Health Financing Fragmentation and Universal Health Coverage in Brazil, Colombia, Mexico and India

The way health systems are structured and financed has major implications for the quality and comprehensiveness of the services they deliver, whether patients use those services, how much they cost and who pays, and whether they deliver improvements in health outcomes. In many low- and middle-income countries (LMICs) health financing is highly fragmented. This can produce different health sub-systems within a country, each with different organizations, eligibility criteria to access services, benefit packages and premiums, payment systems and mechanisms to manage financial risk across patient populations. This fragmentation can negatively impact health system goals including ensuring access to high quality care to all patients, irrespective of their ability to pay. Patients served by fragmented health systems may encounter significant financial and practical barriers that prevent them from receiving the high quality, co-ordinated, and continuous care they need, with the poor and disadvantaged affected most. Despite high levels of health financing fragmentation in LMICs, there is little evidence on its nature, drivers, consequences, and potential solutions. Our research programme seeks to fill these evidence gaps through a range of research activities across four countries which have high levels of poverty and inequality: Brazil, Colombia, Mexico and India. (For more details, please click here)