Health Care Vouchers: Access for Target Populations
In developing settings, successful distribution of public subsidies to their intended beneficiaries is still a big concern. Among demand-side subsidies, consumer-led vouchers are credited with the greatest track record in assuring target populations receive subsidized services.
There are several ways to introduce vouchers into health services delivery. The main features of a voucher scheme depend on to whom the voucher is distributed (provider vs. consumer), when (before vs. after service delivery), and how (administration and monitoring). Vouchers can be exchanged for health care services and products, and even for cash as an incentive to use health services.
Private Sector and Vouchers
The most effective voucher schemes encourage provider competition. Consumer-led vouchers which allow for choice of provider empower the consumer. This is in stark contrast to supply-side subsidies which offer providers little incentive to attract patients or to increase productivity. Furthermore, health care vouchers can be a powerful tool to encourage evidence-based practice in the private sector.
Well-designed vouchers can serve as evidence of service exchange, receipts and survey data collection instruments. In this manner, administration is simpler and cheaper, and valuable information about the target population can be gathered.
- Improved provider accountability
- Increased transparency of subsidy flows
- Encourage cost-effective quality service delivery
- Can target difficult-to-reach groups
- Output based monitoring and evaluation
- Cheap advertising
- Encourage use of underconsumed health services
- Not all health services have a fixed value
- Can result in overservicing
- Designing effective administration
- Minimizing administrative costs
- Preventing ‘leakage’ of subsidies
- Can be associated with stigma when targeted
Vouchers have become so popular in the health policy arena that even developed countries are considering their use in health care delivery. As mentioned above, vouchers can be administered in a number of different ways; however, competitive consumer-led vouchers are becoming the most commonly utilized voucher scheme.
Health planners have not only been able to gather valuable information on difficult-to-reach target populations, but also valuable information on who is not being reached. Data collected through voucher schemes is helping to inform how services are funded and policies surrounding health care delivery.
Another Point Of View
High Transaction Costs
Identifying appropriate beneficiaries, delivering vouchers to them, collecting those same vouchers again from the providers who are eligible to receive them... All of these steps are complex and expensive to implement, and likely to make the cost of delivery of subsidized services via vouchers much more expensive than alternative subsidy methods.
The two most effective voucher programs to date were implemented in South Korea and Taiwan in the late 60's and early 70's as ways of rapidly expanding access to family planning by tapping into the large number of private providers. Critically, both programs were universal or near-universal in coverage: all citizens were eligible and therefore triage of beneficiaries and targeted delivery of vouchers were not needed. This fact was critical to the program success, and the justification for these costs for targeted voucher programs remains a challenge.