Describes a computer model to aid decisionmakers in the health services field in developing countries. As developing countries increasingly depend on user fees to finance health care services, decisionmakers in those countries face the difficult task of developing and implementing cost-recovery systems. In recent years health economists have developed computer models to aid in such analyses. This paper contains a user-friendly computer model on a 3A' diskette which combines information about demand and supply for health care obtained through surveys undertaken in Zaire. It allows the user to enter data from other settings and to simulate various changes in health care financing under a broad range of circumstances. The computer model is provided as a tool for users to assess the impact of health financing policies on health care use and health facility financial performance. The model has been developed in Lotus 1-2-3 and is contained in four spreadsheet files that can be run on any IBM- compatible microcomputer with at least 640 kilobytes of RAM memory. The paper explains in detail the assumptions and theory behind the model, and presents numerous simulations to illustrate how the model can be used. The capabilities and limitations are also outlined, along with a summary and conclusions.

This in-depth study of health insurance schemes in Zaire recommends developing more pilot insurance systems in areas where health systems already function - and strengthening existing systems through training, exchange visits, information systems, and technical assistance. Implementing a nationwide health insurance system is not likely to be as successful as decentralized, locally managed plans.

This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.