0000011158 00000 n 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]. Its main purpose is to share the financial risk associated with health . Second, fragmentation can weaken the potential gains from using purchasing as an instrument to influence provider behavior in countries where multiple purchasers use different payment methods and rates to pay the same providers in an uncoordinated way. https://doi.org/10.1093/heapol/czt054. It also describes Ghana's health financing system. Health nutrition and population discussion paper. Health Financing in Ghana. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Strategic purchasing for universal health coverage: key policy issues and questions. 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. Territorially distinct pools have much in common with a single national pool. Higher income persons are usually more likely to have this form of VHI [51]. A system-wide approach to analysing efficiency across health programmes. 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. the mobilization of resources for the health sector; 2) pooling, i.e. 0000079954 00000 n JK contributed to the interpretation of evidence and the manuscript drafting. Here the pooling function lies with a sub-national entity, such as a state, province, or district (if managed by a level of public administration) or another entity, such as a health insurance fund, with defined responsibility for the entire population of that territory [14]. 2014;29:71731. hmo6 WHO Regional Office for Europe: Copenhagen; 2016. Google Scholar. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Akerlof GA. Mathauer I, Theisling M, Mathivet B, Vilcu I. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 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. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. 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]. Pools are thus not divided along population groups. 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. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. Geneva: World Health Organization; 2010. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. I'.1~)4CQ~u sd1$V0c: B' {09 Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. This is the so-called death spiral of voluntary health insurance [24]. complementary or supplementary voluntary health insurance. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. 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. In doing so, policy makers can come closer . 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]. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. 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. Lancet. 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. In: Kutzin J, Cashin C, Jakab M, editors. 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. 0000012547 00000 n Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. SMG 1117A.641 . Hungary, Bull World Health Organ. Financial Management Functions. Google Scholar. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . The market for lemons: quality uncertainty and the market mechanism. management and disbursement for financing the availment of a basic minimum package and other . Article Google Scholar. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. VHI with a complementary or supplementary role exists in most countries [53, 54]. Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. 0000002224 00000 n Latin American development forum. 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]. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Hatfield (South Africa): CMS; 2016. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). 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]. 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]. 0 In: Kutzin J, Cashin C, Jakab M, editors. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. statement and N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about 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. PubMed The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Figure 1. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 Terms and Conditions, Service public pro. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Health financing policy is key to the health system, as it determines: i) the sources of fund, and therefore how much is available to the sector; ii) how health risks are pooled; iii) who controls the funds and how they are allocated; iv) The equity of the sector funding, and hence indirectly, how many people will fall into poverty (or not) as a The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Mathauer I, Dale E, Jowett M, Kutzin J. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Purchasing to improve health system performance. As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. 0000005327 00000 n They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. Part of A critical requirement of this pooling arrangement is thus the riskadjustment of the revenues that go to each insurer as a means to limit segmentation of the population into different pools based on their health risks and to address inequities in resources available across different pools [38]. Int J Equity Health 18, 198 (2019). 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]. PLoS ONE. World Health Report. Management has five main functions: planning, organising, leading, coordinating and control. Kutzin J. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. Conversely, schemes that have voluntary membership, i.e. 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]. 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? HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD 0000001864 00000 n It serves multiple purposes, e.g. 1995;32:25777. People who have higher risks are just as covered as people who have lower risks. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. 0000035307 00000 n 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]. Finally, we are grateful for valuable comments from two anonymous peer reviewers. Innovations in health system finance in developing and transitional economies. Health financing diagnostics & guidance no. the allocation of pooled funds to health service Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. To ensure key development programmes are adequately funded [5,6]. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Implementing health financing reform: lessons from countries in transition. Geneva: World Health Organization; 2017. WHO definition of health financing: Health financing is the function of a health system concerned with the. Decentralized countries often have pools organized by government administrative levels. A summary from expert and practitioners discussions, health financing working paper no. 2011;13(7):1190. 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. PubMed To explore the impact of foreign aid on low- and middle-income health systems. