4. Hatfield (South Africa): CMS; 2016. . 0000012547 00000 n 0000079931 00000 n As such, automatic entitlement is typically solely funded from general budget revenues. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 154 39 2018;122:45772. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 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/. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. 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. Table1 outlines the respective features under each. 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. Formula funding of health services: learning from experience in some developed countries. The Health Financing Specialist will be based in the Abt office in Antananarivo. Kutzin J. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. 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. Many others receive poor quality of services even when they pay out-of-pocket. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. 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. In 1985, the government commissioned the first of a . Instead, they usually follow a countrys territorial structure, i.e. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. complementary or supplementary voluntary health insurance. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. In: Figueras J, editor. California Privacy Statement, This is inconsistent with the objective of financial protection and equity of access to services in relation to need. basic functions, together with the basic health system objectives they aredesigned to achieve. 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. 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]. 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. 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. PS is a health systems adviser working in the WHO Country Office of Tunisia. 0000002345 00000 n 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. 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]. The health financing system in the country is complex as it involves different layers of financial sources, . However, in some instances, this pooling set up may only be territorially distinct on paper. 1: World Health Organization, 2015. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. 1.2.1. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Healthcare organizations must be able to minimize costs in order to be financially successful. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Health care delivery forms the most visible function of the health system, both to patients and the general public. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Cite this article. (Accessed on 25 February 2018)]. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. To ensure key development programmes are adequately funded [5,6]. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. 2. Bingley: Emerald Group Publishing; 2009. p. 291312. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. In: Chernichovsky D, Hanson K, editors. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Its main purpose is to share the financial risk associated with 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. WHO Regional Office for Europe: Copenhagen; 2016. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Community based health insurance: how can it contribute to progress towards UHC? This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Analysis was performed in line with the various NHA entities and health system financing functions. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Health Systems Financing: The path to universal coverage. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Click the card to flip . Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 787 0 obj <> endobj a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? 0000079954 00000 n Various policy instruments and options exist to reduce fragmentation and increase redistributive capacity: 1) make participation compulsory to cover everybody; 2) merge different pools to increase the pool size and diversity in health risks; 3) cross-subsidize pools that have lower revenues and higher health risks; and 4) harmonize across pools, such as benefits, payment methods and rates [16]. 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. Reforms in the pooling of funds. 1 / 64. There are different classifications for finance functions, and it varies with organization types. 0000001076 00000 n Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). a single pool; (2.) While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Google Scholar. 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. 2. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Spending targets for health: no magic number. SMG 1117A.641 (02/09/2022) 1 . The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Article Sometimes, these arrangements include a purchaser-provider split. 0000001757 00000 n Geneva: World Health Organization; 2017. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 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. People who have higher risks are just as covered as people who have lower risks. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Conversely, schemes that have voluntary membership, i.e. Rather it is a first attempt at a classification, which could encourage further useful work from others. Advances in health economics and health services research, volume 21. 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]. 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. A desciptive framework for country-level analysis for health care financing arrangements. 0000013724 00000 n 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. This is due to two related reasons. "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). 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. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. xref Self-paced (approximately 6 hours of course time) Click to enter this course Download and easily browse by indicator:Health Financing Indicators Reference Sheets OECD reviews of health systems: Switzerland 2011. Google Scholar. For example, even in a single or unified pool, unless health needs are perfectly reflected in the relative allocations to different health programs, further fragmentation occurs, especially when an input-based line item budget structure is in place. View below: When viewing on a desktop, maximize for optimized view. 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]. 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). 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. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. Health Systems in Transition. This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). The quest for universal health coverage: achieving social protection for all in Mexico. Revenue collection is how health systems raise money from households, businesses, and external sources. 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. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. 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. We propose eight broad types of pooling arrangements: (1.) Health Policy. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 0000035307 00000 n VHI with a complementary or supplementary role exists in most countries [53, 54]. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. ), (7.) Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Purchasing health services for universal health coverage: how to make it more strategic? Health Financing in Ghana. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Int J Equity Health. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. The final goals of UHC are equity in service use, quality, and financial protection. There are two forms of institutional setup found for this pooling arrangement. Health financing involves not only methods of raising money for health care, but also allocation of those funds. What are the four major services and healthcare? 0000046058 00000 n Health system review: Achievements and challenges. 0000012340 00000 n 814 0 obj <>stream (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 0000008860 00000 n 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 Spending as % of GDP. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. 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. 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