Health financing challenges and institutional options to move towards universal coverage in Nicaragua.

Abstract

The Nicaraguan government is committed to moving to universal coverage in order to provide adequate quality health care for all. Yet, there are considerable challenges to achieving this within the existing health financing system design. This paper provides an analysis of the Nicaraguan health financing system and assesses its performance on the basis of selected health financing performance indicators. The analytical framework applied to explain the level of performance focuses on the institutional design and organizational practice of the health financing system . The analysis is based on qualitative data from interviews and discussions with health financing stakeholders and on a contents analysis of legal provisions and regulations relating to health financing. Quantitative data from government and social health insurance sources and household surveys were used, and secondary analysis carried out. The analysis reveals that the health financing system suffers from many institutional and organizational deficits, such as gaps in resource mobilization, non-conducive crosssubsidies from the government to the social health insurance scheme, and inefficient purchasing mechanisms. This explains poor health financing performance. Yet the institutional design and organizational practice of a health financing system can be actively shaped and improved. This paper proposes a number of institutional and organizational changes to move towards universal coverage in Nicaragua.