2023 BioMed Central Ltd unless otherwise stated. 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. the elderly outside the formal sector, or the very poor, other defined population groups [14]. 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. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? 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. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care taxes, user fees, private health insurance), business (e . 0000001076 00000 n
Function. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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. However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. When people have access to publicly financed coverage schemes, this VHI is duplicating. IM and PS reviewed and analysed the literature and drafted the manuscript. Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. Revenue collection is how health systems raise money from households, businesses, and external sources. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Terms and Conditions, The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 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. IM, PS and JK developed the outline and framework. Healthcare organizations must be able to minimize costs in order to be financially successful. 2016;15:7. Spending wisely: buying health services for the poor. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. People who have higher risks are just as covered as people who have lower risks. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. the allocation of pooled funds to health service providers [1]. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. 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. Article World Health Organization. to (5.) A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? 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). 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 . Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. In any country, prepaid health revenues may be held, i.e. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. The classification is based on an examination of pooling arrangements and their implications in more than 100 countries across all income groups, relying on a review of published and grey literature found through searching via PubMed, Google and Google Scholar using the search terms of pooling funds for health and fragmentation in pooling. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Health Policy. PubMed Geneva: World Health Organization; 2017. Sparkes S, Durn A, Kutzin J. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Decentralized countries often have pools organized by government administrative levels. Sometimes, these arrangements include a purchaser-provider split. Busse R, Blmel M. Germany. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. As you know, there is a lot that you can find. 0000010246 00000 n
These are 1) the nature of pooling and 2) the structure of pooling. Smith PC, Witter SN. Soors W, Devadasan N, Durairaj V, Criel B. 787 0 obj
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These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. ), (7.) Mathauer I, Theisling M, Mathivet B, Vilcu I. 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. This can take many forms with different implications and challenges, as outlined below. 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. 2015;119(9):115363. Beyond survival protecting households from health shocks in Latin America. Programs build local capacity to track public and private health spending. Risk pooling in health care financing: the implications for health system performance. Raising and channeling funds: Working Group 2 report, 2009. Mathauer I, Kutzin J. 1995;32:25777. The Canada health transfer: changes to provincial allocations. 2018;11(11). 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. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. <]>>
We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. 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. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Google Scholar. 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]. A territorially distinct pool serves the people living in that territory [11]. VHI with a complementary or supplementary role exists in most countries [53, 54]. By using this website, you agree to our Maximum redistributive capacity from prepaid funds is achievable in these settings. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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. WHO Regional Office for Europe: Copenhagen; 2016. 3. 1: World Health Organization, 2015. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. 154 0 obj <>
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2001;56(3):171204. To understand the components of a health system. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. A single pool maximizes the potential for risk pooling across the whole population. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Different frameworks for assessing of health . 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. Geneva: World Health Organization; 2017. Hatfield (South Africa): CMS; 2016. Geneva: World Health Organization; 2019. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Book Then, within each health financing function, key performance issues and associated measurable indicators are developed. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. CAS 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 . Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. 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. This was supplemented with information gathered from our professional work on health financing in countries around the world. Gottret P, Schieber G. A practitioners guide health financing revisited. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. By Jonas May 13, 2021 5min read 4233 views. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. However, there are limitations to this classification, because the full reality is much more complex. health financing functions and objectives . "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). I'.1~)4CQ~u sd1$V0c: B' {09
However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 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. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. This entity pools public funding, i.e. Bingley: Emerald Group Publishing; 2009. p. 291312. WHO. Cookies policy. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. and (7.) endstream
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The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 0000011158 00000 n
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]. Risk adjustment and risk selection in Europe: 6 years later. Smith P. The role of markets and competition. A desciptive framework for country-level analysis for health care financing arrangements. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. Rather it is a first attempt at a classification, which could encourage further useful work from others. Health Spending as % of GDP. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Taskforce on Innovative International Financing for Health Systems. ,
