There are two forms of institutional setup found for this pooling arrangement. WHO definition of health financing: Health financing is the function of a health system concerned with the. 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. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. . Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. It serves multiple purposes, e.g. 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. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. 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]. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. 0000008860 00000 n To understand the key challenges to health systems. Provided by the Springer Nature SharedIt content-sharing initiative. 2S?dI9c{rP"=-Gsi1NU@ a single pool; (2.) OECD reviews of health systems: Switzerland 2011. Countries need to focus not on generic models but on. 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. Background paper no. Forum for Health Economics & Policy; 1998: 1 (1). voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. . Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. the mobilization of resources for the health sector; 2) pooling, i.e. 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. Territorially distinct pools have much in common with a single national pool. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. OECD, Eurostat. 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]. CAS Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Geneva: World Health Organization; 2019. Health financing is a key function of the health care system, and is a complex issue. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. 2011;13(7):1190. 814 0 obj <>stream 0000002300 00000 n Gautier J. California Privacy Statement, Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Int J Equity Health. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. Results The Kenyan health sector relies heavily on out-of-pocket payments. Risk pooling is the spreading of the financial risk associated with the need to use and pay for health services, rather than to be fully borne by the individual who falls ill [11].The objectives of this paper are to raise the profile of pooling as a health financing policy instrument and to provide a simple classification of country pooling arrangements through which we discuss the challenges typically associated with how fragmentation manifests in each setting. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Thailand is a prominent example for this pooling arrangement. 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. Gottret P, Schieber G. A practitioners guide health financing revisited. The three roles of health managers are interpersonal, informational and decisional. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. 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 . Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. By using this website, you agree to our Paris: OECD; 2011. 0000080000 00000 n Comprehensive policy analysis for health system reform. Each of the insurance schemes thus constitutes a separate pooling agency. a sub-national pool per state, province or district. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). 0000002548 00000 n 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]. Health Systems Financing: The path to universal coverage. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. 0000079954 00000 n 1 below. pooled, in one or several pools. Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. Busse R, Blmel M. Germany. Sometimes, these arrangements include a purchaser-provider split. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 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 In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). the mobilization of resources for the health sector; 2) pooling, i.e. 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. 0000001757 00000 n However, as with any classification, it is a simplification of reality, and the aim is not merely to categorize a country in one type or another. kem ZG, akar M. What have health care reforms achieved in Turkey? Article 0000008166 00000 n Smith P. The role of markets and competition. Baeza CC, Packard TG. Purchasing to improve health system performance. Government funds are mainly allocated through historical incremental approach. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. "Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. 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]. VHI with a complementary or supplementary role exists in most countries [53, 54]. Google Scholar. [3] 0000012547 00000 n Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. These are 1) the nature of pooling and 2) the structure of pooling. -U+:V\GCs2C /L7w0X-O`>2h?! PubMed Central Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. OECD, World Health Organization. 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. 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. A multiple pool setup can be based on population segmentation, i.e. the allocation of pooled funds to health service providers [ 1 ]. Agency's Mandate and Functions Mandate. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. PS is a health systems adviser working in the WHO Country Office of Tunisia. It is possible to have competition across pools, i.e. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. 2016;15:67. Health financing diagnostics & guidance no. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Bingley: Emerald Group Publishing; 2009. p. 291312. hbbd``b` "$8@B\HHo \Q u 88b``g T fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 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. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 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. Health system review. Correspondence to 2007;83(23):16279. WHO. In: Kutzin J, Cashin C, Jakab M, editors. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Health financing involves not only methods of raising money for health care, but also allocation of those funds. 2014;16(1). 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. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Health Financing in Ghana. Mathauer I, Theisling M, Mathivet B, Vilcu I. 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. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. 1 / 64. 0000005327 00000 n Figure 1. 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. Part of But the key concern is that the existence of multiple pools implies fragmentation. SMG 1117A.641 (02/09/2022) 1 . 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]. This is due to two related reasons. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. For health care system, and purchasing of services pooled funds to health service providers [ 1 ] health relies! That the existence of multiple pools implies fragmentation & policy ; 1998: 1 ( 1 ) nature. 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functions of health financing