Q J Econ. statement and As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. PubMed [3] SMG 1117A.641 (02/09/2022) 1 . Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. 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. there is no explicit purchaser-provider split. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Implementing health financing reform: lessons from countries in transition. Table1 outlines the respective features under each. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. 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. 0000008166 00000 n K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: 0000002224 00000 n . We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. endstream endobj 168 0 obj<>stream Health Systems in Transition. 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. IM, PS and JK developed the outline and framework. Londoo JL, Frenk J. 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. Health financing for universal coverage and health system performance: concepts and implications for policy. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. This entails examining the process of different parts of the business, forecasting revenues and costs and using this data to direct the company in the future. Health Policy. Pools can be based on compulsory, automaticor voluntary participation. 8. European Observatory on Health Systems and Policies; 2014. Self-paced (approximately 6 hours of course time) Click to enter this course Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 2023 BioMed Central Ltd unless otherwise stated. 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. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. Baeza CC, Packard TG. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. Bull World Health Organ. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. Washington DC: World Bank; 2006. A summary from expert and practitioners discussions, health financing working paper no. Book On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. In any country, prepaid health revenues may be held, i.e. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. 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. 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. Geneva: World Health Organization; 2019. Int J Equity Health. The authors declare they have no competing interests. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. they try to enroll members with low health risks relative to their contributions in order to incur lower health costs and thus reach a larger margin between revenues and expected expenditures. WHO. This entity pools public funding, i.e. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 0000064650 00000 n A 2 0 6. Pools may be organized as territorially distinct. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. It also describes Ghana's health financing system. Comprehensive policy analysis for health system reform. As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. Jowett M, Kutzin J. 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. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Download and easily browse by indicator:Health Financing Indicators Reference Sheets pooled, in one or several pools. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 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. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. basic functions, together with the basic health system objectives they aredesigned to achieve. In: Chernichovsky D, Hanson K, editors. 154 0 obj <> endobj 0000079954 00000 n Cite this article. 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. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Hungary, Bull World Health Organ. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Geneva: World Health Organization; 2016. 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. 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. 4. 2013;91(8):60211. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. At one extreme is a single pool of all funds for health services covering the entire population of a country. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. Beyond survival protecting households from health shocks in Latin America. 2012;380(9849):125979. 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. Health financing policy brief no. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. Health financing involves not only methods of raising money for health care, but also allocation of those funds. 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? xref 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. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. Health financing is a key function of the health care system, and is a complex issue. "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 Geneva: World Health Organization; 2017. Advances in health economics and health services research, volume 21. The market for lemons: quality uncertainty and the market mechanism. 2S?dI9c{rP"=-Gsi1NU@ The federal government does the monitoring and regulatory function, health research, gathering health related data, negotiate with donors on possible avenues of support, participate in international meetings, manage federally controlled hospitals and offices and procurements. Gautier J. the mobilization of resources for the health sector; 2) pooling, i.e. Washington DC: World Bank; 2006. Mathauer I, Theisling M, Mathivet B, Vilcu I. 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