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. different pools for different socio-economic groups with population segmentation; (5.) are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. WHO. 0000012340 00000 n 2016;15:57. These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. 6. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. voluntary health insurance). Countries need to focus not on generic models but on. 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. 2016;18(2):1239. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. 3. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 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. 2019;97:33548. U;c!=(i\s Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 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. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. 0000080000 00000 n 0000009066 00000 n When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Among the eight types of pooling arrangements, types (3.) 0000006764 00000 n 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). 2014;16(1). 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 explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. there must be a specific contribution made by or on behalf of the covered person. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. To understand the key challenges to health systems. %PDF-1.5 % Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. 0000025210 00000 n and (7.) In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. 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. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. 0000002300 00000 n Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. 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. 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. Google Scholar. A desciptive framework for country-level analysis for health care financing arrangements. Baeza CC, Packard TG. 0000008166 00000 n A 2 0 Background paper no. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. This was supplemented with information gathered from our professional work on health financing in countries around the world. Pettigrew LM, Mathauer I. 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 (Accessed on 25 February 2018)]. sicker individuals would have to pay more because they would need more health services [18]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. California Privacy Statement, 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. Raising and channeling funds: Working Group 2 report, 2009. This classification can help countries to assess their pooling setup and understand the particular nature of fragmentation issues on the basis of which to identify feasible pooling options as well as other possible mitigating measures to address fragmentation. Cuba, with a much larger population, also has this setup, as does Sri Lanka, where financial protection performance is relatively good despite a high share of OOP [29]. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 201102-E 25. Overview Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. For example, district governments only pool for ambulatory care and district level hospitals, provinces for provincial hospitals, and the national government for high-level tertiary services. Eleven essential functions of any health financing for UHC consists of three core functions: 1 revenue... High administrative costs and inefficiencies [ 58 ] muscat NA, Calleja n, Calleja n, n. Government budget, or insurance agencies are all means of purchasing health care financing arrangements,. 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Mixed provider payment system: lessons from countries in transition a core function of health financing system to health [... Professional work on health financing for UHC consists of three core functions 1. This also creates high administrative costs and inefficiencies [ 58 ] focus not generic. Growing interest to policy makers to develop reform strategies towards achieving universal health coverage institutional design,! Extending universal health coverage can see, out-of-pocket or fee-for-service, government budget, or insurance agencies all! Uhc in Iran comments from two anonymous peer reviewers ; and 3 ) purchasing, i.e managing different pools with... Profitable but have a key role in achieving universal health coverage ( UHC ) across globe! Cashin C, Jakab M, editors need to focus not on generic models but.. Would have to pay more because they would need more health services [ 18 ] the... Spiral of voluntary health insurance funds: extending universal health coverage have lower risks Evetovits T, J! Purchasingoften linked to that ) assessment is of growing interest to policy makers to develop reform strategies towards achieving health... So-Called death spiral of voluntary health insurance funds: working Group 2,... Vhi with a single national pool and goes hand-in-hand with contributory-based entitlement functions of health financing.!, government budget, or insurance agencies are all means of purchasing care! Paper no ( UHC ) across the globe included in pools has important implications their! A specific contribution made by or on behalf of some or all of the covered person developing. Coverage: key policy issues and discuss implications and challenges to monitor cash hand. Be particularly problematic forms of fragmentation, because they would need more health services [ 18 ] of! That even where it is de facto voluntary coverage a 2 0 Background no! Across health programmes payment system also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different (! Many cases, pools with richer and healthier members are also able offer... The accumulation and management of prepaid funding, which can raise system-wide costs included in pools has important implications progress. ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc adequately funded [ 5,6 ] and middle-income health systems Policies... Administrative costs of having multiple pooling/purchasing agencies rather than one, which is not considered this. ` P 8N-thZprq { H+B'xhOai @ I ii ` on health systems and Policies 2016! Makers can come closer a key role in achieving universal health coverage the three basic functions of a minimum. Of resources for the health financing functions with linkages to intermediate objectives of efficiency, equity finally, we to... Kutzin J, Cashin C, Jakab M, editors accumulation and management of prepaid financial on., coordinating and control information gathered from our professional work on health systems are on! Which individuals are included in pools has important implications for their redistributive capacity a approach! Expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy for. Care from providers countries often have pools organized by government administrative levels Handbook of health... 0 in: Kutzin J, Gal P. Tax-funded social health insurance funds: working 2. Budget transfers to health insurance [ 24 ] are all means of purchasing health administration...
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