Article 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]. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. 2018;11(11). The operation of a health financing system entails transactions by the three main functions of health financing: revenue-raising, pooling and purchasing - such as, for example, payment of social insurance contributions to a single national fund and distribution of the resources, first among the different purchasing organisations, and then . 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). . 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. 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. Department of Health and Human Services 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]. 0000007449 00000 n Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 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. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Raising and channeling funds: Working Group 2 report, 2009. the allocation of pooled funds to health service Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. 0000079954 00000 n 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. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 0000002345 00000 n Google Scholar. Cutler DM, Zeckhauser RJ. Each of the insurance schemes thus constitutes a separate pooling agency. Geneva: World Health Organization; 2019. 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. 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. 0000010246 00000 n Background paper no. Programs build local capacity to track public and private health spending. Londoo JL, Frenk J. Many others receive poor quality of services even when they pay out-of-pocket. The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. 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. 2019;97:33548. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. The report is divided into five chapters. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Cite this article. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. The complex structure of Australia's . As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. 814 0 obj <>stream Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. the mobilization of resources for the health sector; 2) pooling, i.e. Revenue collection is how health systems raise money from households, businesses, and external sources. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Health Systems in Transition. 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. 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. What are the types of health care financing? Bingley: Emerald Group Publishing; 2009. p. 291312. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. type of pooling arrangement, namely territorially distinct pools. In: Kutzin J, Cashin C, Jakab M, editors. Pools are fragmented when there are barriers to redistribution of available prepaid funds. 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]. Thailand is a prominent example for this pooling arrangement. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. JK contributed to the interpretation of evidence and the manuscript drafting. Health financing involves not only methods of raising money for health care, but also allocation of those funds. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 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. startxref 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. different pools for different population groups, with explicit coverage for all; (6.) The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. California Privacy Statement, Cookies policy. The purpose of pooling is to spread financial risk across the population so that no individual carries the full burden of paying for health care. Sometimes, these arrangements include a purchaser-provider split. 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]. 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]. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. 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. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Health Systems Financing: The path to universal coverage. Beyond survival protecting households from health shocks in Latin America. 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. Its main purpose is to share the financial risk associated with health . 0000003940 00000 n 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 However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Geneva: World Health Organization; 2017. Health Care Syst Transit. %PDF-1.4 % Different frameworks for assessing of health . (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. CAS Springer Nature. The classification is presented in Fig. 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. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. But the CBHIs expenditure and population coverage is very low in most countries [57]. 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. 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. 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. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . 0000002224 00000 n 2023 BioMed Central Ltd unless otherwise stated. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 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]. 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. 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. 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. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Smith PC, Witter SN. Formula funding of health services: learning from experience in some developed countries. Purchasing health services for universal health coverage: how to make it more strategic? 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 better-off groups - those in formal employment benefit from much higher per capita funding and a much higher level of benefits compared to the rest of the population with much lower levels of financial protection. Rather it is a first attempt at a classification, which could encourage further useful work from others. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Geneva: World Health Organization; 2010. Bingley: Emerald Group Publishing; 2009. p. 291312. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 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]. population density). Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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 . 2015;119(9):115363. VHI with a complementary or supplementary role exists in most countries [53, 54]. Then, within each health financing function, key performance issues and associated measurable indicators are developed. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. -U+:V\GCs2C /L7w0X-O`>2h?! To discuss Malawi as a case study in health systems. 6. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Table1 outlines the respective features under each. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. U;c!=(i\s 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. PubMed Central Health Financing. 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. These are 1) the nature of pooling and 2) the structure of pooling. SMG 1117A.641 (02/09/2022) 1 . 0000074834 00000 n &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 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. Fragmentation in pooling is a particular challenge for UHC objectives. Another function of finance in business is the creation of long-term strategies. Health financing: the basics FP Financing Roadmap. the mobilization of resources for the health sector; 2) pooling, i.e. Geneva: World Health Organization; 2010. . Soors W, Devadasan N, Durairaj V, Criel B. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. 2016;15(1):165. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. PubMedGoogle Scholar. Capacity strengthening of the MSP will also be an important component of this program. Territorially distinct pools have much in common with a single national pool. Agency's Mandate and Functions Mandate. Int J Equity Health. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. Financial Management Functions. Health Policy. To cite variations across countries of different income levels. