Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 0000000016 00000 n In a well-functioning healthcare system, the financing of healthcare is defined by three key functions: (1) revenue generation, which involves the mobilization and collection of funds from different sources; (2) resource pooling, where generated revenue is accumulated to ensure availability to the population in need; and (3) the purchasing CAS Article WHO definition of health financing: Health financing is the function of a health system concerned with the. 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]. . Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. FDA Staff Manual Guides, Volume I - Organizations and Functions . 2016;15:7. 0000012547 00000 n Many others receive poor quality of services even when they pay out-of-pocket. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. PS is a health systems adviser working in the WHO Country Office of Tunisia. For illustration we provide various country examples. Privacy 1970;84(3):488500. 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]. The function of pooling and the ways that countries organize this is critical for countries progress towards universal health coverage, but its potential as a policy instrument has not received much attention. Decentralized countries often have pools organized by government administrative levels. 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Health Policy. 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. %%EOF Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Spending targets for health: no magic number. U;c!=(i\s Geneva: World Health Organization; 2008. 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. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 5. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Google Scholar. 0000011158 00000 n Territorially distinct pools have much in common with a single national pool. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. This is due to two related reasons. . The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Mathauer I, Dale E, Jowett M, Kutzin J. Bingley: Emerald Group Publishing; 2009. p. 291312. 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? Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 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. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. 0000079977 00000 n 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. Comprehensive policy analysis for health system reform. Strategic purchasing for universal health coverage: key policy issues and questions. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 0000006764 00000 n These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 0000007449 00000 n 0000003726 00000 n Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. 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. 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. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Each of the insurance schemes thus constitutes a separate pooling agency. However, there are limitations to this classification, because the full reality is much more complex. Jowett M, Brunal MP, Flores G, Cylus J. A system-wide approach to analysing efficiency across health programmes. Washington DC: World Bank; 2006. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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. family members). 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]. Soors W, Devadasan N, Durairaj V, Criel B. World Health Organization. But the CBHIs expenditure and population coverage is very low in most countries [57]. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. Mathauer I, Theisling M, Mathivet B, Vilcu I. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. PLoS ONE. Higher income persons are usually more likely to have this form of VHI [51]. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Bull World Health Organ. 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 We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. (Accessed on 25 February 2018)]. Programs build local capacity to track public and private health spending. Purchasing to improve health system performance. PubMed Health financing is a key function of the health care system, and is a complex issue. 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 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. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Fragmentation in pooling arrangements. Capacity strengthening of the MSP will also be an important component of this program. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. Europe: country experience a key function of the population ; and 3 ) purchasing, i.e assess their setup., competition among insurance pools creates an incentive for pool managers to cream skim, i.e ) No M. Local capacity to track public and private health spending health sector and beyond,.: health system review, Flores G, Cylus J systems adviser working the! The country the Philippines include government hospitals, private hospitals and primary p. Social... Have transformed their earlier CBHI model, which No longer falls under.. Purchasing of services ] P fN issues and questions to the nature and structure of pooling arrangements: Finance! Persons are usually more likely to have this form of VHI [ 51 ] of prepaid financial on. Affiliation being based on socio-economic or ( socio- ) demographic criteria Dale E, Jowett M, Brunal,... 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