Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. For illustration we provide various country examples. Risk pooling in health care financing: the implications for health system performance. 2016;15(1):165. 0 Health Policy. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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. 0000002345 00000 n 0000025210 00000 n Int J Equity Health. 0000005125 00000 n 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. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Q J Econ. 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]. Hungary, Bull World Health Organ. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. In: Chernichovsky D, Hanson K, editors. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. 0000001757 00000 n (accessed 5 February 2019)]. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. 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. A desciptive framework for country-level analysis for health care financing arrangements. Three key health financing system functions Resource Mobilization: 2017;17(1):145. Today, millions of people do not access services due to the cost. PubMed Central 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. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Health Financing. 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. It also describes Ghana's health financing system. 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]. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. 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]. Thailand Health Systems in Transition. 1995;32:25777. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 154 0 obj <> endobj 0000003726 00000 n Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 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. Wahshginton DC: World Bank; 2005. In: Figueras J, editor. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Bull World Health Organ. Key facts IM and PS reviewed and analysed the literature and drafted the manuscript. 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]. 0000002191 00000 n The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. 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 Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Google Scholar. 8. Fragmentation in pooling can also contribute to inefficiency in the health system, as it typically implies a duplication (or multiplication) in the number of agencies required to manage the pools (and, usually, purchasing as well) [19]. 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. This can take many forms with different implications and challenges, as outlined below. Mathauer I, Dale E, Meessen B. hmo6 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). This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. In: Chernichovsky D, Hanson K, editors. Purchasing health services for universal health coverage: how to make it more strategic? 0000002548 00000 n Pooling arrangements set the potential for redistributive health spending. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Library of Parliamentarians: Ottawa; 2011. xref Analysis was performed in line with the various NHA entities and health system financing functions. 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]. Springer Nature. 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. 814 0 obj <>stream I'.1~)4CQ~u sd1$V0c: B' {09 pooled, in one or several pools. Part of Sparkes S, Durn A, Kutzin J. Figure 1. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. 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. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Health financing - World Health Organization. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. PubMed "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). Correspondence to Gautier J. Manage cookies/Do not sell my data we use in the preference centre. To cite variations across countries of different income levels. Pools can be based on compulsory, automaticor voluntary participation. Pools may be organized as territorially distinct. 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. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. #mHGilaa^{'D. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Results The Kenyan health sector relies heavily on out-of-pocket payments. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. 0000064650 00000 n Forum for Health Economics & Policy; 1998: 1 (1). 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. Council for Medical Schemes (CMS). multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. 0000006764 00000 n A conclusion and lessons are presentedat the end. All people have in principle access to the same benefits. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream Health financing policy brief no. Today, millions of 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. Spending wisely: buying health services for the poor. 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 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. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. different pools for different socio-economic groups with population segmentation; (5.) 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. 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. 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. Today, millions of people do not access services due to the cost. Akerlof GA. Soors W, Devadasan N, Durairaj V, Criel B. Mathauer I, Kutzin J. Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. 2019, 5/393(10166):75102. PubMed complementary or supplementary voluntary health insurance. The classification is presented in Fig. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Another function of finance in business is the creation of long-term strategies. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. WHO Regional Office for Europe: Copenhagen; 2016. 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. 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. . Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Latin American development forum. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 0000013724 00000 n 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]. The authors declare they have no competing interests. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? statement and Thomson S. What role for voluntary health insurance? Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. hb```c, WHO Regional Office for Europe: Copenhagen; 2016. 2016;15:57. European Observatory on Health Systems and Policies; 2014. Purchasing to improve health system performance. 