financing policy areas are identified in the PAD for Component A, as follows: Strengthen the capacity of the Ministry of Health to plan resource needs for the health sector (Area #1) Strengthen the role of the Ministry of Health to finance primary health care and preventive services (Area #2) Develop options to finance health services (including overseas treatment, user fees and health insurance) and pilot and evaluate the preferred option prior to full implementation (Area #3) These objectives are to be achieved through technical support, training, studies, and extensive consultations with stakeholders and beneficiaries. Area #1: Strengthen the capacity of the Ministry of Health to plan resource needs for the health sector. The main activity under Area #1 is to initiate, implement and sustain a system of National Health Accounts (NHA). The NHA analysis is expected to help in developing policies to address the three issues of resource mobilization, resource allocation, and efficiency of production. According to the PAD, a key component of the NHA is the estimation of household expenditure. The 2003 Tonga Health Survey will provide the information on household expenditure that will be used to prepare the first NHA estimates for Tonga. The specific objectives of Area #1 are to: Create sustainable capacity and a sustainable system within the MOH to prepare NHA estimates Provide accurate information on health expenditure in Tonga, including government, household and donor expenditure; on the sources of health funding; on the intermediaries through which funds flow; and on their end use Improve the capacity of MOH to develop, inform and introduce policies pertaining to health-care financing Integrate NHA findings into the planning process Area #2: Strengthen the role of the Ministry of Health to finance primary health care and preventive services. This area of Component A is designed to address a perceived misallocation of resources toward curative care, as evidenced by the fact that 66% of MOH resources were being allocated for hospital care at the time of project preparation. According to the PAD, the MOH recognizes the need to increase funding for preventive and primary health care. However, the absence of accurate information on the current Identify the preferred health-financing option Pilot and evaluate the preferred option, including putting into place necessary legal regulations and administrative procedures Component A is being implemented by a group of MOH and PMU staff that is referred to as the "NHA Unit," and its work is guided by senior MOH staff and representatives of the MOF who are members of an "MOH/NHA Steering Committee." In addition, the project has contracted with an Australian firm to provide technical support and training in connection with various Component A activities. The contracted firm is providing technical assistance through the following key staff:
The purpose of this note is to report on discussions between Jim Knowles, visiting POLICY project... more The purpose of this note is to report on discussions between Jim Knowles, visiting POLICY project consultant, and the New Era team that worked on the sectoral projections. These discussions were held in a series of meetings in Kathmandu during the period 11-20 January, 2000. The purpose of the discussions was to review the methodologies and assumptions used in making the projections and to explore some of their possible policy implications. 1. It was noted that the declines in labor force participation rates among youth (ages 15-24) seem appropriate and broadly consistent with the education sector projections.
Source: The percentages in column 1 are based on data from the TA Staff Census, while the percent... more Source: The percentages in column 1 are based on data from the TA Staff Census, while the percentages in columns 2-4 are based on official university records.
More productive and employable graduates. Increased FDI. Reduced use of imported labor. Reduced u... more More productive and employable graduates. Increased FDI. Reduced use of imported labor. Reduced unit costs at HEIs. b. Strengthen Quality Assurance, Accreditation, and Credit System Strengthen DHE quality assurance, accreditation, credit system and recognition of degrees and qualifications in accordance with international standards. Develop improved admissions standards and entrance examinations.
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Papers by James C Knowles