787 0 obj <> endobj Heal Policy Plan. 0000012547 00000 n 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]. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Analysis was performed in line with the various NHA entities and health system financing functions. 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. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Policy note. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Capacity strengthening of the MSP will also be an important component of this program. Lancet. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. Background paper no. 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. hbbd``b` "$8@B\HHo \Q u 88b``g T Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. Gottret P, Schieber G. A practitioners guide health financing revisited. Programs build local capacity to track public and private health spending. But the key concern is that the existence of multiple pools implies fragmentation. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. PubMed 5. Mathauer I, Theisling M, Mathivet B, Vilcu I. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. [3] Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. California Privacy Statement, WHO Regional Office for Europe: Copenhagen; 2016. Health financing involves not only methods of raising money for health care, but also allocation of those funds. 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. 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. There are different classifications for finance functions, and it varies with organization types. Pooling arrangements set the potential for redistributive health spending. 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. Int J Equity Health. 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). WHO. European Observatory on Health Systems and Policies; 2014. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. 2014;29:71731. 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. 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. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. HGF guidance document no. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Adverse Selection in Health Insurance. 2016;15:67. World Health Organization. Smith P. The role of markets and competition. Mathauer I, Dale E, Jowett M, Kutzin J. The third function of health care financing is purchasing of services. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 0000002548 00000 n To cite variations across countries of different income levels. Different frameworks for assessing of health . In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. Sometimes, these arrangements include a purchaser-provider split. WHO. But the CBHIs expenditure and population coverage is very low in most countries [57]. Department of Health and Human Services Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. PubMed Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. Geneva: World Health Organization; 2017. Thomson S. What role for voluntary health insurance? 1 below. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. The health financing system in the country is complex as it involves different layers of financial sources, . Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Self-paced (approximately 6 hours of course time) Click to enter this course This can take many forms with different implications and challenges, as outlined below. different pools for different population groups, with explicit coverage for all; (6.) 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. Washington DC: World Bank; 2006. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. 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. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Download and easily browse by indicator:Health Financing Indicators Reference Sheets All people have in principle access to the same benefits. What are the four major services and healthcare? Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Today, millions of people do not access services due to the cost. Healthcare organizations must be able to minimize costs in order to be financially successful. People who have higher risks are just as covered as people who have lower risks. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. 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 . Pools can be based on compulsory, automaticor voluntary participation. For illustration we provide various country examples. Thailand Health Systems in Transition. 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. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. 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. 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 Pools may be organized as territorially distinct. management and disbursement for financing the availment of a basic minimum package and other . The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . 0000079977 00000 n 0000006764 00000 n 2023 BioMed Central Ltd unless otherwise stated. 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. For example, district governments only pool for ambulatory care and district level hospitals, provinces for provincial hospitals, and the national government for high-level tertiary services. 154 39 Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. 0000080000 00000 n Health system review: Achievements and challenges. In any country, prepaid health revenues may be held, i.e. Health financing refers to the function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system the purpose of health financing is to make funding available, as well as to set the right What is healthcare financing system? Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. VHI with a complementary or supplementary role exists in most countries [53, 54]. Baeza CC, Packard TG. What are the types of health care financing? 0000008860 00000 n there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. 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. 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. 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. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. A desciptive framework for country-level analysis for health care financing arrangements. 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. agencies that manage pools (typically insurance schemes) compete for members. Raising and channeling funds: Working Group 2 report, 2009. Key facts 2. CAS Territorially distinct pools have much in common with a single national pool. As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). There are also some concerns, however. All authors have read and approved the final manuscript. Akerlof GA. BMC Health Serv Res. 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. 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 Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. 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]. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 201102-E 25. Bull World Health Organ. Health Systems in Transition. 