This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). Moving toward UHC requires a strong health system with sustainable financing, which countries strive to achieve through various approaches appropriate to their country contexts. Great efforts have been made by financing reforms through resource mobilization, risk pooling, resource allocation, and strategic purchasing. Overall governance of health financing systems has improved within the context of service delivery and budget reforms. But there are still challenges and ongoing needs to continue expanding health financing mechanisms equitably and efficiently, improving stewardship and accountability, strengthening the transition to domestic financing, and enabling evidence-informed priority setting and benefits design processes. Asian countries are rapidly developing and moving to more prepaid financing mechanisms with government subsidies to reduce relatively high out-of-pocket expenses, while facing implementation challenges in the governance and expansion of social health insurance. The Pacific island countries, on the other hand, face stagnating economic growth and rely on government financing, with some countries receiving significant external funding, making it important to have strong stewardship and public financing systems in place. The way forward calls for continuing to strengthen the evidence generation and monitoring function to assess country progress, reorienting primary health care as the foundation of the health sector to ensure that continuity of care is affordable and accountable, and leveraging the private sector to contribute to an equitable and efficient health system.

Objective: Assess whether reform in the Tanzanian medicines delivery system from a central ‘push' kit system to a decentralized ‘pull' Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines.

c This paper explores the patterns of buyer and seller strucfure among business uniis in the PIMS database and how buyerlseller structure is related to profit outcomes, both long-term through the product life cycle and short-term between periods of boom and recession. Businesses with a favourable structure (few sellers, many buyers buying items of low importance) typically maintain margins through the product life cycle, but if there are many sellers facing few and determined buyers, margins and profitability are likely to deteriorate in recession and to continue to decline through the life cycle.

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Background Private Hospital Growth Trends in Laos PDR, Viet Nam, and China Characterization of Private Hospitals by UHC Attribute Maximizing Private Hospital Contributions to UHC Conclusions References BACKGROUND Many transitional economies in the Western Pacific Region (WPR) have been moving away from the public sector fully funding and providing health care services. Many governments are looking to the private sector for their expertise in organization and bringing efficiency to the provision of health care. Public hospitals are also gaining more financial and administrative autonomy, with more hospitals moving across the spectrum from fully public to mixed public and private models with for-profit behavior. With rising demand for modern and highquality health services and severe fiscal constraints on public financing for health services, the private sector has recently expanded its presence in the health care sector. This transition has been particularly rapid in Viet Nam, China, and the Lao People's Democratic Republic (Lao PDR). The role of the private sector in the provision of health care services dominates the hospital and primary health care (PHC) sectors in Japan and Korea, where there is a long history of private hospitals using social health insurance and state budget funding to advance hospital-based contributions to universal health coverage (UHC). The major challenge in this transition is aligning both public and private hospitals to achieve equitable access to services, better quality, and improved efficiency. Through a series of public hospital reforms, including granting various levels of autonomy in managing public hospitals and introducing some forms of public-private partnerships, the governments of Lao PDR, China, and Viet Nam have attempted to make public hospitals work more efficiently. The move toward fully autonomous public hospitals is one aspect of Viet Nam's broader "social mobilization" policy that has also led to increased private investment in state hospitals along with government granting them more decision rights in generating and retaining revenues. In Lao PDR, the private hospital regulations recently introduced more attractive incentives for private investors, such as allowing 100% foreign-owned investment, land concessions, and tax or duty exemptions on medical equipment and supplies. In addition, through Lao