Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. SMG 1117A.641 . However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD PubMed Central For illustration we provide various country examples. Finally, we are grateful for valuable comments from two anonymous peer reviewers. Council for Medical Schemes (CMS). A conclusion and lessons are presentedat the end. 6. "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Today, millions of The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily Agency's Mandate and Functions Mandate. Provided by the Springer Nature SharedIt content-sharing initiative. WHO Regional Office for Europe: Copenhagen; 2016. Int J Equity Health. ), (7.) Government funds are mainly allocated through historical incremental approach. Manage cookies/Do not sell my data we use in the preference centre. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Jowett M, Brunal MP, Flores G, Cylus J. It also describes Ghana's health financing system. pooled, in one or several pools. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. 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. Table1 outlines the respective features under each. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 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. 2018;122:45772. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. 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. Geneva: World Health Organization; 2008. 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. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). Geneva: World Health Organization; 2017. 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. Health financing for universal coverage and health system performance: concepts and implications for policy. Geneva: World Health Organization; 2010. In: Chernichovsky D, Hanson K, editors. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. 0 Analysis was performed in line with the various NHA entities and health system financing functions. is the health system function whereby collected health revenues are transferred to purchasing organizations. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 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. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. endstream endobj startxref 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. 0000001076 00000 n Article fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Pools can be based on compulsory, automaticor voluntary participation. Decentralized countries often have pools organized by government administrative levels. Spending wisely: buying health services for the poor. %PDF-1.4 % Google Scholar. kem ZG, akar M. What have health care reforms achieved in Turkey? However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. Australia's health system is a complex mix of service providers and other health professionals from a range of organisations - from Australian and state and territory governments and the non-government sector. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. 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. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Kutzin J. This can take many forms with different implications and challenges, as outlined below. 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. 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]. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. Instead, they usually follow a countrys territorial structure, i.e. 'p 6l3/%J there is one fund for the population in that one territory. 0000002300 00000 n 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. Among the eight types of pooling arrangements, types (3.) Geneva: World Health Organization; 2010. 0000010246 00000 n [3] 0000014440 00000 n OECD reviews of health systems: Switzerland 2011. 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]. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Preker A, Langenbrunner J. 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. 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. 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 . 2012;380(9849):125979. 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. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. . Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. 2016;15:7. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Click the card to flip . There are different classifications for finance functions, and it varies with organization types. This entity pools public funding, i.e. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. By Jonas May 13, 2021 5min read 4233 views. 0000025210 00000 n a single pool; (2.) International Journal for Equity in Health An appraisal of the health transformation Programme. 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. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Many others receive poor quality of services even when they pay out-of-pocket. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . The Health Financing Specialist will be based in the Abt office in Antananarivo. There are some countries that rely predominantly on a single national pool funded from general government revenues. Mathauer I, Theisling M, Mathivet B, Vilcu I. Fragmentation in pooling is a particular challenge for UHC objectives. the allocation of pooled funds to health service providers [1]. California Privacy Statement, Paris: OECD; 2011. 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. 2. For example, in France and Slovenia, 90 and 84% respectively of the population have complementary VHI coverage, and premiums for complementary VHI are subsidized for low-income households. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. %%EOF These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 0000011158 00000 n All remaining errors are with the authors. Ministry of Health Swaziland. 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]. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 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. The report is divided into five chapters. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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). 0000006764 00000 n In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. 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. In course two, students will learn how to conduct a health impact assessment and how to assess the impacts of policies, plans and projects, as well as how that support decision-makers make choices regarding alternatives and improvements to prevent disease or injury and to actively promote health. Fragmentation in pooling arrangements. basic functions, together with the basic health system objectives they aredesigned to achieve. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. 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. A 2 0 They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. There are also some concerns, however. Implementing health financing reform: lessons from countries in transition. 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. As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. PubMed Beyond survival protecting households from health shocks in Latin America. 787 0 obj <> endobj Health Systems in Transition. Structured pluralism: towards an innovative model for health system reform in Latin America. Smith P. The role of markets and competition. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. 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. Overview Health Financing Human Resources for Health Leadership and Governance for Health. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 1970;84(3):488500. 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. 2001;56(3):171204. 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. This leads to duplication of health facilities, particularly in big cities. Figure 1. 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. Each of the insurance schemes thus constitutes a separate pooling agency. 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 . Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. 2018;11(11). Different frameworks for assessing of health . 0000001864 00000 n Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. Bingley: Emerald Group Publishing; 2009. p. 291312. Therefore, maximizing the potential to redistribute from lower-need to higher-need individuals by de-linking contributions (of whatever form, such as taxes or insurance premiums) from their health risk is the central objective for pooling. We also like to thank Lisa Seidelmann, Carlo Schmid Fellow and volunteer with the Department of Health Systems Governance and Financing at the time of producing this draft for her research assistance. 2016;15(1):165. 2013;91(8):60211. 0000079977 00000 n Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. -U+:V\GCs2C /L7w0X-O`>2h?! Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. The quest for universal health coverage: achieving social protection for all in Mexico. Heal Policy Plan. 0000079931 00000 n Annual report 20152016. Bingley: Emerald Group Publishing; 2009. p. 291312. 4. Health Policy. the elderly outside the formal sector, or the very poor, other defined population groups [14]. 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. 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. 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. Health Policy. there is no explicit purchaser-provider split. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. These are 1) the nature of pooling and 2) the structure of pooling. trailer Three key health financing system functions Resource Mobilization: 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]. 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.
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