Table 7.

Summary of relative attributes of funding flows to public hospitals.

Attributes	Government funding			Out of pocket payment	NHIS		Donor funds
	Salaries (personnel)	Recurrent budget	Capital budget		Capitation	Fee for service
Relative share of funding	Highest share	Third highest	Fourth highest	Second highest	Fifth highest	Less share	Least share
Duplication or gaps in service coverage	No gaps or duplication	Does not cover highly specialized services	No gaps or duplication	Gaps—many people cannot afford the cost of highly specialized services	Gaps—NHIS drug formulary is restrictive		Duplication—donors run parallel programs as other funding sources
Relative adequacy of funds	Most adequate	Least adequate	Low adequacy—depends on availability of funds	Adequacy is low because services are subsidized	Capitation rate is inadequate but pooled capitation is moderately adequate	FFS rate and payments are highly inadequate	Moderately adequate for earmarked services
Relative flexibility of funding flows	Not at all flexible	Very flexible	Not at all flexible	Varies. Highly flexible in tertiary hospitals. Not flexible in secondary hospitals	Highly flexible and centrally pooled with other flexible sources	Highly flexible	Moderate flexibility
Relative predictability	Most predictable in terms of timing and amount	Highly unpredictable	Most unpredictable	Majority opinion is that it is highly predictable	Highly predictable in terms of amount Less predictable in terms of timing	FFS is less predictable in terms of timing and amount	Very irregular and has the least predictability
Relative complexity of accountability mechanisms	Less complex compared to OOP because personnel budget, which contributes the largest share, is earmarked			Most complex. Requires extra vigilance of accounting staff	Less complex than OOP but more complex than GF		Least complex. Funds are earmarked
Acceptability of process of developing and introducing funding sources	Less acceptable Decided by central government and lacking in fairness and accountability			More acceptable. Rates were decided by a committee	Least acceptable. Current design and rates were decided at the national level. Benefit package is not robust		Less acceptable Decision is made by donors.