Cost recovery in public sector hospitals in Ecuador

The study includes brief background notes explaining the current financial difficulties the public health sector faces, including legal restrictions on fee collection, fees that do not reflect market realities, and flawed means testing and billing systems. The simulations offer a solution by updating the prices, while proposing policy and administrative changes to improve financial management. Specifically, the authors recommend revenue sharing and increased autonomy for the facilities. Individual performance would be subject to review and determine future government subsidies for each facility. Such incentives would provide the impetus for quality improvements. Finally, the authors recommend more localized means testing programs to protect the poor and eliminate prevalent leakage. (Author abstract)