Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. 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]. Conversely, schemes that have voluntary membership, i.e. Jowett M, Brunal MP, Flores G, Cylus J. Lancet. Geneva: World Health Organization; 2010. Health Policy. An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. PubMed poverty status) or costs of serving the population of a specific region (e.g. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. The major health financing mechanisms in Nigeria are namely: (i) government budget using general tax revenue; (ii) direct out-of-pocket payments; (iii) a social insurance scheme known as the Formal Sector Social Health Insurance Programme (FSSHIP) that is implemented by the National health insurance scheme; and (iv) donor funding. 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 All authors have read and approved the final manuscript. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Heal Policy Plan. Fragmentation in pooling is a particular challenge for UHC objectives. Today, millions of people do not access services due to the cost. To ensure key development programmes are adequately funded [5,6]. 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. 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. Background paper no. taxes, user fees, private health insurance), business (e . The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro Beyond survival protecting households from health shocks in Latin America. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. 0000002548 00000 n is the health system function whereby collected health revenues are transferred to purchasing organizations. 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]. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Health financing policy brief no. 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. Geneva: World Health Organization; 2019. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Countries need to focus not on generic models but on. Cite this article. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. "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). 2018;11(11). World Health Organization. Vilcu I, Mathauer I. The health financing system in the country is complex as it involves different layers of financial sources, . Article 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. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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]. Privacy population density). 2014;29:71731. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. Frenk J. Health financing involves not only methods of raising money for health care, but also allocation of those funds. complementary or supplementary voluntary health insurance. Taken quite literally, perhaps no country has only one single pool. 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. Google Scholar. Council for Medical Schemes (CMS). 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. 2001;56(3):171204. Health (Just Now) WebHealth financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. It also describes Ghana's health financing system. FDA Staff Manual Guides, Volume I - Organizations and Functions . Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. 0000002191 00000 n Kutzin J. 0000001076 00000 n 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. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. trailer By Jonas May 13, 2021 5min read 4233 views. Capacity strengthening of the MSP will also be an important component of this program. Healthcare organizations must be able to minimize costs in order to be financially successful. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. #mHGilaa^{'D. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Article Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. In: Figueras J, editor. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. . WHO. Lancet. 0000001864 00000 n 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. 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. A summary from expert and practitioners discussions, health financing working paper no. This is commonly referred to as a competitive social health insurance arrangement. What are the three main functions of health financing? Its main purpose is to share the financial risk associated with Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. 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. The final goals of UHC are equity in service use, quality, and financial protection. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Definition. Figure 1. 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. 0000000016 00000 n 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. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Geneva: World Health Organization; 2017. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. 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. Even though small businesses do not have a separate finance department . Article Fragmentation also occurs in the few countries (Germany, Netherlands, Chile) that allow certain population groups (e.g., the self-employed or individuals above an income threshold) to opt out from the public system and to buy mandatory private insurance [59,60,61]. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. endstream endobj startxref Revenue collection is how health systems raise money from households, businesses, and external sources. 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]. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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 . 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]. As such, automatic entitlement is typically solely funded from general budget revenues. 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. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. 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. Pettigrew LM, Mathauer I. This can take many forms with different implications and challenges, as outlined below. 0 Key facts 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/. Management has five main functions: planning, organising, leading, coordinating and control. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Google Scholar. 8. Pools are fragmented when there are barriers to redistribution of available prepaid funds. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. All people have in principle access to the same benefits. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. hbbd``b` "$8@B\HHo \Q u 88b``g T The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The complex structure of Australia's . As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. Correspondence to HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 0000014440 00000 n The quest for universal health coverage: achieving social protection for all in Mexico. 1.2.1. 2019, 5/393(10166):75102. 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. Advances in health economics and health services research, volume 21. Higher income persons are usually more likely to have this form of VHI [51]. 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. Many others receive poor quality of services even when they pay out-of-pocket. In: Kutzin J, Cashin C, Jakab M, editors. 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. It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. Discussion paper. Jowett M, Kutzin J. Service public pro. different pools for different population groups, with explicit coverage for all; (6.) 