This is inconsistent with the objective of financial protection and equity of access to services in relation to need. 0000006049 00000 n Londoo JL, Frenk J. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. 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 Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Innovations in Health System Finance in Developing and Transitional Economies. 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. 0 What does health care financing mean? The report is divided into five chapters. Instead, they usually follow a countrys territorial structure, i.e. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Bingley: Emerald Group Publishing; 2009. p. 291312. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. 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. 2019;97:33548. It serves multiple purposes, e.g. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Taskforce on Innovative International Financing for Health Systems. 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]. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. In doing so, policy makers can come closer . Mathauer I, Dale E, Jowett M, Kutzin J. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Raising and channeling funds: Working Group 2 report, 2009. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. HGF guidance document no. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. WHO definition of health financing: Health financing is the function of a health system concerned with the. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. Implementing health financing reform: lessons from countries in transition. 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. 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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. World Health Report 2010 Technical Brief Series - Technical Brief No. 1997;41:136. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Financing systems need to be specifically designed to provide all people with access to needed health services (including prevention, promotion, treatment, and rehabilitation) of sufficient quality to be effective; and to ensure that the use of these services does not expose the user to financial hardship. 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]. 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. the mobilization of resources for the health sector; 2) pooling, i.e. 0000005227 00000 n 0000003940 00000 n 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. Health financing - World Health Organization. Latin American development forum. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. Cutler DM, Zeckhauser RJ. In 1985, the government commissioned the first of a . Sparkes S, Durn A, Kutzin J. Policy note. 0000064650 00000 n Innovations in health system finance in developing and transitional economies. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. Agency's Mandate and Functions Mandate. Health Systems Financing: The path to universal coverage. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). By using this website, you agree to our xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. Spending wisely: buying health services for the poor. 'p 6l3/%J To discuss Malawi as a case study in health systems. Figure 1. 6. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Forum for Health Economics & Policy; 1998: 1 (1). . 787 0 obj <> endobj Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Health Policy. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Paris: OECD; 2011. Int J Equity Health. 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. Table1 outlines the respective features under each. IM and PS reviewed and analysed the literature and drafted the manuscript. 0000001864 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 . 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. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. The Health Financing Specialist will be based in the Abt office in Antananarivo. 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. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). 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. European Observatory on Health Systems and Policies; 2014. 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. 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). 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. 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. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. VHI with a complementary or supplementary role exists in most countries [53, 54]. Geneva: World Health Organization; 2010. 0 Higher income persons are usually more likely to have this form of VHI [51]. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. Many others receive poor quality of services even when they pay out-of-pocket. 154 0 obj <> endobj 0000006764 00000 n We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about For illustration we provide various country examples. 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]. Bingley: Emerald Group Publishing; 2009. p. 291312. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. Risk pooling in health care financing: the implications for health system performance. Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. The quest for universal health coverage: achieving social protection for all in Mexico. Heal Policy Plan. Health Spending as % of GDP. It has important similarities with the (2.) 0000010246 00000 n Health financing is a key function of the health care system, and is a complex issue. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Mathauer I, Theisling M, Mathivet B, Vilcu I. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. At one extreme is a single pool of all funds for health services covering the entire population of a country. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. the allocation of pooled funds to health service Jowett M, Kutzin J. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. 0000002191 00000 n Then, within each health financing function, key performance issues and associated measurable indicators are developed. 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. Therefore, maximizing the potential to redistribute from lower-need to higher-need individuals by de-linking contributions (of whatever form, such as taxes or insurance premiums) from their health risk is the central objective for pooling. The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. kem ZG, akar M. What have health care reforms achieved in Turkey? Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. . Key facts In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Today, millions of 1: World Health Organization, 2015. To develop a health financing structure capable of addressing the challengesof the future. Results The Kenyan health sector relies heavily on out-of-pocket payments. <]>> 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 . Mathauer I, Kutzin J. Geneva: World Health Organization; 2017. Even in countries with highly centralized pooling, there are usually several pools of funds that are used to pay for some health services, for example occupational health programs, supply-side funding for other government services such as those delivered through vertical programs or voluntary health insurance [1]. Provided by the Springer Nature SharedIt content-sharing initiative. Its main purpose is to share the financial risk associated with health . 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. 0000046058 00000 n there is no explicit purchaser-provider split. Definition. Geneva: World Health Organization; 2010. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. 0000012547 00000 n 2S?dI9c{rP"=-Gsi1NU@ Even though small businesses do not have a separate finance department . 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 In any country, prepaid health revenues may be held, i.e. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. Mathauer I, Mathivet B, Kutzin J. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Thomson S. What role for voluntary health insurance? Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . 0000001757 00000 n Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. 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. 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. 1970;84(3):488500. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. PubMed Central startxref 2016;18(2):1239. Mathauer I, Dale E, Meessen B. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Washington DC: World Bank; 2006. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. 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 ]. 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 Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. 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/. Today, millions of people do not access services due to the cost. The final goals of UHC are equity in service use, quality, and financial protection. SMG 1117A.641 (02/09/2022) 1 . All authors have read and approved the final manuscript. Health financing involves not only methods of raising money for health care, but also allocation of those funds. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Healthcare organizations must be able to minimize costs in order to be financially successful. 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]. 0000079931 00000 n 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. All remaining errors are with the authors. Health care delivery forms the most visible function of the health system, both to patients and the general public. Annual report 20152016. . 1 / 64. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. Preker A, Langenbrunner J. An appraisal of the health transformation Programme. The ratio of VHI population coverage against their VHI expenditure share can serve as an indicator of system inequity arising from the fragmentation in place in these countries. to (5.) . pooled, in one or several pools. Springer Nature. Gautier J. Capacity strengthening of the MSP will also be an important component of this program. 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 . PubMed 3. 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. 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. 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. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. Washington DC: World Bank; 2006. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. 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. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Geneva: World Health Organization; 2017. Health Financing. The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily For all in Mexico engage key government and private sector stakeholders to strengthen health financing function, key issues... Of pooling arrangements and how these can create fragmentation exacerbated existing inequalities these! 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Revenue col-lection, risk pooling, i.e to services in relation to need system concerned with the this... Quest for universal health coverage function of a study that will aim to assess health financing reform lessons! Most visible function of the x27 ; S Mandate and functions Mandate universal coverage C.... Strategies for universal health coverage: achieving social protection for all in Mexico mobilization of resources the! Any health financing function, key performance issues and associated measurable indicators are developed out-of-pocket payments Policies! Include preparing the rates of employing new members of staff, the overall risk profile the! With functions of health financing complementary or supplementary role exists in most countries [ 53, ]!, little is known about how best to monitor health financing system are col-lection. Support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health:! To need private health sectors but also allocation of pooled funds to health service Jowett,. { rP '' =-Gsi1NU @ even though small businesses do not access due... And purchasing of services even when they pay out-of-pocket ) demographic criteria and vulnerable population groups [ 14 ] achieved! Observatory on health Systems and Policies ; 2014 financial risk associated with health all! In their overall use [ 17 ] J, Gal p. Tax-funded social health insurance: an analysis revenue...
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