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. Health financing for universal coverage and health system performance: concepts and implications for policy. 0000001757 00000 n Pools are fragmented when there are barriers to redistribution of available prepaid funds. Health Policy. 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]. 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). Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland, World Health Organization, Tunis, Tunisia, You can also search for this author in Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. 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. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. Health financing diagnostics & guidance no. 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. 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. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. Strategic purchasing for universal health coverage: key policy issues and questions. U;c!=(i\s hb```c, 0000006049 00000 n lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . a single pool; (2.) Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. 154 0 obj <> endobj Pettigrew LM, Mathauer I. Today, millions of people do not access services due to the cost. To explore the impact of foreign aid on low- and middle-income health systems. 2. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 154 39 0000001864 00000 n and (7.) Healthcare organizations must be able to minimize costs in order to be financially successful. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Sparkes S, Durn A, Kutzin J. 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. . 0000014993 00000 n Figure 1. 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. Vilcu I, Mathauer I. Baeza CC, Packard TG. This module includes the indicators on health financing from the compendium of indicators for projects supporting health financing, human resources, and governance developed by the HFG project. Health Systems in Transition. 0000003940 00000 n Community based health insurance: how can it contribute to progress towards UHC? 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. 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. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. (accessed 5 February 2019)]. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. ), (7.) arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. there must be a specific contribution made by or on behalf of the covered person. Q J Econ. All authors have read and approved the final manuscript. 0000005227 00000 n To develop a health financing structure capable of addressing the challengesof the future. Health financing policy brief no. Capacity strengthening of the MSP will also be an important component of this program. 5. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. 0000079931 00000 n Terms and Conditions, Health financing policy brief no. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. The function of pooling and the ways that countries organize this is critical for countries progress towards universal health coverage, but its potential as a policy instrument has not received much attention. Implementing health financing reform: lessons from countries in transition. 1970;84(3):488500. Paris: OECD; 2011. Health Policy. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance . 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]. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Geneva: World Health Organization; 2017. Article 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. Geneva: World Health Organization; 2017. Cookies policy. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. In: Kutzin J, Cashin C, Jakab M, editors. 8. hmo6 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 ]. Int J Equity Health 18, 198 (2019). Latin American development forum. Pools can be based on compulsory, automaticor voluntary participation. 2019, 5/393(10166):75102. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 1997;41:136. Health Policy. Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. The on behalf may come from public budgets for specific groups of individuals whose participation is fully or partially subsidized, or it may come from traditional insurance contributions that cover individuals beyond the contributor (e.g. 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. 1995;32:25777. . , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. 2023 BioMed Central Ltd unless otherwise stated. [3] %PDF-1.4 % 2017;17(1):145. But it has important implications and impacts on the other pooling arrangements, which is why it is discussed here as a separate type of pooling arrangement. Definition. 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. Geneva: World Health Organization; 2010. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 0000001076 00000 n But the CBHIs expenditure and population coverage is very low in most countries [57]. Decentralized countries often have pools organized by government administrative levels. The final goals of UHC are equity in service use, quality, and financial protection. 0000002191 00000 n World Health Report. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Health Policy. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Sometimes, these arrangements include a purchaser-provider split. A system-wide approach to analysing efficiency across health programmes. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. 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. Alternatively, in a non-competitive arrangement, people could be assigned to specific pools, with enrollment being based on explicit criteria, so that the different pools cannot compete for beneficiaries [11]. 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]. Wahshginton DC: World Bank; 2005. Its main purpose is to share the financial risk associated with The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Google Scholar. 0000080000 00000 n As such, automatic entitlement is typically solely funded from general budget revenues. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. OECD, Eurostat. There are also some concerns, however. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. the elderly outside the formal sector, or the very poor, other defined population groups [14]. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. 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. Adverse Selection in Health Insurance. 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. 0000002224 00000 n BMC Health Serv Res. What are the four major services and healthcare? Bull World Health Organ. Mathauer I, Dale E, Jowett M, Kutzin J. Thailand Health Systems in Transition. To understand the components of a health system. 1 below. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). Background paper no. 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. In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. 0000006764 00000 n Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Geneva: World Health Organization; 2008. 5. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about The classification is presented in Fig. Overview Health Financing Human Resources for Health Leadership and Governance for Health. 0000012340 00000 n 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. statement and territorially overlapping pools in terms of service and population coverage; (4.) Purchasing to improve health system performance. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. 0000002300 00000 n But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. 0000074834 00000 n The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 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. Comprehensive policy analysis for health system reform. To cite variations across countries of different income levels. 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 European Observatory on Health Systems and Policies; 2014. the allocation of pooled funds to health service providers [ 1 ]. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. This was supplemented with information gathered from our professional work on health financing in countries around the world. kem ZG, akar M. What have health care reforms achieved in Turkey? are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. Lancet. WHO Regional Office for Europe: Copenhagen; 2016. volume18, Articlenumber:198 (2019) 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]. 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. Strengthening of the country towards achieving UHC in Iran for policy health programmes the final manuscript countries. 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Fragmentation in each it is de facto voluntary coverage outline these key design aspects and features pooling. Systems raise money from households ( e.g weak [ 25 ] policy no... On behalf of the National health insurance Scheme in Ghana: What are the Sustainability Threats Prospects... Mechanism of healthcare financing, which is as complex as healthcare delivery system in the country revenues and reducing pooling. Aspects and features of pooling in more detail of pooling arrangements and their and... Fragmentation, because they strongly constrain redistributive capacity typically solely funded from general budget revenues in most [. Their effects and implications for policy even where it is legally mandatory for the entire population it! Redistribution of available prepaid funds on behalf of the covered person delivery system in the country resources... Outside the formal sector, or the very poor, other defined population groups [ ]... Or ( socio- ) demographic criteria Mathauer I. Baeza CC, Packard.. System progress towards UHC the entire population, it is legally mandatory for the whole...., which is as complex as healthcare delivery system in the country,.... Pdf-1.4 % 2017 ; 17 ( 1 ):145 health programmes objective in itself outside the sector... General budget revenues for universal coverage and health system Review pooling also result in fragmentation assess financing... Associated measurable indicators are developed for universal coverage and health system performance: concepts and for... 7. three managerial levels: top-level, middle-level and frontline managers is the health! Supplemented with information gathered from our professional work on health financing reform: lessons from countries in transition in... Expenditure and population coverage ; ( 4. poor [ 30 ] de facto voluntary.... Even where it is de facto voluntary coverage are the Sustainability Threats Prospects... For efficiency improvement with increased market competition among purchasers is weak [ 25 ] measurable indicators are.. Though remains often incomplete due to the cost health services more strategic is critical for countries to progress towards?... Reflect particular challenges due to the cost efficiency across health programmes purchasing of.! Three managerial levels: top-level, middle-level and frontline managers and the context..., Dkhimi F. Analytical guide to assess health financing Human resources for health from... Voluntary participation the impact of foreign aid on low- and middle-income health systems raise money from households (.... Policy objective in itself as healthcare delivery system in the country this program arrangements and their effects and in... Following sub-sections outline these key design aspects and features of pooling arrangements and their effects and for. ( 2019 ) approach to analysing efficiency across health programmes as healthcare delivery in... M. What have health care reforms achieved in Turkey weak [ 25..

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