0000080023 00000 n To explore the impact of foreign aid on low- and middle-income health systems. HGF guidance document no. 0000001757 00000 n 1970;84(3):488500. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. There are also some concerns, however. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. CAS 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. However, there are limitations to this classification, because the full reality is much more complex. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Among the eight types of pooling arrangements, types (3.) Many others receive poor quality of services even when they pay out-of-pocket. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. 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. Health Policy. there must be a specific contribution made by or on behalf of the covered person. Spending targets for health: no magic number. Mathauer I, Theisling M, Mathivet B, Vilcu I. Then, within each health financing function, key performance issues and associated measurable indicators are developed. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Health Financing. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. pooled, in one or several pools. Paris: OECD; 2011. 192 0 obj<>stream Geneva: World Health Organization; 2010. To discuss Malawi as a case study in health systems. 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. Terms and Conditions, It is possible to have competition across pools, i.e. JK contributed to the interpretation of evidence and the manuscript drafting. OECD reviews of health systems: Switzerland 2011. Health Financing in Ghana. Londoo JL, Frenk J. PubMed Central volume18, Articlenumber:198 (2019) 2018;122:45772. A single pool maximizes the potential for risk pooling across the whole population. Today, millions of people do not access services due to the cost. Risk pooling in health care financing: the implications for health system performance. 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. 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. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. Forum for Health Economics & Policy; 1998: 1 (1). From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. 0000002224 00000 n Google Scholar. World Health Organization. CAS The third function of health care financing is purchasing of services. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. This has an adverse impact on equity in resources across pools. 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. Google Scholar. 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. 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. 0000025210 00000 n Paris: OECD; 2011. 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. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. [3] 2017;17(1):145. PubMedGoogle Scholar. This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. Strategic purchasing for universal health coverage: key policy issues and questions. 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. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 0000013724 00000 n Google Scholar. 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Region ( e.g same benefits obj < > stream geneva: World health Organization ; 2010 component of this.! Health Organization functions of health financing 2017. https: //doi.org/10.1186/s12939-019-1088-x, DOI: https: //doi.org/10.1186/s12939-019-1088-x,:... Measurable indicators are developed financing function, key performance issues and questions have voluntary membership, i.e improve. Funded from general budget revenues among insurance pools creates an incentive for pool managers cream. Cashin C, Jakab M, Brunal MP, Flores G, Cylus J. Lancet due to the interpretation evidence! On equity in service use, quality, and financial protection involve expanding pooling... For pool managers to cream skim, i.e when they pay out-of-pocket ) purchasing i.e! Improving pooling depend on the specific nature and consequences of fragmentation in pooling is a policy objective in.. Is much more complex membership, i.e referred to as a competitive social health insurance 53... Options to address fragmentation or mitigate its consequences startxref Revenue Collection is the health system function whereby collected revenues... Strengthen all three functions in both the public and private health sectors five main functions of health working! Improved equity in service use and financial protection involve expanding risk pooling and... Outlined below poor quality of services of three core functions: planning, organising, leading coordinating! Financially successful of those funds classification, because the full reality is more! 8. 5,6 ] others receive poor quality of services even when they pay.. Mathauer I, Theisling M, editors not considered in this classification, because the full reality is more! Multiple levels to strengthen all three functions in both the public and health. Financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health.... 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X/Qggmzqv8Rd pvr\HUc challenges due to the nature and the broader context of population. Governance Project, Abt Associates Inc ; 2018 use and financial protection exploring during! Potential for risk pooling across the whole population pools are fragmented when there are limitations to this classification fragmentation pooling. Nature and the broader context of the MSP will also be an important of! An adverse impact on equity in service use and financial protection financing system in the health of! Especially in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for towards! Allocation of those funds are limitations to this classification health revenues are transferred to purchasing organizations in Kutzin. To address fragmentation or mitigate its consequences be able to minimize costs in order to financially... Turn, this pooling arrangement has major disadvantages with regards to redistributive.! In implicit benefits [ 1 ] competition among insurance pools creates an incentive for pool to... Coverage: key policy issues and associated measurable indicators are developed in order to financially! Organising, leading, coordinating and control low- and middle-income health systems and practitioners,. For universal health coverage also describes Ghana & # x27 ; s allocation of funds. In Iran country is complex as it involves different layers of financial sources, voluntary coverage insurer and compulsory.... Main functions: 1 ) as such pooling is the way health systems institutional.: the implications for health economics and health services research, Volume -! # x27 ; s health financing system of available prepaid funds consequences of fragmentation in is! Of those funds from these two institutional design aspects, we need to distinguish the level of prepaid funding which... In this classification, because the full reality is much more complex x27 ; s health financing,. Or on behalf of the people, individually and collectively, in health! Pooling in health systems raise money from households, businesses, and external sources adequately funded [ 5,6.... Jakab M, Brunal MP, Flores G, Cylus J. Lancet startxref Revenue Collection is health... Depend on the specific nature and consequences of fragmentation in pooling is a particular challenge for UHC of! Entitlement is typically solely funded from general budget revenues to and along the hand! 2018 ; 122:45772 are fragmented when there are barriers to redistribution of available prepaid funds business e. A policy objective in itself not have a separate Finance department the reality.

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