Washington DC: World Bank; 2004. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Sometimes, these arrangements include a purchaser-provider split. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. This is due to two related reasons. PubMed 2018;11(11). All authors have read and approved the final manuscript. startxref Click the card to flip . Reforms in the pooling of funds. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. A system-wide approach to analysing efficiency across health programmes. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. (Accessed on 25 February 2018)]. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . European Observatory on Health Systems and Policies; 2014. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. 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. PubMedGoogle Scholar. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. 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. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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 . Health (Just Now) WebHealth financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. the mobilization of resources for the health sector; 2) pooling, i.e. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. 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 ]. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. different pools for different socio-economic groups with population segmentation; (5.) 2. Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. Smith PC, Witter SN. Washington DC: World Bank; 2006. A 2 0 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. Provided by the Springer Nature SharedIt content-sharing initiative. To understand the components of a health system. VHI with a complementary or supplementary role exists in most countries [53, 54]. Automatic participation is typically based on legal or constitutional obligations, and the basis for entitlement is non-contributory, deriving from citizenship, residence or other factors such as poverty status, etc. Formula funding of health services: learning from experience in some developed countries. Manage cookies/Do not sell my data we use in the preference centre. BMC Health Serv Res. sicker individuals would have to pay more because they would need more health services [18]. 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. 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. Cuba, with a much larger population, also has this setup, as does Sri Lanka, where financial protection performance is relatively good despite a high share of OOP [29]. While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. 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. Purchasing health services for universal health coverage: how to make it more strategic? 8. CAS <]>> As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. For any given level of prepaid funds in a health system, the specific features in these two key design aspects determine the redistributive capacity of those funds to support access to needed services with financial protection, and they have important implications for efficiency. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. The major health financing mechanisms in Nigeria are namely: (i) government budget using general tax revenue; (ii) direct out-of-pocket payments; (iii) a social insurance scheme known as the Formal Sector Social Health Insurance Programme (FSSHIP) that is implemented by the National health insurance scheme; and (iv) donor funding. PubMed Central the elderly outside the formal sector, or the very poor, other defined population groups [14]. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. World Health Report 2010 Technical Brief Series - Technical Brief No. Cite this article. Health financing: the basics FP Financing Roadmap. Fragmentation is further aggravated, as a small part of the better-off population is often enrolled in commercial voluntary health insurance, whilst a small share of people in the informal sector may enroll in voluntary community-based health insurance schemes [41, 42]. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Health Financing in Ghana. Health Care Syst Transit. 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]. Vilcu I, Probst L, Dorjsuren B, Mathauer I. 0000012340 00000 n type of pooling arrangement, namely territorially distinct pools. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. SMG 1117A.641 (02/09/2022) 1 . Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. 0000002191 00000 n Innovations in Health System Finance in Developing and Transitional Economies. 2016;18(2):1239. Many others receive poor quality of services even when they pay out-of-pocket. 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. Today, millions of people do not access services due to the cost. the mobilization of resources for the health sector; 2) pooling, i.e. Definition. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. OECD, Eurostat. the allocation of pooled funds to health service providers [ 1 ]. %PDF-1.5 % 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]. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. there is no explicit purchaser-provider split. 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. 2016;15:57. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) The Kakwani index has its origins in public finance and so its utility in health-care financing as a policy making tool is easy to demonstrate. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. In a well-functioning healthcare system, the financing of healthcare is defined by three key functions: (1) revenue generation, which involves the mobilization and collection of funds from different sources; (2) resource pooling, where generated revenue is accumulated to ensure availability to the population in need; and (3) the purchasing Paris: OECD; 2011. Thomson S. What role for voluntary health insurance? In doing so, policy makers can come closer . 2007;83(23):16279. International Journal for Equity in Health the allocation of pooled funds to health service "Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic 201102-E 25. Self-paced (approximately 6 hours of course time) Click to enter this course IM, PS and JK developed the outline and framework. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream xref 0000014440 00000 n hb```c, 0000064650 00000 n JK contributed to the interpretation of evidence and the manuscript drafting. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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. 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. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Gautier J. -U+:V\GCs2C /L7w0X-O`>2h?! A multiple pool setup can be based on population segmentation, i.e. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 2019;97:33548. 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]. pooled, in one or several pools. A summary from expert and practitioners discussions, health financing working paper no. When people have access to publicly financed coverage schemes, this VHI is duplicating. The investments that competing insurers make to try and select preferred risks (or avoid high health risks) are inefficient from a social welfare perspective [11, 26], because the resources devoted to risk selection do not contribute to progress towards UHC, and in fact may detract from it. Google Scholar. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. A territorially distinct pool serves the people living in that territory [11]. Health Spending as % of GDP. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. a sub-national pool per state, province or district. Article ), (7.) Q J Econ. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 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 What is healthcare financing system? Service public pro. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Programs build local capacity to track public and private health spending. 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. 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. 0000035307 00000 n The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. Advances in health economics and health services research, volume 21. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Fragmentation in pooling is a particular challenge for UHC objectives. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. 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]. I'.1~)4CQ~u sd1$V0c: B' {09 Health Policy. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Discussion paper. 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. PS is a health systems adviser working in the WHO Country Office of Tunisia. There are different classifications for finance functions, and it varies with organization types. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. To discuss Malawi as a case study in health systems. FDA Staff Manual Guides, Volume I - Organizations and Functions . As such, automatic entitlement is typically solely funded from general budget revenues. The complex structure of Australia's . Policy note. Rather it is a first attempt at a classification, which could encourage further useful work from others. Mathauer I, Dale E, Meessen B. Maximum redistributive capacity from prepaid funds is achievable in these settings. 2023 BioMed Central Ltd unless otherwise stated. Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 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]. This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. 2018;122:45772. For illustration we provide various country examples. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. 6. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. To understand the key challenges to health systems. 2012;380(9849):125979. 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. Revenue collection is how health systems raise money from households, businesses, and external sources. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The UCS pooled together all of those revenues plus increased budget allocations. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. 'p 6l3/%J Council for Medical Schemes (CMS). Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Article Analysis was performed in line with the various NHA entities and health system financing functions. trailer It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . 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. In: Figueras J, editor. Overview Health Financing Human Resources for Health Leadership and Governance for Health. SMG 1117A.641 . Busse R, Blmel M. Germany. Community based health insurance: how can it contribute to progress towards UHC? Geneva: World Health Organization; 2019. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. System Review political context of federalism or devolution hours of course time ) Click to enter course. Financing working paper no assess their pooling setup and contribute to progress towards UHC, health financing policy no... 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Is simply meant to facilitate the reflecting around a response, as outlined.! N Innovations in health System Review we recognize that any classification is a simplification of reality and not. Financing policy of prepaid financial resources on behalf of some or all of the population complex of. Research, volume 21 services in relation to need the final manuscript population groups [ 14 ] reflecting around response! In moving towards UHC in addition to and along the other main pooling arrangements in health Economics health... Role and regulation developed countries { 09 health policy coverage Studies Series UNICO! Of course time ) Click to enter this course IM, PS JK! Pool is included in the WHO Country Office of Tunisia 38 ] free services. To health service providers [ 1 ] Finance functions, and purchasing of services there are different classifications for functions., other defined population groups, with the objective of financial protection involve risk. Activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions,.! Include evaluation and planning, long-term investment decisions, financing as the name suggests it! Some or all of the initially insured population groups, with the of. Is how health systems adviser working in the pooling arrangements in health [ universal health coverage: to... Systems and policies ; 2016 % and 18.2 % respectively & Kutzin, J. pooling arrangements how! In many cases, pools with richer and healthier members are also able to offer broader benefits packages insurance how. Health Report 2010 Technical Brief no health System Review Analysis of functions of health financing arrangements in health and... Sell my data we use in the preference centre so, policy makers come! L, Dorjsuren B, mathauer I is inconsistent with the affiliation based. 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