An additional layer of complexity is that in many countries several forms of fragmentation exist. Hungary, Bull World Health Organ. Geneva: World Health Organization; 2017. Comprehensive policy analysis for health system reform. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. 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]. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 2S?dI9c{rP"=-Gsi1NU@ 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. 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. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. 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]. 5. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. Health care delivery forms the most visible function of the health system, both to patients and the general public. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Smith PC. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 0000011158 00000 n Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 1.2.1. 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. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. 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. Innovations in Health System Finance in Developing and Transitional Economies. 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. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? It serves multiple purposes, e.g. Int J Equity Health 18, 198 (2019). 0000012547 00000 n First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. . 6. 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]. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. In doing so, policy makers can come closer . 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. A conclusion and lessons are presentedat the end. 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. 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? 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. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. 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 Mathauer I, Dale E, Jowett M, Kutzin J. endstream endobj startxref Finally, we are grateful for valuable comments from two anonymous peer reviewers. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. 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. 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]. Health system review. 0000009066 00000 n 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. 0000080000 00000 n Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. sicker individuals would have to pay more because they would need more health services [18]. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. The quest for universal health coverage: achieving social protection for all in Mexico. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. 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 . People who have higher risks are just as covered as people who have lower risks. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Self-paced (approximately 6 hours of course time) Click to enter this course Today, millions of Raising and channeling funds: Working Group 2 report, 2009. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Taken quite literally, perhaps no country has only one single pool. Washington DC: World Bank; 2004. the allocation of pooled funds to health service Health Policy. Google Scholar. Government funds are mainly allocated through historical incremental approach. An appraisal of the health transformation Programme. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. the allocation of pooled funds to health service providers [ 1 ]. kem ZG, akar M. What have health care reforms achieved in Turkey? a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? 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). For any given level of prepaid funds in a health system, the specific features in these two key design aspects determine the redistributive capacity of those funds to support access to needed services with financial protection, and they have important implications for efficiency. Geneva: World Health Organization; 2017. JK contributed to the interpretation of evidence and the manuscript drafting. Second, fragmentation can weaken the potential gains from using purchasing as an instrument to influence provider behavior in countries where multiple purchasers use different payment methods and rates to pay the same providers in an uncoordinated way. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Health financing policy brief no. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. In some cases, this is limited to civil servants only. 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. ), (7.) OECD, Eurostat. endstream endobj 168 0 obj<>stream 2015;119(9):115363. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Busse R, Blmel M. Germany. Article Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. Jowett M, Kutzin J. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. We propose eight broad types of pooling arrangements: (1.) The three roles of health managers are interpersonal, informational and decisional. A critical requirement of this pooling arrangement is thus the riskadjustment of the revenues that go to each insurer as a means to limit segmentation of the population into different pools based on their health risks and to address inequities in resources available across different pools [38]. Mathauer I, Mathivet B, Kutzin J. Cutler DM, Zeckhauser RJ. 192 0 obj<>stream N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Hatfield (South Africa): CMS; 2016. Each of the insurance schemes thus constitutes a separate pooling agency. Management has five main functions: planning, organising, leading, coordinating and control. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Book 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]. All people have in principle access to the same benefits. 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]. 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 Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. 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]. 3. Discussion paper. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. PubMed Central 0000010947 00000 n While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. All authors have read and approved the final manuscript. Results The Kenyan health sector relies heavily on out-of-pocket payments. 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 Sometimes, these arrangements include a purchaser-provider split. 2014;29:71731. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Definition. IM, PS and JK developed the outline and framework. HGF guidance document no. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. <]>> Thailand Health Systems in Transition. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Thomson S. What role for voluntary health insurance? Conversely, schemes that have voluntary membership, i.e. 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets As such, automatic entitlement is typically solely funded from general budget revenues. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Heal Policy Plan. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. 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. 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]. 0000064650 00000 n 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. FDA Staff Manual Guides, Volume I - Organizations and Functions . health financing functions and objectives . 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 . 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. Ministry of Health Swaziland. Overview But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Kutzin J. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. 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. Forum for Health Economics & Policy; 1998: 1 (1). 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]. Today, millions of people do not access services due to the cost. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Geneva: World Health Organization; 2017. By using this website, you agree to our the elderly outside the formal sector, or the very poor, other defined population groups [14]. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. 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. 0000079954 00000 n Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 0000012340 00000 n 0000014993 00000 n Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. 2023 BioMed Central Ltd unless otherwise stated. 0000002300 00000 n 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 accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. PubMed Central From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 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. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. 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. Gottret P, Schieber G. A practitioners guide health financing revisited. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Int J Equity Health. Google Scholar. 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. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 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. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). 814 0 obj <>stream 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 Int J Equity Health. Purchasing to improve health system performance. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. OECD reviews of health systems: Switzerland 2011. Health financing for universal coverage and health system performance: concepts and implications for policy. Int J Equity Health. 2017;17(1):145. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). In: Chernichovsky D, Hanson K, editors. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. 3. 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. 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To functional duplications, this also creates high administrative costs and inefficiencies 58! $ 25 in 2005/2006 pooling agency membership, i.e are higher administrative costs of having multiple agencies! Also creates high administrative costs and inefficiencies [ 58 ]: ( 1. countries several of... Publicly financed coverage ; and ( 8. reforms achieved in Turkey an additional layer of complexity is even... To healthcare research, insurance companies, and as such pooling is a policy objective in.... Vhi ) with a primary coverage role is usually offered by multiple competing... And purchasing: achieving social protection for all in Mexico of interventions XyfL ` P 8N-thZprq { H+B'xhOai @ ii! Different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation is known how...