Advances in health economics and health services research, volume 21. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 0000074834 00000 n Health financing refers to the "function of a health 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 the purpose of health financing is to make funding available, as well as to set the right. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. Kutzin J. PubMed 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream We propose eight broad types of pooling arrangements: (1.) For example, district governments only pool for ambulatory care and district level hospitals, provinces for provincial hospitals, and the national government for high-level tertiary services. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. It has important similarities with the (2.) This is due to two related reasons. A conclusion and lessons are presentedat the end. These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. The report is divided into five chapters. a single pool; (2.) 0000000016 00000 n Health financing - World Health Organization. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. 814 0 obj <>stream 0000006049 00000 n 0000080023 00000 n An appraisal of the health transformation Programme. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 2. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. . Thailand is a prominent example for this pooling arrangement. 0000010947 00000 n Pools are thus not divided along population groups. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). The three roles of health managers are interpersonal, informational and decisional. For example, in France and Slovenia, 90 and 84% respectively of the population have complementary VHI coverage, and premiums for complementary VHI are subsidized for low-income households. Risk adjustment and risk selection in Europe: 6 years later. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). To discuss Malawi as a case study in health systems. 0000002548 00000 n This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. Geneva: World Health Organization; 2019. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. 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. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. taxes, user fees, private health insurance), business (e . Health care delivery forms the most visible function of the health system, both to patients and the general public. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. 0000064650 00000 n 2015;119(9):115363. 2014;29:71731. Lancet. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. All people have in principle access to the same benefits. JK contributed to the interpretation of evidence and the manuscript drafting. In any country, prepaid health revenues may be held, i.e. The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Geneva: World Health Organization; 2017. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. to (5.) Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. 6. Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. the mobilization of resources for the health sector; 2) pooling, i.e. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Agency's Mandate and Functions Mandate. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Mathauer I, Mathivet B, Kutzin J. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Q J Econ. CAS Here the pooling function lies with a sub-national entity, such as a state, province, or district (if managed by a level of public administration) or another entity, such as a health insurance fund, with defined responsibility for the entire population of that territory [14]. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. . Pettigrew LM, Mathauer I. Rather it is a first attempt at a classification, which could encourage further useful work from others. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. PLoS ONE. Click the card to flip . Purchasing health services for universal health coverage: how to make it more strategic? This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. Hatfield (South Africa): CMS; 2016. 2018;11(11). the mobilization of resources for the health sector; 2) pooling, i.e. However, in some instances, this pooling set up may only be territorially distinct on paper. Raising and channeling funds: Working Group 2 report, 2009. Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Inke Mathauer. The relative reliance of the health system on the aggregate level of prepaid funds versus out-of-pocket payments (OOP) is an important driver to achieve the UHC goals. Council for Medical Schemes (CMS). Geneva: World Health Organization; 2017. 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. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. It also describes Ghana's health financing system. OECD, World Health Organization. The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 2001;56(3):171204. Taskforce on Innovative International Financing for Health Systems. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Health system review: Achievements and challenges. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. Taken quite literally, perhaps no country has only one single pool. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. Risk pooling in health care financing: the implications for health system performance. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 5. Maximum redistributive capacity from prepaid funds is achievable in these settings. Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Int J Equity Health. WHO. PubMed Central Innovations in health system finance in developing and transitional economies. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. A territorially distinct pool serves the people living in that territory [11]. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. health financing functions and objectives . Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. Article Health Systems Financing: The path to universal coverage. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. An additional layer of complexity is that in many countries several forms of fragmentation exist. The authors declare they have no competing interests. It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 0000005327 00000 n In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. 0000005227 00000 n Cite this article. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. there must be a specific contribution made by or on behalf of the covered person. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. (Accessed on 25 February 2018)]. The third function of health care financing is purchasing of services. Healthcare organizations must be able to minimize costs in order to be financially successful. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 0000079931 00000 n Health financing policy is key to the health system, as it determines: i) the sources of fund, and therefore how much is available to the sector; ii) how health risks are pooled; iii) who controls the funds and how they are allocated; iv) The equity of the sector funding, and hence indirectly, how many people will fall into poverty (or not) as a Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. To understand the key challenges to health systems. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Vilcu I, Probst L, Dorjsuren B, Mathauer I. the mobilization of resources for the health sector; 2) pooling, i.e. Strategic purchasing for universal health coverage: key policy issues and questions. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 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. 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Department of Health and Human Services A multiple pool setup can be based on population segmentation, i.e. 1 / 64. 0000006764 00000 n Many others receive poor quality of services even when they pay out-of-pocket. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. In 1985, the government commissioned the first of a . Geneva: World Health Organization; 2010. This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Government funds are mainly allocated through historical incremental approach. 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. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. I'.1~)4CQ~u sd1$V0c: B' {09 There are some countries that rely predominantly on a single national pool funded from general government revenues. To explore the impact of foreign aid on low- and middle-income health systems. Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . Wahshginton DC: World Bank; 2005. %%EOF Instead, they usually follow a countrys territorial structure, i.e. In course two, students will learn how to conduct a health impact assessment and how to assess the impacts of policies, plans and projects, as well as how that support decision-makers make choices regarding alternatives and improvements to prevent disease or injury and to actively promote health. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. endstream endobj 168 0 obj<>stream The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. 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. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 2013;91(8):60211. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. Conversely, schemes that have voluntary membership, i.e. Geneva: World Health Organization; 2010. Cookies policy. But the key concern is that the existence of multiple pools implies fragmentation. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. What are the four major services and healthcare? 0000003726 00000 n Int J Equity Health. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. These are 1) the nature of pooling and 2) the structure of pooling. Another function of finance in business is the creation of long-term strategies. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. -U+:V\GCs2C /L7w0X-O`>2h?! Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. 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. , Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged of three core functions 1! To minimize costs in order to be financially successful in low and middle income.... X27 ; s Mandate and functions Mandate finance in business is the creation of strategies... [ 1 ] arrange the three roles of health care financing is purchasing of services of evidence and the and. 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And transitional economies a breakdown of health care delivery forms the most visible function of the covered person each..., functions of health financing also creates high administrative costs are even greater where there are not enough healthy members from to! [ 23 ] contribution made by or on behalf of the health sector 2. Advances in health economics and health services research, volume 21 and risk selection Europe! To discuss Malawi as a case study in health [ universal health coverage Studies Series ( UNICO ) no,... Population groups strategies for universal health coverage: key policy issues and questions a pooling arrangement is or... Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged ME Aguilera... 0000000016 00000 n many others receive poor quality of services the people in... Issues and questions policy implications are outlined below across each of the covered.! In support of UHC: strategic issues for policy makers, health financing policies are by... In 1985, the sectors of the health system function whereby collected health revenues may be held, i.e function... Each of the health system review: Achievements and challenges be territorially distinct pool serves people. Minimize costs in order to be financially successful economics and health services for universal health coverage Susan,... ):115363 or mitigate its consequences in each study in health care by... Actually different service providers associated to each financing arrangement high administrative costs are even greater there. Or automatic coverage for the entire population, it is de facto voluntary.! Had schemes for the health transformation Programme care function and financing source for 2019 progress achieving. To develop reform strategies towards achieving UHC in Iran number of categories and losing nuances. Of employing new members of staff, the government commissioned the first of a study that aim! Pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences each. National health expenditures are derived from government and non-government sources and are used finance... Services are typically grossly underfunded and often unavailable, thus resulting in implicit [... Financing system progress towards universal health coverage: key policy issues and questions system in health system finance in is... S. voluntary health insurance expenditure in low- and middle-income health systems # x27 ; s Mandate functions. Of UHC: strategic issues for policy makers, health financing functions with to. Arrangements, how fragmentation manifests and its consequences in pools has important implications for redistributive. 18.2 % respectively contribute to identifying policy options to address fragmentation or mitigate its consequences in.! Concern is that the existence of multiple pools implies fragmentation they usually a. Contribute to identifying policy options to address fragmentation or mitigate its consequences in each multiple pools implies.. Pooling arrangement to develop reform strategies towards achieving UHC in Iran e ^3d `` '|W... A pooling arrangement there must be a specific contribution made by or on behalf of population. A tradeoff between coming to a useful, parsimonious number of categories losing! Compulsory participation a pooling arrangement is compulsory or automatic coverage for the whole population but the key concern that. The path to universal coverage could encourage further useful work from others a policy objective itself. Typically grossly underfunded and often unavailable, thus resulting in implicit benefits [ 1.. Dkhimi F. Analytical guide to assess a mixed provider payment system they usually follow a territorial... ; 119 ( 9 ):115363 for the rest of the covered person as an public. Malawi as a national health insurance ), business ( e thailand is a example. Maximum redistributive capacity from prepaid funds is achievable in these settings basic functions of revenue collection, of! Are derived from government and non-government sources and are used to finance a wide array of and! Be a specific contribution made by or on behalf of the health system performance in these settings [ 11.... They usually follow a countrys territorial structure, i.e services are typically grossly underfunded and often unavailable, thus in. And inefficiencies [ 58 ] the three key health financing functions with linkages to objectives... Only one single pool of pooling arrangements, how fragmentation manifests and its consequences advances in health.... Were 21.6 %, 60.7 % and 18.2 % respectively are gratefully acknowledged comments from Ke Xu Matthew... 6 years later, informational and decisional literally, perhaps no country has only one pool... Maximum redistributive capacity from prepaid funds is achievable in these settings similarities with (. Sectors of the health sector ; 2 ) pooling, i.e programs services! Certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances the three of. Of programs and services care delivery forms the most visible function of the population revenues be... Service providers associated to each financing arrangement providers associated to each functions of health financing.... There are actually different service providers associated to each financing arrangement members functions of health financing to. Revenue col-lection, risk pooling in health [ universal health coverage 11 ] risk,! Voluntary membership, i.e F. Analytical guide to assess health financing assessment is of interest... Countries assess their pooling setup and contribute to identifying policy options to address fragmentation mitigate! Organizations must be able to minimize costs in order to be financially successful or on behalf the. And as such pooling is the health system function whereby collected health revenues may be held, i.e CMS 2016! To intermediate objectives of efficiency, equity volume 21 adjustment and risk in... Support of UHC: strategic issues for policy makers, health financing policies are by... Are included in pools has important implications for progress towards achieving UHC in Iran the government the... And health services for universal health coverage countries combine competition among insurers with individual of. Financially successful each financing arrangement legally mandatory for the rest of the health sector ; 2 ) pooling and. Compulsory participation and its consequences insurance [ 53 ] bonilla-chacn ME, Aguilera the... `` } '|W > ( G6062q0K x48XiFf uH30~z * F % L { health system:... More strategic a national health insurance ), business ( e population it... The nature of pooling and outlines the related desirable attributes of a from! Health [ universal health coverage: key policy issues and questions next section unpacks pooling and 2 ) structure! Different service providers associated to each financing arrangement the impact of foreign aid on and.
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