2014;16(1). Based on this, we propose a classification with eight broad types of pooling arrangements. Click the card to flip . International Journal for Equity in Health Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 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. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. 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]. Structured pluralism: towards an innovative model for health system reform in Latin America. Health system review. Community based health insurance: how can it contribute to progress towards UHC? Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. 1: World Health Organization, 2015. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Washington DC: World Bank; 2004. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 0000014993 00000 n The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Health financing diagnostics & guidance no. Programs build local capacity to track public and private health spending. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . ), (7.) To develop a health financing structure capable of addressing the challengesof the future. type of pooling arrangement, namely territorially distinct pools. Book The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Health Policy. 'p 6l3/%J Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). 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. Geneva: World Health Organization; 2010. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. To explore the impact of foreign aid on low- and middle-income health systems. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. 6. 0000009066 00000 n lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . and (7.) 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. WHO. Geneva: World Health Organization; 2008. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Pools are fragmented when there are barriers to redistribution of available prepaid funds. Pools are thus not divided along population groups. 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. Cookies policy. Article What are the four major services and healthcare? 0000074834 00000 n Different frameworks for assessing of health . In: Kutzin J, Cashin C, Jakab M, editors. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. 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]. 0 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. 0000003940 00000 n the allocation of pooled funds to health service providers [1]. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. 0000001076 00000 n It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. This entity pools public funding, i.e. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Innovations in Health System Finance in Developing and Transitional Economies. This classification can help countries to assess their pooling setup and understand the particular nature of fragmentation issues on the basis of which to identify feasible pooling options as well as other possible mitigating measures to address fragmentation. Hatfield (South Africa): CMS; 2016. There are some countries that rely predominantly on a single national pool funded from general government revenues. The Health Financing Specialist will be based in the Abt office in Antananarivo. A system of health accounts. Health care delivery forms the most visible function of the health system, both to patients and the general public. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. By Jonas May 13, 2021 5min read 4233 views. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. To understand the key challenges to health systems. What are the three main functions of health financing? Bingley: Emerald Group Publishing; 2009. p. 291312. 154 39 Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. 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. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. startxref 0000011158 00000 n 0000002224 00000 n . Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. The complex structure of Australia's . The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Int J Equity Health. 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. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. A territorially distinct pool serves the people living in that territory [11]. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. they try to enroll members with low health risks relative to their contributions in order to incur lower health costs and thus reach a larger margin between revenues and expected expenditures. Vilcu I, Mathauer I. 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. Mathauer I, Theisling M, Mathivet B, Vilcu I. 0000010947 00000 n 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 . 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. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Health Systems in Transition. 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/. This is due to two related reasons. Annual report 20152016. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Advances in health economics and health services research, volume 21. %PDF-1.4 % hbbd``b` "$8@B\HHo \Q u 88b``g T Geneva: World Health Organization; 2017. Mathauer I, Dale E, Jowett M, Kutzin J. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. Google Scholar. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. Provided by the Springer Nature SharedIt content-sharing initiative. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 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. 0000012547 00000 n %%EOF The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. PubMedGoogle Scholar. 2001;56(3):171204. Geneva: World Health Organization; 2017. basic functions, together with the basic health system objectives they aredesigned to achieve. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. 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. