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Table 4 Health financing benchmarking matrix

From: Assessing the feasibility and appropriateness of introducing a national health insurance scheme in Malawi

Health financing objective Reform scenarios
MOH NHI Purchaser
Technical efficiency No change expected, potential improvements depending on the outcomes of decentralization and hospital autonomy reforms Potential improvements associated with more efficient purchasing e.g. improved treatment protocols, better financial management Potential improvements associated with more efficient purchasing e.g. improved treatment protocols, better financial management
Equity Improvement dependent on national rollout of national ID User fees likely necessary to incentivize enrolment – reduction in access for poor because of dysfunctional targeting and identification systems in place. Potential improvements in service quality. Potential improvements in service quality
Financial risk protection No change expected Depends on the introduction of user-fees and on the effectiveness of the identification of poor people and of the enrolment of informal sector populations; potential improvement through decreased reliance on informal payments No direct impact; in the longer term, it can reduce providers’ reliance on user fees and informal payments
Policy coordination and resource allocation process Depends on implementation of upcoming reforms e.g. revised EHP Opportunities and challenges, outcome dependant on strengthening MOH stewardship position Opportunities and challenges, outcome dependant on strengthening MOH stewardship position
Health outcomes No change expected Can improve outcomes through enforcement of standards of care and appropriate provider payment mechanisms Can improve outcomes through enforcement of standards of care and appropriate provider payment mechanisms
Revenue mobilisation Widening funding gap Potential savings due to improved contracting + additional revenue from premium collection, partially offset by higher administration costs No additional revenue collection mechanism, but potential savings due to improved contracting