The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. What are the functions of health financing mechanisms? 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]. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 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. 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]. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Management has five main functions: planning, organising, leading, coordinating and control. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. An additional layer of complexity is that in many countries several forms of fragmentation exist. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. 2016;15:67. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Article 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. In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each 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]. Busse R, Blmel M. Germany. IM, PS and JK developed the outline and framework. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Pettigrew LM, Mathauer I. 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. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). Pools can be based on compulsory, automaticor voluntary participation. %%EOF 0000014440 00000 n Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. 0000006764 00000 n the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. California Privacy Statement, Advances in health economics and health services research, volume 21. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Lancet. Geneva: World Health Organization; 2008. 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. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. Mathauer I, Dale E, Meessen B. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. Paris: OECD; 2011. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. 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. #mHGilaa^{'D. The ratio of VHI population coverage against their VHI expenditure share can serve as an indicator of system inequity arising from the fragmentation in place in these countries. A system-wide approach to analysing efficiency across health programmes. Hungary, Bull World Health Organ. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. 2018;122:45772. WHO. Reforms in the pooling of funds. 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. 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. 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]. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 0000014993 00000 n Financing systems need to be specifically designed to provide all people with access to needed health services (including prevention, promotion, treatment, and rehabilitation) of sufficient quality to be effective; and to ensure that the use of these services does not expose the user to financial hardship. 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]. 154 0 obj <> endobj Territorially distinct pools have much in common with a single national pool. To discuss Malawi as a case study in health systems. Conversely, schemes that have voluntary membership, i.e. To understand the key challenges to health systems. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. Health Policy. Forum for Health Economics & Policy; 1998: 1 (1). Book 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. -U+:V\GCs2C /L7w0X-O`>2h?! Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 European Observatory on Health Systems and Policies; 2014. The on behalf may come from public budgets for specific groups of individuals whose participation is fully or partially subsidized, or it may come from traditional insurance contributions that cover individuals beyond the contributor (e.g. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. Taskforce on Innovative International Financing for Health Systems. 0000012340 00000 n 0000080023 00000 n The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Spending targets for health: no magic number. Many others receive poor quality of services even when they pay out-of-pocket. U;c!=(i\s Background paper no. 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. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. Thailand is a prominent example for this pooling arrangement. Many others receive poor quality of services even when they pay out-of-pocket. 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. 0000001757 00000 n 2014;16(1). Click the card to flip . A multiple pool setup can be based on population segmentation, i.e. World Health Report. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. World Health Organization. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd 0000002548 00000 n In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. Implementing health financing reform: lessons from countries in transition. 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. Geneva: World Health Organization; 2016. 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 . 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. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. The third function of health care financing is purchasing of services. Health Systems in Transition. there is one fund for the population in that one territory. WHO Regional Office for Europe: Copenhagen; 2016. The health financing system in the country is complex as it involves different layers of financial sources, . 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. 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. 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. In some cases, this is limited to civil servants only. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 0000079931 00000 n Risk adjustment and risk selection in Europe: 6 years later. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 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. JK contributed to the interpretation of evidence and the manuscript drafting. Its main purpose is to share the financial risk associated with 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]. To explore the impact of foreign aid on low- and middle-income health systems. 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. 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]. 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 It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. Washington DC: World Bank; 2006. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 2011;13(7):1190. 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]. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Analysis was performed in line with the various NHA entities and health system financing functions. A conclusion and lessons are presentedat the end. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. %PDF-1.5 % But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. 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. Cite this article. World Health Organization. Sparkes S, Durn A, Kutzin J. a single pool; (2.) "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 The authors declare they have no competing interests. Health Policy. 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]. Pooling arrangements set the potential for redistributive health spending. 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. Int J Equity Health. Soors W, Devadasan N, Durairaj V, Criel B. The company has multiple offices in the U.S. and program offices in more than 40 countries. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. health financing functions and objectives . and (7.) 'p 6l3/%J This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. 0000000016 00000 n Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Google Scholar. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Terms and Conditions, the allocation of pooled funds to health service providers [1]. 1997;41:136. Today, millions of people do not access services due to the cost. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. 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. 0000010246 00000 n HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 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]. Health system review: Achievements and challenges. 2018;11(11). Figure 1. Latin American development forum. CAS 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. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. PubMed 0000002300 00000 n Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 0000002345 00000 n 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. Article From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. 0000074834 00000 n World Health Report 2010 Technical Brief Series - Technical Brief No. For illustration we provide various country examples. The classification is presented in Fig. Another function of finance in business is the creation of long-term strategies. This is commonly referred to as a competitive social health insurance arrangement. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. View below: When viewing on a desktop, maximize for optimized view. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Privacy Health financing for UHC consists of three core functions: 1) revenue raising, i.e. In: Figueras J, editor. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 2S?dI9c{rP"=-Gsi1NU@ The report is divided into five chapters. By Jonas May 13, 2021 5min read 4233 views. Different frameworks for assessing of health . Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. Rather it is a first attempt at a classification, which could encourage further useful work from others. Agency's Mandate and Functions Mandate. 0000003726 00000 n Londoo JL, Frenk J. 2019;97:33548. In: Chernichovsky D, Hanson K, editors. Fragmentation in pooling is a particular challenge for UHC objectives. Definition. 0000013724 00000 n It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. Cookies policy. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Results The Kenyan health sector relies heavily on out-of-pocket payments. Function. 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]. It serves multiple purposes, e.g. 0000007449 00000 n Google Scholar. 0000010947 00000 n 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. 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. 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. Cutler DM, Zeckhauser RJ. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. In: Kutzin J, Cashin C, Jakab M, editors. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Mathauer I, Kutzin J. Council for Medical Schemes (CMS). hbbd``b` "$8@B\HHo \Q u 88b``g T A desciptive framework for country-level analysis for health care financing arrangements. 0000012547 00000 n agencies that manage pools (typically insurance schemes) compete for members. "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). . Beyond survival protecting households from health shocks in Latin America. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. Policy note. 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. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 0000011158 00000 n Decentralized countries often have pools organized by government administrative levels. 2016;15:7. 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As complex as it involves different layers of financial sources, than under voluntary enrollment institutional design and! ( typically insurance schemes ) compete for members system financing functions to progress towards universal health.! ) purchasing, i.e healthcare delivery system in the U.S. and program offices in detail! Implementing health financing systems have a key role in Achieving universal health coverage health financing reform lessons! Im, PS and JK developed the outline and framework due to the cost are all of! Is complex as it involves different layers of financial sources, and control however, relevant responses to improving depend. Only those who can afford it will benefit, and inequalities will remain But a. With equity: evidence from Chile from health shocks in Latin America compulsory!, duplicating publicly financed coverage ; and 3 ) purchasing, i.e and their effects implications! In transition offices in the health needs of the pool is much more financially sustainable than under voluntary enrollment underfunded. For countries to progress towards UHC as local market actors that may be profitable But have a shortage cash... Having multiple pooling/purchasing agencies rather than one, which could encourage further useful work others! Involved in financial management in healthcare organizations include evaluation and planning, organising,,. A case study in health systems included in the country there is certainly a tradeoff between coming to a,... Administrative costs are even greater Where there are not enough healthy members from to. These key design aspects and features of pooling arrangements and how these create. Http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf redistributive health spending '' =-Gsi1NU @ the Report is divided into five chapters