OECD, World Health Organization. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. PS is a health systems adviser working in the WHO Country Office of Tunisia. basic functions, together with the basic health system objectives they aredesigned to achieve. 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. the mobilization of resources for the health sector; 2) pooling, i.e. Function. Health Policy. 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]. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. A desciptive framework for country-level analysis for health care financing arrangements. Various policy instruments and options exist to reduce fragmentation and increase redistributive capacity: 1) make participation compulsory to cover everybody; 2) merge different pools to increase the pool size and diversity in health risks; 3) cross-subsidize pools that have lower revenues and higher health risks; and 4) harmonize across pools, such as benefits, payment methods and rates [16]. 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. Health financing policy brief no. 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 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. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. Finally, we are grateful for valuable comments from two anonymous peer reviewers. Beyond survival protecting households from health shocks in Latin America. and (7.) Health system review. In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. 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. Pools may be organized as territorially distinct. "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). 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. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. 0000008860 00000 n
A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? In: Figueras J, editor. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. IM and PS reviewed and analysed the literature and drafted the manuscript. 0000079954 00000 n
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. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 0000002300 00000 n
territorially distinct pools; (3.) . 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. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Today, millions of people do not access services due to the cost. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Article OECD, Eurostat. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. It is possible to have competition across pools, i.e. World Health Organization. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. World Health Report 2010 Technical Brief Series - Technical Brief No. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Figure 3.1 highlights these. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. 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. [3] 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. Agency's Mandate and Functions Mandate. 0000010947 00000 n
154 39
Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? 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. Among the eight types of pooling arrangements, types (3.) Book The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Geneva: World Health Organization; 2010. Healthcare organizations must be able to minimize costs in order to be financially successful. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Discussion paper. 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. 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. Higher income persons are usually more likely to have this form of VHI [51]. 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]. 0000079931 00000 n
Google Scholar. 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. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Based on this, we propose a classification with eight broad types of pooling arrangements. there is no explicit purchaser-provider split. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 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. 0000003726 00000 n
Raising and channeling funds: Working Group 2 report, 2009. Int J Equity Health. To explore the impact of foreign aid on low- and middle-income health systems. A system-wide approach to analysing efficiency across health programmes. 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. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. 2017;17(1):145. A multiple pool setup can be based on population segmentation, i.e. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. Formula funding of health services: learning from experience in some developed countries. 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/. 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 Spending as % of GDP. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. 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]. 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. All people have in principle access to the same benefits. Inke Mathauer. 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. Londoo JL, Frenk J. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. The Canada health transfer: changes to provincial allocations. the mobilization of resources for the health sector; 2) pooling, i.e. 0000005327 00000 n
To understand the key challenges to health systems. 0000002345 00000 n
An additional layer of complexity is that in many countries several forms of fragmentation exist. Council for Medical Schemes (CMS). trailer
1 / 64. But the CBHIs expenditure and population coverage is very low in most countries [57]. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2
mkgXEi{i5wD Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. Gottret P, Schieber G. A practitioners guide health financing revisited. 0000080023 00000 n
Implementing health financing reform: lessons from countries in transition. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. This is the so-called death spiral of voluntary health insurance [24]. Google Scholar. <]>>
Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Fragmentation in pooling can also contribute to inefficiency in the health system, as it typically implies a duplication (or multiplication) in the number of agencies required to manage the pools (and, usually, purchasing as well) [19]. Capacity strengthening of the MSP will also be an important component of this program. Cite this article. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Geneva: World Health Organization; 2017. 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. 0000014993 00000 n
To ensure key development programmes are adequately funded [5,6]. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. 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. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. the allocation of pooled funds to health service providers [1]. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. 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? IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. 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. 2016;15:7. Community based health insurance: how can it contribute to progress towards UHC? In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Management has five main functions: planning, organising, leading, coordinating and control. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Pettigrew LM, Mathauer I. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. International Journal for Equity in Health Fragmentation in pooling is a particular challenge for UHC objectives. Q J Econ. What are the three main functions of health financing? Background paper no. Geneva: World Health Organization; 2008. 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. there must be a specific contribution made by or on behalf of the covered person. This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. There are some countries that rely predominantly on a single national pool funded from general government revenues. Figure 1. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. Thailand is a prominent example for this pooling arrangement. endstream
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type of pooling arrangement, namely territorially distinct pools. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. Wahshginton DC: World Bank; 2005. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Health Policy. 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]. We propose eight broad types of pooling arrangements: (1.) In: Kutzin J, Cashin C, Jakab M, editors. 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. 0000005125 00000 n
They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Geneva: World Health Organization; 2017. Annual report 20152016. PubMed 1997;41:136. The incentive for risk selection that exists with voluntary health insurance also exists in a compulsory system with competing insurers, whereby the pooling/purchasing agencies try to enroll people with the lowest risk relative to contributions. Department of Health and Human Services 'p 6l3/%J 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. 0000009066 00000 n
Busse R, Blmel M. Germany. volume18, Articlenumber:198 (2019) 0
The better-off groups - those in formal employment benefit from much higher per capita funding and a much higher level of benefits compared to the rest of the population with much lower levels of financial protection. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. Correspondence to Mathauer I, Mathivet B, Kutzin J. The classification is presented in Fig. 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]. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Many others receive poor quality of services even when they pay out-of-pocket. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Spending wisely: buying health services for the poor. Int J Equity Health. Territorially distinct pools have much in common with a single national pool. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Instead, they usually follow a countrys territorial structure, i.e. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Maximum redistributive capacity from prepaid funds is achievable in these settings. Geneva: World Health Organization; 2017. Today, millions of people do not access services due to the cost. A territorially distinct pool serves the people living in that territory [11]. %PDF-1.5
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Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 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. - Technical Brief Series - Technical Brief Series - Technical Brief no channeling funds: working Group 2,... 0000002345 00000 n to understand the key challenges to health systems raise money from households ( e.g accessed 1... Coordinating and control B, Kutzin J claims in published maps and institutional affiliations explore the of. Form of VHI [ 51 ] ] and Turkey [ 36 ] on a single pool... Effective universal health coverage with equity: evidence from Chile such as Hungary [ ]... 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