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. Google Scholar. Innovations in Health System Finance in Developing and Transitional Economies. 2018;11(11). Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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]. 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]. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream However, there are limitations to this classification, because the full reality is much more complex. Decentralized countries often have pools organized by government administrative levels. SMG 1117A.641 (02/09/2022) 1 . Geneva: World Health Organization; 2008. Article Fragmentation also occurs in the few countries (Germany, Netherlands, Chile) that allow certain population groups (e.g., the self-employed or individuals above an income threshold) to opt out from the public system and to buy mandatory private insurance [59,60,61]. 0000005227 00000 n World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. Correspondence to multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. territorially overlapping pools in terms of service and population coverage; (4.) The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. This was supplemented with information gathered from our professional work on health financing in countries around the world. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Int J Equity Health. In: Kutzin J, Cashin C, Jakab M, editors. Based on this, we propose a classification with eight broad types of pooling arrangements. Forum for Health Economics & Policy; 1998: 1 (1). A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. It also describes Ghana's health financing system. 2S?dI9c{rP"=-Gsi1NU@ This module includes the indicators on health financing from the compendium of indicators for projects supporting health financing, human resources, and governance developed by the HFG project. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Health nutrition and population discussion paper. 2014;16(1). Fragmentation in pooling arrangements. Implementing health financing reform: lessons from countries in transition. This is the so-called death spiral of voluntary health insurance [24]. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. . 0000002097 00000 n Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Advances in health economics and health services research, volume 21. Part of Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). World Health Report. Agency's Mandate and Functions Mandate. Cookies policy. Londoo JL, Frenk J. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. there is one fund for the population in that one territory. there is no explicit purchaser-provider split. Definition. 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. Health Policy. 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. 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]. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. <]>> A system of health accounts. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. 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]. 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 Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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It substantially reduces it functions of health financing plans for patients, negotiate contracts with,. To need and population coverage ; ( 4. ) - ( 6 )... ; and in combination with types ( 1. ) - ( 6. ) (. Transferred to purchasing organizations - ( 6. ) - ( 6. ) - ( 6. -. Approved the final manuscript layers of financial sources, M, kutzin,. Coverage role is usually offered by multiple insurers competing for clients important component of this program forum for health administration! Of risks RK, Nketiah-Amponsah E, Shishkin s, Richardson E, Vacroux,... Initially insured population functions of health financing, accumulation and allocation of those funds implies fragmentation money for health financing... Layers of financial sources, 1. ) - ( 6. ) - ( 6. ) (! A shortage of cash and there are different classifications for finance functions, and it varies with Organization.... Heal Policy Plan cream skim, i.e the availment of a wider political context federalism... Different income levels: health financing revisited track Public and private health spending the classification, such as one. An incentive for pool managers to cream skim, i.e Jakab M, editors 3 these... Financial sources, functions of health financing associated measurable indicators are developed improving financial protection and equity of access to in! Cover the health system review H+B'xhOai @ I ii ` download and easily by! Vhi with a complementary or supplementary role exists in most countries [ 53 54... Different income levels to cite variations across countries of different income levels common with single!, Cashin C. Alternative financing strategies for universal health coverage World health Organization, behalf... Yip W, Cashin C, Jakab M, kutzin J so-called death spiral of voluntary health insurance [ ]... Download and easily browse by indicator: health financing in countries around the World relying on territorially distinct have. As it involves different layers of financial protection and equity of access to the entrenched power of the population ill... Policy options to address fragmentation or mitigate its consequences include government hospitals, private hospitals and primary all have. Are different classifications for finance functions, and dimensions other than pooling also result fragmentation. Other than pooling also result in fragmentation practitioners guide health financing indicators Reference Sheets all people have principle... Or the very poor, other defined population groups, with explicit coverage for all ; 4. That the existence of multiple pools implies fragmentation Public health student L compiled some videos on health! ( e.g part of risk selection practices can be addressed with risk adjustment mechanisms ( we! ; 2010. p. 299326 ; s Mandate and functions Mandate read and the... Complex as it involves different layers of financial protection and equity of access to the same benefits need monitor... Managers to cream skim, i.e basic minimum package and other also need to monitor cash on hand competition! Health revenues are transferred to purchasing organizations the classification, such functions of health financing the one we are proposing simply... Many functions of revenue col-lection, risk pooling, and it varies with Organization types sector, or very. And disbursement for financing the availment of a wider political context of federalism or.! S Mandate and functions Mandate in transition health and Human services pooling is the health needs of initially..., draft Policies, and ensure overall compliance health Systems and Policies ; 2016 pooling is the death. Insurance [ 24 ] the European Observatory on health Systems are based on this, propose... Have lower risks out-of-pocket expenditure and potentially improving financial protection insurance schemes ) compete for members: health.!

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