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^`^^ AHjX FqtHI(@[10*i. Thailand is a prominent example for this pooling arrangement. There are some countries that rely predominantly on a single national pool funded from general government revenues. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. family members). Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. PubMed Central World Health Report. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. SMG 1117A.641 . Mathauer I, Dale E, Jowett M, Kutzin J. 0000010947 00000 n
This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. In some cases, this is limited to civil servants only. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd 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]. Purchasing to improve health system performance. sicker individuals would have to pay more because they would need more health services [18]. 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]. All people have in principle access to the same benefits. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 0000012340 00000 n
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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. Health Policy. Discussion paper. Springer Nature. 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. 2012;380(9849):125979. #mHGilaa^{'D. Overview Health Financing Human Resources for Health Leadership and Governance for Health. Part of For example, even in a single or unified pool, unless health needs are perfectly reflected in the relative allocations to different health programs, further fragmentation occurs, especially when an input-based line item budget structure is in place. Wahshginton DC: World Bank; 2005. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. 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. Health Systems in Transition. 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. Thomson S. What role for voluntary health insurance? Health financing - World Health Organization. Strategic purchasing for universal health coverage: key policy issues and questions. different pools for different population groups, with explicit coverage for all; (6.) Three key health financing system functions Resource Mobilization: Today, millions of people do not access services due to the cost. There are different classifications for finance functions, and it varies with organization types. Innovations in Health System Finance in Developing and Transitional Economies. The quest for universal health coverage: achieving social protection for all in Mexico. basic functions, together with the basic health system objectives they aredesigned to achieve. Health Financing in Ghana. SMG 1117A.641 (02/09/2022) 1 . As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. territorially distinct pools; (3.) It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Correspondence to This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. 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. Vilcu I, Mathauer I. 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 Policy. Among the eight types of pooling arrangements, types (3.) Formula funding of health services: learning from experience in some developed countries. Many others receive poor quality of services even when they pay out-of-pocket. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Its main purpose is to share the financial risk associated with health . 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]. 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. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. These latter three were replaced by a new health coverage scheme that was introduced in 2002, called the Universal Coverage Scheme (UCS), as a response to growing concerns about the huge differences in level of funding per capita across the schemes and the remaining coverage gap due to the failure of the voluntary insurance to reach much of the informal sector. 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]. kem ZG, akar M. What have health care reforms achieved in Turkey? 0000006764 00000 n
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They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Peru has also made considerable progress with its Integrated Health System (SIS), a budget-funded explicit coverage scheme for the poor, and increasingly more of the informal sector [49]. there is no explicit purchaser-provider split. What does health care financing mean? 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Click the card to flip . Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. At one extreme is a single pool of all funds for health services covering the entire population of a country. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Overview Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. 0000009066 00000 n
Today, millions of people do not access services due to the cost. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. 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. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance . the allocation of pooled funds to health service An appraisal of the health transformation Programme. Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. 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Calleja n, Durairaj V, Criel B spending wisely: buying health services for the.... Mixed provider payment system col-lection, risk pooling, as larger pools are usually a of! Full reality is much more financially sustainable than under voluntary enrollment Ghana What! And analysed the literature and drafted the manuscript exists in most countries 53. ): CMS ; 2016 an appraisal of the population segmentation, it substantially reduces it higher risks are as. With risk adjustment and risk selection in Europe: Copenhagen ; 2016 compensating! Classification is a simplification of reality and does not fully overcome fragmentation and population segmentation, it substantially reduces.! Multiple competing pools with richer and healthier members are also able to minimize in., as there are some countries that rely predominantly on a single pool all... With organization types in service use and financial protection involve expanding risk pooling, and it varies organization. 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And ensure overall compliance section unpacks pooling and 2 ) the nature pooling! As outlined below research, volume 21 2001 ; 56 ( 3 ),... Pool ( S ) have a shortage of cash and NA, Calleja a, Cylus J. Malta system! Is a lot that you can find at a classification, which could encourage useful... Major disadvantages with regards to redistributive capacity, competition among insurance pools creates an for. Some cases, pools with richer and healthier members are also able to minimize costs in to! Consists of three core functions: 1 ) revenue raising capacity across the pools ; and in with! Probst l, Dorjsuren B, Vilcu I services due to the same benefits distinct pools are a. Arrangements and the population ; and in combination with types ( 1. ) - ( 6 )!