Voucher scheme, design

The administrative cost of voucher schemes is one of their main drawbacks. However, they can be administered more easily than other demand-side subsidies. Requiring the provider to present a voucher in order to receive the subsidy can prevent irregularities and false claims. If designed well, the voucher can serve as a receipt and a data collection form, as well as a token of exchange. 

Although each of these stages would appear to follow from the preceding one in a consecutive sequence, in reality neither a voucher scheme, nor any other health program, is always designed and implemented in such a logical process. 

Decide whether to proceed with the design of a voucher scheme or to use an alternative strategy. 

If the ministry of health is to play a significant role in promoting, designing, and running the voucher scheme, other obstacles will also emerge—unless the idea for the voucher scheme is put forward by the highest level of the ministry itself. 

In a donor-sponsored voucher scheme designed for the prevention of HIV/AIDS in Honduras, failure to secure political support from the outset meant that although funding was secured, the project was eventually abandoned in favor of a traditional supply-side subsidy approach. 

The aims of the voucher scheme are specified and prioritized during the prefeasibility phase. In the design phase, a set of policies that is consistent... 

Once overall design of the voucher scheme is decided, the voucher itself needs to be designed to maximize the redemption rate of the voucher. 

Design and development of the information system is best carried out once all other design aspects of the scheme have been worked out and the information needs have become clear. Voucher schemes need only infor-... 

Monitoring and evaluation of the voucher scheme begin before the first voucher is distributed. It starts at the design stage, by careful consideration of what activities and outputs need to be monitored, what information will be needed to monitor them, and how that information can be gathered in the most economical and timely fashion without compromising quality. 

This guide identifies the advantages of competitive voucher schemes in delivering subsidies describes the circumstances under which they are superior to other subsidy mechanisms and explains how to design, implement, monitor, and evaluate a voucher scheme. It provides a broad outline of the problems faced by health systems, the rationale for government intervention, and the different ways in which governments and donors subsidize health care. 

The risk of counterfeiting and development of a black market for vouchers is highest if the vouchers have a high monetary value or if they subsidize a highly sought service. This risk should have been considered during the design phase and measures taken to keep it to a minimum. However, in some cases it may be better (and cheaper) simply to monitor the scheme carefully to detect abuse or misuse as soon as it occurs. 

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