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 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 there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. pooled, in one or several pools. 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. 0000002097 00000 n The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. 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 Google Scholar. Pools can be based on compulsory, automaticor voluntary participation. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Bull World Health Organ. 192 0 obj<>stream We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. HGF guidance document no. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. 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. What are the three main functions of health financing? WHO Regional Office for Europe: Copenhagen; 2016. The third function of health care financing is purchasing of services. 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]. Geneva: World Health Organization; 2019. hmo6 health financing functions and objectives . This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Forum for Health Economics & Policy; 1998: 1 (1). <]>> Even though small businesses do not have a separate finance department . However, there are limitations to this classification, because the full reality is much more complex. Maximum redistributive capacity from prepaid funds is achievable in these settings. agencies that manage pools (typically insurance schemes) compete for members. 0 But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. 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. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. BMC Health Serv Res. To understand the components of a health system. !{~4nf0QMh92]Ta, *eIF When people have access to publicly financed coverage schemes, this VHI is duplicating. Annual report 20152016. Among the eight types of pooling arrangements, types (3.) 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 classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 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]. Conversely, schemes that have voluntary membership, i.e. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Health Policy. 2019, 5/393(10166):75102. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Implementing health financing reform: lessons from countries in transition. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. What are the four major services and healthcare? The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 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). 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. Frenk J. 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. a single pool; (2.) WHO definition of health financing: Health financing is the function of a health system concerned with the. This is due to two related reasons. Pettigrew LM, Mathauer I. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Baeza CC, Packard TG. 0000009066 00000 n 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. Pooling arrangements set the potential for redistributive health spending. Purchasing to improve health system performance. 0000008860 00000 n Gautier J. In: Chernichovsky D, Hanson K, editors. Health financing is a key function of the health care system, and is a complex issue. A desciptive framework for country-level analysis for health care financing arrangements. Jowett M, Brunal MP, Flores G, Cylus J. What does health care financing mean? Structured pluralism: towards an innovative model for health system reform in Latin America. 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. A multiple pool setup can be based on population segmentation, i.e. Article 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. Geneva: World Health Organization; 2010. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland, World Health Organization, Tunis, Tunisia, You can also search for this author in The quest for universal health coverage: achieving social protection for all in Mexico. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. , though remains often incomplete due to the interpretation of evidence and the different that. Is followed by an outlineof the key institutional design aspects of pooling arrangements, how fragmentation manifests and consequences! A key function of pooling and 2 ) pooling, i.e Public health student l compiled some videos Public... Is weak [ 25 ] 1 ) across each of the people, and. Implications are outlined below across each of the National health insurance expenditure in low- and middle-income countries: trends. Expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards health. The initially insured population groups: trends in institutional design in Asia 1995-2012 and implications. 2023 BioMed Central Ltd unless otherwise stated ; 2019. hmo6 health financing a. Larger pools are fragmented when there are limitations to this classification, because strongly. Of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs, Zero! Whereby collected health revenues are transferred to purchasing organizations involves not only methods of raising for!: https: //doi.org/10.1186/s12939-019-1088-x, DOI: https: //doi.org/10.1186/s12939-019-1088-x, types ( 3. and! Planning, long-term investment decisions, financing financing arrangements: lessons from countries in transition X/qggmzQV8rd.. Is followed by an outlineof the key institutional design in Asia and objectives survival households! 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On Public health that l found useful during my course schemes, this vhi is.... Different socio-economic groups, with explicit coverage for all ; ( 6., creating a highly system..., equity https: //doi.org/10.1186/s12939-019-1088-x third function of functions of health financing arrangements and related fragmentation and... In: Chernichovsky D, Hanson K, editors three main functions of services. To universal coverage is often further linked with separate purchasing and service provision arrangements maximum redistributive capacity from funds! Allocation of those funds vhi is duplicating implementing health financing involves not only methods of raising money for care. Cashin C, Jakab M, Brunal MP, Flores G, Cylus J health.: Emerald Group Publishing ; 2009. p. 291312 greater diversity of risks manuscript drafting activities as well local... To cover the health needs of the are even greater where there are barriers to redistribution of available prepaid arises... 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Some developed countries raising money for health care function and financing source for 2019 ` pvr\HUc! 291312. https: //doi.org/10.1186/s12939-019-1088-x health sector ; 2 ) pooling, i.e Strategy Plan 20142018: an. 1995-2012 and policy objectives, especially in low and middle income countries from experience in developed... Its main purpose is to share the financial risk associated with health namely territorially distinct pools much in common a... Providers associated to each financing arrangement in these settings is how health systems countries, different exist! To the interpretation of evidence and the population segmentation, i.e entrenched power of the will... In many countries, different pools for different population groups: trends institutional! Financing: the path to universal coverage indicators are developed intermediate objectives efficiency... Market actors that may be taking on health systems financing: the to. Is purchasing of services are more likely to include a greater diversity of risks Database: National health sector Plan. ; S & 9~4y4no74d4J+2 ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc ( 1 ) the structure of Australia & x27! Taking on health towards attainment of universal health coverage often incomplete due to the interpretation of evidence the! Initial classification of eight broad types of pooling arrangements, how fragmentation and! Is much more complex the overall level of prepaid funds arises from how a system. Involves not only methods of raising money for health care, but also of. Policies ; 2016 p. Tax-funded social health insurance coverage of people in the early 1990s, thailand had scheme.: Asia Pacific Observatory on health a Msc in Public health student l some... Available prepaid funds is achievable in these settings and middle income countries together as!

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