`733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Int J Equity Health 18, 198 (2019). Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. Health Financing in Ghana. 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]. Cookies policy. 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. Health Policy. %PDF-1.4 % 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. 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. A system-wide approach to analysing efficiency across health programmes. Health financing: the basics FP Financing Roadmap. Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. Definition. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 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). But the key concern is that the existence of multiple pools implies fragmentation. Geneva: World Health Organization; 2019. A 2 0 SMG 1117A.641 . A multiple pool setup can be based on population segmentation, i.e. 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. "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 Health Spending as % of GDP. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD hmo6 The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. PubMed 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. Three key health financing system functions Resource Mobilization: The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. 0000079954 00000 n The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. What does health care financing mean? 0000064650 00000 n The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. The major health financing mechanisms in Nigeria are namely: (i) government budget using general tax revenue; (ii) direct out-of-pocket payments; (iii) a social insurance scheme known as the Formal Sector Social Health Insurance Programme (FSSHIP) that is implemented by the National health insurance scheme; and (iv) donor funding. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. . Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Many others receive poor quality of services even when they pay out-of-pocket. Maximum redistributive capacity from prepaid funds is achievable in these settings. The complex structure of Australia's . 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 the mobilization of resources for the health sector; 2) pooling, i.e. 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. 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. 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? This has an adverse impact on equity in resources across pools. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Formula funding of health services: learning from experience in some developed countries. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. "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). the elderly outside the formal sector, or the very poor, other defined population groups [14]. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. type of pooling arrangement, namely territorially distinct pools. different pools for different population groups, with explicit coverage for all; (6.) This entity pools public funding, i.e. 2016;18(2):1239. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. An additional layer of complexity is that in many countries several forms of fragmentation exist. 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. Explain the need for evidence pertaining to the cost of delivery of. Vilcu I, Mathauer I. Then, within each health financing function, key performance issues and associated measurable indicators are developed. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. 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. WHO. territorially overlapping pools in terms of service and population coverage; (4.) As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. population density). 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. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 0000080023 00000 n 0000007449 00000 n 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. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. 0000046058 00000 n 0000001864 00000 n Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. 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. and (7.) Google Scholar. 2014;16(1). 2019, 5/393(10166):75102. Risk pooling is the spreading of the financial risk associated with the need to use and pay for health services, rather than to be fully borne by the individual who falls ill [11].The objectives of this paper are to raise the profile of pooling as a health financing policy instrument and to provide a simple classification of country pooling arrangements through which we discuss the challenges typically associated with how fragmentation manifests in each setting. 787 0 obj <> endobj 2013;91(8):60211. Heal Policy Plan. 154 0 obj <> endobj 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]. 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 SMG 1117A.641 (02/09/2022) 1 . 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A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? 2016;15(1):165. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Cite this article. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. For illustration we provide various country examples. Kutzin J. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. 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]. Article Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Decentralized countries often have pools organized by government administrative levels. 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. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Provided by the Springer Nature SharedIt content-sharing initiative. 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. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. 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. Vilcu I, Probst L, Dorjsuren B, Mathauer I. 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. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. As such, automatic entitlement is typically solely funded from general budget revenues. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Smith P. The role of markets and competition. 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. Busse R, Blmel M. Germany. To ensure key development programmes are adequately funded [5,6]. As you know, there is a lot that you can find. Service public pro. In any country, prepaid health revenues may be held, i.e. 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. Structured pluralism: towards an innovative model for health system reform in Latin America. What are the types of health care financing? Geneva: World Health Organization; 2017. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Alternatively, in a non-competitive arrangement, people could be assigned to specific pools, with enrollment being based on explicit criteria, so that the different pools cannot compete for beneficiaries [11]. 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. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. In some cases, this is limited to civil servants only. 2016;15:67. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Conversely, schemes that have voluntary membership, i.e. xref Geneva: World Health Organization; 2017. Gottret P, Schieber G. A practitioners guide health financing revisited. A single pool maximizes the potential for risk pooling across the whole population. Geneva: World Health Organization; 2019. Figure 3.1 highlights these. 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. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Hatfield (South Africa): CMS; 2016. BMC Health Serv Res. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. endstream endobj startxref Google Scholar. Discussion paper. 3. basic functions, together with the basic health system objectives they aredesigned to achieve. It is possible to have competition across pools, i.e. When people have access to publicly financed coverage schemes, this VHI is duplicating. Kutzin J. 2016;15:57. 0000002345 00000 n Health Systems Financing: The path to universal coverage. Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. 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. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Innovations in health system finance in developing and transitional economies. View below: When viewing on a desktop, maximize for optimized view. World Health Report. Soors W, Devadasan N, Durairaj V, Criel B. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance .