@incollection{PAR00007379,
  title = {{I}mplementing funding modalities for free access : the case for a "purchasing fund system" to cover medical care},
  author = {{V}inard, {P}. and {D}iop, {K}. and {T}averne, {B}ernard},
  editor = {},
  language = {{ENG}},
  abstract = {{T}he principle of free access to {ARV}s was recognized in {S}enegal in 2003. {D}ebate now focuses on its expansion to cover all therapeutic care (consultations, exams, treatment for opportunistic infections). {E}xpenditures incurred by this complementary packet often impede access to care. {T}he main difficulty does not really arise from the need for funding but rather from how this treatment is managed and its impact on the current financing systems. {I}n fact, four types of possible funding exist: (1) provision in kind of products necessary for the consumption of free services; (2) providing equipment that allows other revenues in compensation for losses created by free access; (3) increased public budgetary grants; (4) reimbursement for services by a third party. {I}n this last solution, the third party may be the {S}tate or an ad hoc organism ({NGO}, insurance, designated fund). {T}he study compares these different modalities across specific conditions in {S}enegal and describes their possible impact on the present and future health system. {I}n effect, this analysis fits into a much broader debate since the principle of free access has already expanded to other domains, particularly childbirth (2003) and care for the elderly (2006). {T}he study shows that the multiplication of parallel supplies, the coexistence of various ?free? stocks and insufficient accounting of services might create serious disturbances in current management and financing systems. {O}n the other hand, invoice reimbursements set up in some districts by various partners preserve financial autonomy and strengthen the managerial capacities of health structures. {N}evertheless, with the increased number of people who are treated and the expansion of free access to other services, there is a risk of letting the number of individual mechanisms multiply when common services would be more effective. {G}iven the financial limitations of community financing schemes and the difficulties to develop insurance systems in a very informal economy, it is now necessary to envisage the implementation of ?purchasing funds,? for which the study proposes basic guidelines. {B}ased on the logic of insurance, they rely on purchasing a predetermined service package (contractualization and accreditation), using the sectoral approach (by ?pooling? public, private and international resources), funding based on results (a payment for services rendered) and management that is independent of public budgetary blockages (with the participation of civil society). {C}omplete medical treatment for {PLWHA} may be the best way to progressively start this process because the service package is clearly predetermined, its cost has been assessed and the number of beneficiaries, in a country like {S}enegal, is still low. {M}oreover, if proper management of this fund can be ensured, institutional sustainability will ensure its financial sustainability. {T}herefore the fight against {HIV}/{AIDS} could contribute to reflection on health system reform.},
  keywords = {{VIH} ; sida ; acc{\`e}s aux soins ; financement de la sant{\'e} ; fonds d'achat ; gratuit{\'e} ; {S}{\'e}n{\'e}gal},
  booktitle = {{T}he {P}olitical {E}conomy of {HIV}/{AIDS} in {D}eveloping {C}ountries. {TRIPS}, {P}ublic {H}ealth {S}ystems and {F}ree {A}ccess},
  numero = {},
  pages = {291--311},
  address = {},
  publisher = {{E}. {E}lgar},
  series = {},
  year = {2008},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00007379},
}