Browsing by Author "Cattaneo Adriano"

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All That Glitters is Not “Macroeconomics”
(Uganda Martyrs University, Department of Health Sciences, 2003-12) Cattaneo Adriano
Despite many problems, the Report on Macroeconomics and Health is an important document. It re-launches the role of the WHO, which in itself is a good thing, as the WHO is an organisation potentially more independent and democratic than the World Bank. “Combating disease will be clearest proof of our capacity to construct an authentic global community. There is no justification in the world today for those millions of individuals suffering and dying every year for lack of the $34 dollars per head necessary to have essential health care services. A world that is just and looks to the future will not allow this tragedy to continue. Governments will follow commitments taken in recent years with what actions are necessary to give dignity, hope and life itself to the poorer and more vulnerable nations of the world. We know that this is possible and we are sure that in the years to come the world will dedicate all its energy to the service of this noble and vital task’. This is the concluding paragraph to the Report “Macroeconomics and Health: Investing in Health for Economic Development”, published by the WHO on 20 December 2001. Full marks go to Gro Harlem the attempt at restoring visibility to the WHO, which has been obscured recently by a colourless of the World Bank. She has started by evening Primary Health Care and gone on with an important, even if controversial, Annual Report on the performance of health care systems which is stimulating new and hopefully productive discussion of international public health care.
User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity
(BioMed Central Ltd., 2005) Amone Joseph; Asio Salome; Cattaneo Adriano; Kweyatulira Annet Kakinda; Macaluso Anna; Maciocco Gavino; Mukokoma Maurice; Ronfani Luca; Santini Stefano
Background: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. Methods: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and nonhospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. Results: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. Conclusion: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible.