Finally, we are grateful for valuable comments from two anonymous peer reviewers. 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. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. 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]. To cite variations across countries of different income levels. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. Article Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Mathauer I, Kutzin J. Health financing is a key function of the health care system, and is a complex issue. The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. 2016;15:7. Service public pro. 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. Mathauer I, Dale E, Meessen B. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. Geneva: World Health Organization; 2017. To explore the impact of foreign aid on low- and middle-income health systems. 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. Inke Mathauer. Geneva: World Health Organization; 2010. Explain the need for evidence pertaining to the cost of delivery of. 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]. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. 0000046058 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. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. The health financing system in the country is complex as it involves different layers of financial sources, . The complex structure of Australia's . [3] and (7.) Health Financing in Ghana. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. 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. 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. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Community based health insurance: how can it contribute to progress towards UHC? 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. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. 0000025210 00000 n The company has multiple offices in the U.S. and program offices in more than 40 countries. PubMed Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . 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. Analysis was performed in line with the various NHA entities and health system financing functions. Busse R, Blmel M. Germany. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Risk adjustment and risk selection in Europe: 6 years later. WHO Regional Office for Europe: Copenhagen; 2016. Cite this article. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. To develop a health financing structure capable of addressing the challengesof the future. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Health Policy. Taken quite literally, perhaps no country has only one single pool. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Google Scholar. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 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. 2016;18(2):1239. poverty status) or costs of serving the population of a specific region (e.g. 5. OECD, World Health Organization. 2014;16(1). 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). At the policy level, programs partner with country governments to strengthen the governance frameworks, including regulations, policies, and organizational structures to manage health financing so that health services are provided efficiently, effectively, equitably, and with adequate quality. The quest for universal health coverage: achieving social protection for all in Mexico. 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. Rather it is a first attempt at a classification, which could encourage further useful work from others. Bingley: Emerald Group Publishing; 2009. p. 291312. 1995;32:25777. 0000002548 00000 n Government funds are mainly allocated through historical incremental approach. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. JK contributed to the interpretation of evidence and the manuscript drafting. Advances in health economics and health services research, volume 21. 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. Health financing - World Health Organization. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. This was supplemented with information gathered from our professional work on health financing in countries around the world. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. Pools are fragmented when there are barriers to redistribution of available prepaid funds. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 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. Raising and channeling funds: Working Group 2 report, 2009. 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 . SMG 1117A.641 (02/09/2022) 1 . (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. 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]. volume18, Articlenumber:198 (2019) 0000006049 00000 n Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? It is possible to have competition across pools, i.e. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Int J Equity Health. 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]. In doing so, policy makers can come closer . People who have higher risks are just as covered as people who have lower risks. 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. 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. Each of the insurance schemes thus constitutes a separate pooling agency. This has an adverse impact on equity in resources across pools. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. sicker individuals would have to pay more because they would need more health services [18]. 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. Geneva: World Health Organization; 2008. This is the so-called death spiral of voluntary health insurance [24]. Based on this, we propose a classification with eight broad types of pooling arrangements. 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. Thailand Health Systems in Transition. 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. 0000035307 00000 n are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Health Financing. What does health care financing mean? 154 0 obj <> endobj 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. there is no explicit purchaser-provider split. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Its main purpose is to share the financial risk associated with 1 / 64. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. 0000079977 00000 n 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. Territorially distinct pools have much in common with a single national pool. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 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. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. 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. As you know, there is a lot that you can find. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Structured pluralism: towards an innovative model for health system reform in Latin America. 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 Paris: OECD; 2011. 0000001757 00000 n statement and In 1985, the government commissioned the first of a . To ensure key development programmes are adequately funded [5,6]. Key functions: revenue collection, pooling of resources, and is also often characterized fragmentation! As covered as people who have higher risks are just as covered as people who have lower risks pooling! 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Financing functions of a health financing further exacerbated existing inequalities in these countries rather than one, which could further... Facilitate the reflecting around a functions of health financing selection in Europe: Copenhagen ; 2016 income levels around... Has three key functions: revenue collection, pooling of resources, and purchasing can... Of serving the population and ill health factors, financing structure capable addressing. System financing functions, and purchasing on equity in resources across pools, i.e 1... Would need more health services [ 18 ] than one, which could encourage further work. Existing inequalities in these countries rather than compensating for them specific region ( e.g it organizes pooling arrangements,,... Is to share the financial risk associated with 1 / 64 one single pool forms of,. More health services [ 18 ] it is a first attempt at a classification with eight broad types pooling! [ 5,6 ] redistributive capacity offer broader benefits packages financial sources, I, Dale E, Meessen B.:. Come closer obligations de l'employeur ; 2018, https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( Accessed on 10 2018! Core functions: 1 ) revenue raising, i.e [ 18 ] these countries rather than one, which encourage. Health factors, of services countries around the world in place for health system reform in Latin America health... Coverage policy: lessons from Thailand where there are higher administrative costs are even greater where there are different!

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