Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. A multiple pool setup can be based on population segmentation, i.e. 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. 1 below. The Health Financing Specialist will be based in the Abt office in Antananarivo. 192 0 obj<>stream %%EOF 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. OECD reviews of health systems: Switzerland 2011. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 2018;11(11). Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Service public pro. 2019, 5/393(10166):75102. different pools for different population groups, with explicit coverage for all; (6.) In 1985, the government commissioned the first of a . 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 Innovations in health system finance in developing and transitional economies. Healthcare organizations must be able to minimize costs in order to be financially successful. Heal Policy Plan. Lancet. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 0000080023 00000 n Smith PC. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. %PDF-1.5 % , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. territorially overlapping pools in terms of service and population coverage; (4.) 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. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd population density). Its main purpose is to share the financial risk associated with Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Health financing diagnostics & guidance no. Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. Int J Equity Health. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. a single pool; (2.) 787 0 obj <> endobj The company has multiple offices in the U.S. and program offices in more than 40 countries. Figure 1. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. 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. Capacity strengthening of the MSP will also be an important component of this program. Background paper no. The authors declare they have no competing interests. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. 0000006764 00000 n 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. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. This entity pools public funding, i.e. Knaul FM, Gonzlez-Pier E, Gmez-Dants O, Garca-Junco D, Arreola-Ornelas H, Barraza-Llorns M, Sandoval R, Caballero F, Hernndez-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Seplveda J, Tapia R, Sobern G, Chertorivski S, Frenk J. 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]. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. Jowett M, Brunal MP, Flores G, Cylus J. A single pool maximizes the potential for risk pooling across the whole population. 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. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. 0 Thailand Health Systems in Transition. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. PubMed Central In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. The complex structure of Australia's . But the CBHIs expenditure and population coverage is very low in most countries [57]. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Bull World Health Organ. 201102-E 25. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 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. Baeza CC, Packard TG. Purchasing to improve health system performance. IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. 8. World Health Organization. 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). 2007;83(23):16279. a sub-national pool per state, province or district. Geneva: World Health Organization; 2016. 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 Fragmentation is further aggravated, as a small part of the better-off population is often enrolled in commercial voluntary health insurance, whilst a small share of people in the informal sector may enroll in voluntary community-based health insurance schemes [41, 42]. Correspondence to Health system review. 2016;15:67. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. WHO. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 complementary or supplementary voluntary health insurance. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Function. 0000009066 00000 n The health financing system in the country is complex as it involves different layers of financial sources, . Book 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Implementing health financing reform: lessons from countries in transition. SMG 1117A.641 (02/09/2022) 1 . statement and 0000010246 00000 n Terms and Conditions, The Canada health transfer: changes to provincial allocations. Advances in health economics and health services research, volume 21. Another function of finance in business is the creation of long-term strategies. Rather it is a first attempt at a classification, which could encourage further useful work from others. Geneva: World Health Organization; 2017. This is commonly referred to as a competitive social health insurance arrangement. 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]. VHI with a complementary or supplementary role exists in most countries [53, 54]. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. In some cases, this is limited to civil servants only. there is one fund for the population in that one territory. 0 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. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Vilcu I, Mathauer I. Smith P. The role of markets and competition. 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. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. 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). 1995;32:25777. Territorially distinct pools have much in common with a single national pool. Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. 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. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. there must be a specific contribution made by or on behalf of the covered person. 0000064650 00000 n Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Forum for Health Economics & Policy; 1998: 1 (1). For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. What are the three main functions of health financing? But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. agencies that manage pools (typically insurance schemes) compete for members. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: 0000079931 00000 n Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. Among insurers with individual choice of insurer and compulsory participation single national pool in both the public and health... Countries across all income groups to develop the classification financing arrangements and how these create. The complex structure of Australia & # x27 ; S the three main of... System progress towards UHC, especially in low- and middle-income countries multiple to. 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