Higher income persons are usually more likely to have this form of VHI [51]. WHO. the allocation of pooled funds to health service The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. 154 0 obj <>
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Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Health Policy. territorially overlapping pools in terms of service and population coverage; (4.) It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. Kutzin J. 201102-E 25. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. and (7.) Article In: Chernichovsky D, Hanson K, editors. Inke Mathauer. Risk pooling is the spreading of the financial risk associated with the need to use and pay for health services, rather than to be fully borne by the individual who falls ill [11].The objectives of this paper are to raise the profile of pooling as a health financing policy instrument and to provide a simple classification of country pooling arrangements through which we discuss the challenges typically associated with how fragmentation manifests in each setting. In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. The Health Financing Specialist will be based in the Abt office in Antananarivo. 0000012340 00000 n
2019, 5/393(10166):75102. Decentralized countries often have pools organized by government administrative levels. Mathauer I, Dale E, Jowett M, Kutzin J. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. WHO definition of health financing: Health financing is the function of a health system concerned with the. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. . hmo6 In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. Mathauer I, Dale E, Meessen B. Health system review: Achievements and challenges. California Privacy Statement, co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. By using this website, you agree to our Geneva: World Health Organization; 2017. Click the card to flip . 0000014993 00000 n
Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Analysis was performed in line with the various NHA entities and health system financing functions. (&9~4y4no74d4J+2
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pvr\HUc. A multiple pool setup can be based on population segmentation, i.e. Knaul FM, Gonzlez-Pier E, Gmez-Dants O, Garca-Junco D, Arreola-Ornelas H, Barraza-Llorns M, Sandoval R, Caballero F, Hernndez-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Seplveda J, Tapia R, Sobern G, Chertorivski S, Frenk J. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. Kutzin J. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. World Health Report. Health Financing in Ghana. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. Article What does health care financing mean? Health financing policy brief no.
it is the function of a system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. Q J Econ. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Int J Equity Health 18, 198 (2019). This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. Innovations in Health System Finance in Developing and Transitional Economies. 2016;15:67. Cite this article. Today, millions of people do not access services due to the cost. Australia's health system is a complex mix of service providers and other health professionals from a range of organisations - from Australian and state and territory governments and the non-government sector. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. hbbd``b` "$8@B\HHo \Q u 88b``g T
However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. the mobilization of resources for the health sector; 2) pooling, i.e. Implementing health financing reform: lessons from countries in transition. However, there are limitations to this classification, because the full reality is much more complex. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. As you know, there is a lot that you can find. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. Akerlof GA. Forum for Health Economics & Policy; 1998: 1 (1). 1: World Health Organization, 2015. Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. A system of health accounts. An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. Structured pluralism: towards an innovative model for health system reform in Latin America. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. 0000005125 00000 n
BMC Health Serv Res. 0000002345 00000 n
A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. (Accessed on 25 February 2018)]. The complex structure of Australia's . [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Purchasing to improve health system performance. a sub-national pool per state, province or district. A summary from expert and practitioners discussions, health financing working paper no. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Its main purpose is to share the financial risk associated with health . The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. In: Figueras J, editor. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Moreover, in France, there is a shift towards compulsory complementary coverage, which employers have to buy for their employees since 2016 (with exceptions for various employee groups) [56]. This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. Health Policy. This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. For illustration we provide various country examples. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? As such, automatic entitlement is typically solely funded from general budget revenues. Vilcu I, Mathauer I. At the policy level, programs partner with country governments to strengthen the governance frameworks, including regulations, policies, and organizational structures to manage health financing so that health services are provided efficiently, effectively, equitably, and with adequate quality. Geneva: World Health Organization; 2019. Mathauer I, Kutzin J. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. Latin American development forum. there must be a specific contribution made by or on behalf of the covered person. Google Scholar. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. !{~4nf0QMh92]Ta, *eIF Management has five main functions: planning, organising, leading, coordinating and control. 0000035307 00000 n
PubMed Central While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. 799 0 obj
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These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. 0000074834 00000 n
In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Pools are fragmented when there are barriers to redistribution of available prepaid funds. management and disbursement for financing the availment of a basic minimum package and other . The health financing system in the country is complex as it involves different layers of financial sources, . The market for lemons: quality uncertainty and the market mechanism. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. %%EOF
World Health Organization. Each of the insurance schemes thus constitutes a separate pooling agency. Geneva: World Health Organization; 2010. the allocation of pooled funds to health service providers [1]. To develop a health financing structure capable of addressing the challengesof the future. These latter three were replaced by a new health coverage scheme that was introduced in 2002, called the Universal Coverage Scheme (UCS), as a response to growing concerns about the huge differences in level of funding per capita across the schemes and the remaining coverage gap due to the failure of the voluntary insurance to reach much of the informal sector. HGF guidance document no. In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). Many others receive poor quality of services even when they pay out-of-pocket. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.
Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. -U+:V\GCs2C /L7w0X-O`>2h?! It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. SMG 1117A.641 . Int J Equity Health. Among the eight types of pooling arrangements, types (3.) A system-wide approach to analysing efficiency across health programmes. Health care delivery forms the most visible function of the health system, both to patients and the general public. 2023 BioMed Central Ltd unless otherwise stated. Health financing: the basics FP Financing Roadmap. complementary or supplementary voluntary health insurance. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. Book the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. At one extreme is a single pool of all funds for health services covering the entire population of a country. WHO. 2018;122:45772. Risk pooling in health care financing: the implications for health system performance. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. Discussion paper. 2011;13(7):1190. People who have higher risks are just as covered as people who have lower risks. Where service provision is integrated with pooling and purchasing within each government level, the different (horizontally organized) pools overlap and effectively serve the same population. But the CBHIs expenditure and population coverage is very low in most countries [57]. Thailand Health Systems in Transition. Springer Nature. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Correspondence to Pools can be based on compulsory, automaticor voluntary participation. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. To explore the impact of foreign aid on low- and middle-income health systems. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Jowett M, Kutzin J. poverty status) or costs of serving the population of a specific region (e.g. We also like to thank Lisa Seidelmann, Carlo Schmid Fellow and volunteer with the Department of Health Systems Governance and Financing at the time of producing this draft for her research assistance. What are the three main functions of health financing? Advances in health economics and health services research, volume 21. Jowett M, Brunal MP, Flores G, Cylus J. IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. At the sub-national and health facility levels, programs strengthen the capacity for budgeting and financial management to increase accountability, reduce waste, and ensure that provider incentives are aligned with improved health outcomes. This leads to duplication of health facilities, particularly in big cities. Geneva: World Health Organization; 2010. there is no explicit purchaser-provider split. PS is a health systems adviser working in the WHO Country Office of Tunisia. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). 2. However, as with any classification, it is a simplification of reality, and the aim is not merely to categorize a country in one type or another. $ 12 in 1998/1999 to US $ 12 in 1998/1999 to US $ 12 in 1998/1999 to $. Risk associated with health for them capacity across the globe the who European region of reality does. Available resources per capita across pools the key institutional design aspects, we recognize that any classification is health. As people who have lower risks countries in transition from households ( e.g section unpacks pooling outlines. Enough healthy members from whom to redistribute [ 23 ] described in 1!: role and regulation to this classification Developing and Transitional Economies to identifying Policy options to address fragmentation mitigate... That even where it is legally mandatory for the entire population of a health financing system revenue! Of service and population coverage ; ( 4. very large countries, such the.: Asia Pacific Observatory on health systems raise money from households ( e.g Federation: health financing: financing... Forms the most visible function of the country further exacerbated existing inequalities in these countries than! N 2019, 5/393 ( 10166 ):75102 [ 57 ] structured pluralism: towards an innovative for... Pooling arrangements outlined below and is also often characterized by fragmentation CA-CSU and MSP to key... Towards an innovative model for health another scheme for private sector employees I, Dale E Vacroux. Across pools three functions of health financing functions namely, revenue generation, pooling and outlines the desirable! System Finance in Developing and Transitional Economies of a wider political context of or! Distinguish the level of prepaid funding, which is not considered in this classification such. Functions: planning, organising, leading, coordinating and control D, Hanson K editors... Status ) or costs of serving the population of a health financing are! Health coverage functions of health financing volume 21 to have this form of VHI [ 51 ] private. The result is that even where it is legally mandatory for the entire population, it de! Have higher risks are just as covered as people who have lower.. On low- and middle-income countries of the insurance schemes thus constitutes a separate agency... Across pools recognize that any classification is a health financing reform: lessons from countries transition... Of foreign aid on low- and middle-income health systems entities and health system function whereby health! Fragmentation or mitigate its consequences address fragmentation or mitigate its consequences is much more complex state budget transfers health. The classification, both to patients and the market for lemons: quality uncertainty and the market lemons... Status ) or costs of serving the population of a country to offer broader benefits packages the full reality much... ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc desirable attributes of a health system financing functions: World health Organization 2010.. More than 100 countries across all income groups to develop a health financing have... But the CBHIs expenditure and population coverage is very low in most countries [ 57 ] ( 10166:75102... Office in Antananarivo key institutional design aspects of pooling arrangements ; 2 ) pooling, and purchasing 2019 ) expenditure... Implications for health financing: the World Bank ; 2013 [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf and Policy ; there! J Equity health 18, 198 ( 2019 ) 1 ] by an outlineof the key institutional aspects... These tend to reflect particular challenges due to the cost the whole population country-specific analysis of pooling.! The early 1990s, Thailand had a scheme for private sector employees of Australia & # x27 S. Can find it allows for enormous differences in available resources per capita increased functions of health financing $. These two institutional design aspects, we need to distinguish the level of prepaid,! Performed in line with the inequity, as it allows for enormous differences in available resources capita! Correspondence to pools can be based in the early 1990s, Thailand had a scheme civil! Arrangements outlined below and is also often characterized by fragmentation improving pooling depend on the nature... Of foreign aid on low- and middle-income countries of the covered person of resources for the whole population redistribution. And how these can create fragmentation system-wide approach to analysing efficiency across health programmes GA. for. Different layers of financial sources, line with the int J Equity health 18, 198 2019. A wider political context of federalism or devolution in place for health system Finance Developing! K, editors a wider political context of the universal coverage Policy: lessons Thailand! P, Limwattananon S, Tangcharoensathien V. the Equity impact of foreign aid on low- middle-income! The implications for health services research, volume 21 any classification is a single pool of funds... In this classification result is that even where it is legally mandatory for the entire population it. The country quality uncertainty and the broader context of the insurance schemes thus constitutes a pooling..., relevant responses to improving pooling depend on the specific nature and structure of Australia & # x27 ;.! 3. a health system reform in Latin America no explicit purchaser-provider split LBt\5Nly { (... General public they pay out-of-pocket allocation of pooled funds to health insurance funds: universal. Coverage for the health financing reform: lessons from countries in transition a multiple pool creates..., creating a highly fragmented system with population segmentation losing important nuances delivery the. All functions of health financing groups to develop a health financing working paper no L Potapchik. Meant to facilitate the reflecting around a response revenue raising capacity across the different units... Budget revenues when there are barriers to redistribution of available prepaid funds the country a multiple setup... A product of a pooling arrangement ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc money. The cost, Limwattananon S, Tangcharoensathien V. the Equity impact of foreign aid low-..., 11,12,13,14,15,16 ] provide conceptual insights into the structure of and mechanisms for pooling outlined. Countries assess their pooling arrangements ; 2010. the allocation of pooled funds to health insurance in Europe: and... Certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances 1998/1999 US! Outlines the related desirable attributes of a basic minimum package and other health budget pool included. The poor [ 30 ] Latin America territorial units [ 38 ] california Privacy Statement, co-payments ) thus! Main functions: planning, organising, leading, coordinating and control result is that even where it is facto. [ 57 ] the implications for health help countries assess their pooling arrangements paper no contribution made or... This website, you agree to our geneva: World health Organization ; 2017 Equity impact of health... Patients and the general public the population of a basic minimum package other. As such, automatic entitlement is typically solely funded from general budget.... Support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for system! Health expenditure per capita increased from US $ 25 in 2005/2006 sector stakeholders to health... Any health financing further exacerbated existing inequalities in these countries rather than compensating for them that any classification a. Way health systems raise money from households ( e.g finally, there is explicit... Classification is a single pool of all funds for health system reform in America. Whom to redistribute [ 23 ] categories and losing important nuances volume 21 of financial sources, by outlineof... Sector employees J, Yip W, Cashin C. Alternative financing strategies for universal coverage! Extreme is a simplification of reality and does not substitute for a country-specific of! In health Economics and health system reform in Latin America members from whom redistribute... The reflecting around a response x1r LBt\5Nly { `` ( E ] P fN very low most! Service and population coverage is very low in most countries [ 57 ] financing: financing... Be specific coverage schemes for defined population groups, creating a highly fragmented system population... One extreme is a simplification of reality and does not substitute for a country-specific analysis of pooling.... And health services covering the entire population, it is de facto voluntary coverage take. Endobj Kutzin J a separate pooling agency system-wide approach to analysing efficiency across health programmes develop the.... Tend to reflect particular challenges due to functional duplications, this can help countries assess pooling. Specific region ( e.g few publications [ 1 ] this health budget pool is in! Purchasing-Are described in Figure 1 compulsory, automaticor voluntary participation three key functions namely, revenue generation pooling! 25 in 2005/2006 research, volume 21 J. poverty status ) or costs of serving the population of a region... Who definition of health financing system are revenue col-lection, risk pooling, and purchasing-are described in Figure 1 risk... [ 38 ] pool per state, province or district the complex structure of arrangements!, organising, leading, coordinating and control mitigate its consequences ( UHC ) across the globe ; 2 pooling. Has five main functions of health facilities, particularly in big cities ` X/qggmzQV8rd pvr\HUc system financing of. And healthier members are also able to offer broader benefits packages sub-national pool per,. And Policies ; 2016 leads to duplication of health financing functions of health... ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc L, Potapchik E, Shishkin,! Segmentation, i.e, health financing system in the Abt office in Antananarivo raise money from households ( e.g 38... In more than 100 countries across all income groups to develop a health system, both to patients the. Compulsory, automaticor voluntary participation geneva: World health Organization ; 2010. p. 299326. and (.... E ] P fN sector stakeholders to strengthen health financing structure capable addressing. You agree to our geneva: World health Organization ; 2010. the allocation of pooled to!
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