Improving financial management of health care in the Caribbean: conceptual and empirical issues

ABSTRACT

Structural adjustment is reducing the traditional dominant role of the state in the financing and provision of health care. Issues of equity, allocative efficiency, sustainability and clinical freedom are brought into question. This paper examines two models of escalating health costs and discusses the possibilities and limitations of cost sharing mainly health insurance), cost recovery (user fees) and cost containment (privatisation and decentalisation) measures in the health sector. It also explores additional measures to improve financial management in the health sector -- this must be seen as a moral oblication by all rather than a managerial imperative by a few (AU)