Importance and Limitations of Healthcare Verification for Accelerating Implementation of Universal Health Coverage in Burundi

Abstract

Introduction: As one of the avenues for implementing universal health coverage, healthcare verification for financing health facilities is receiving increased attention. Verification is the process of ensuring that healthcare services provided to users meet the predetermined criteria for billing and payment. The objective of this article was to examine the Burundi health system practices in healthcare verification for financing health facilities in order to identify strengths, limitations, and potential solutions for more advancement in universal health coverage implementation. Methods: A critical case study was used as the overall methodological approach and a narrative review design to draw conclusions about the case. Results: The results show that verification helps visualise the country’s level of progression in implementation of universal health coverage. While it promotes efficiency in healthcare service reimbursement by allowing payment for quality care services, verification has proven to be a resilient function to fraud, abuse, and waste in the demand for, and supply of, healthcare services. However, verification has some limitations in terms of services and population targeting, and technical effectiveness of the verification team. The most important way identified for alleviating these limitations is to separate the demand for, and supply of, healthcare services. Conclusions: More investments in research are required to recognise verification as an essential sub-function of health financing for universal health coverage implementation.