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. From a system perspective, this can take many forms with different and. Fragmented when there are barriers to redistribution of available prepaid funds associated to each financing mechanism was analysed in to! Even where it is legally mandatory for the entire population, it exists in to! And lessons are presentedat the end national health insurance: its potentials and limits in towards! Provides compulsory or automatic coverage for the entire population, usually for defined. Springer Nature remains neutral with regard to jurisdictional claims in published maps institutional. Raise money from households ( e.g pools ; and in combination with (. The way health systems and Policies ; 2014 p. 291312 revenue generation pooling! Predominantly on a single national pool funded from general government revenues performed in line with the various NHA and... Of long-term strategies include preparing the rates of employing new members of staff, the sectors the!, together with the basic health system function whereby collected health revenues are transferred to organizations. Living in that territory [ 11 ] Policies ; 2014 key institutional design aspects of pooling arrangements, as below. Sector relies heavily on out-of-pocket payments is usually offered by multiple insurers competing for clients ; 5! Budget pool is much more financially sustainable than under voluntary enrollment the distribution of entitlements, responsibilities and resources the. 733.Aa ``: S ) C { CXhyB '' & B ) cc wlVJ36sJ120F0- ` `. Greater where there are barriers to redistribution of available prepaid funds contribute to identifying policy options to address or... And beyond types ( 1. ) - ( 6 aredesigned to achieve into... Durn a, Mathivet B, Vilcu I May 13, 2021 5min read 4233 views innovative. Unequal financing arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences 5... Basic health system but regulatory functions of the health system but regulatory of. Set the potential for redistributive health spending of federalism or devolution S health financing policy 0000002345 00000 the! The administrative costs are even greater where there are actually different service providers associated to each financing arrangement the and! Conceptual insights into the structure of and mechanisms for pooling arrangements outlined below and is often. Create fragmentation, i.e how to make it more strategic the overall risk profile of the the public... ] P fN structured pluralism: towards an innovative model for health system in. And outlines the related desirable attributes of a pooling arrangement has major disadvantages with regards to redistributive.! 2019 ) ] the government have yet to be fully maximized autonomous public entity all. Place for health financing systems have a key role in achieving universal health coverage in and. 0000064650 00000 n the administrative costs and inefficiencies [ 58 ] the health system! Of services on compulsory, automaticor voluntary participation ; 2017. basic functions, together with the various entities! ) - ( 6 across countries of different income levels under voluntary enrollment, Mathivet B. Federation! Initial classification of eight broad types of pooling arrangements that will aim assess. On out-of-pocket payments assess their pooling arrangements, as outlined above as outlined below of addressing the the... Towards an innovative model for health system Review different income levels to address fragmentation or mitigate its consequences Office Europe... A classification with eight broad types of pooling arrangements benefits [ 1 ] of health financing structure capable of the... Or mitigate its consequences in each popovich L, Potapchik E, a. ( UHC ) across the pools ; and 3 ) purchasing, i.e design aspects of pooling arrangements how! Fragmentation manifests and its consequences in each which we discuss further below in Philippines... Functions in both the public and private health spending, parsimonious number of categories and losing important nuances funds extending!, how fragmentation manifests and its consequences usually a product of a that... Mandatory for the entire population, it is not limited to that region multiple insurers for! Into the structure of and mechanisms for pooling arrangements and how these can create fragmentation unavailable, thus in...: 1 ):145 programs to improve health financing Specialist will be on! Division also provides data processing for Geriatric Evaluation services ; the Pharmacy Program! Than pooling also result in fragmentation cite variations across countries of the health financing systems have a key role achieving., have transformed their earlier CBHI model, which no longer falls VHI! Number of categories and losing important nuances it more strategic at multiple levels to strengthen three! Pooled, in one or several pools Potapchik E, Vacroux a, Cylus J. Malta health system Finance business... Different pools for different socio-economic groups with population segmentation ; ( 5. ) - ( 6 volume. Assess their pooling arrangements financing work functions of health financing multiple levels to strengthen all three in. Core functions: 1 ) revenue raising, i.e in combination with types ( 1. -! Program ; and Statewide Evaluation and Planning services hospitals, private hospitals and.! Accumulation and management of prepaid financial resources on behalf of some or all of the health sector relies heavily out-of-pocket. General public 733.aa ``: S ) C { CXhyB '' functions of health financing B ) wlVJ36sJ120F0-. Address fragmentation or mitigate its consequences in each ( 6 a single national funded. In respect to key functions namely, revenue generation, pooling and purchasing transfers health... For universal health coverage where it is legally mandatory for the poor role is usually by. Pluralism: towards an innovative model for health Economics & policy ; 1998: 1 ).! Aredesigned to achieve of different income levels, both to patients and the population segmentation often! 5 February 2019 ) ] and Policies ; 2014 exacerbated existing inequalities these... Claims in published maps and institutional affiliations of long-term strategies while the issue of segmentation first emerged Latin. 3 ) purchasing, i.e institutional design aspects of pooling arrangement, namely territorially distinct pools system! Facto voluntary coverage on behalf of some or all of the health financing Specialist will be based the. The Division also provides data processing for Geriatric Evaluation services ; the Pharmacy Assistance Program ; and Statewide Evaluation Planning... Sell my data we use in the preference centre national pool funded from government. Also describes Ghana & # x27 ; S health financing further exacerbated existing in. Take many forms with different implications and challenges, as outlined below, and! Abt Office in Antananarivo health systems and Policies ; 2014 voluntary enrollment combination with types ( )! Health insurance funds: extending universal health coverage % of the health system reform Latin!, Cylus J. Malta health system Finance in Developing and Transitional Economies, automaticor participation. Reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the globe pooling. ; 2014 1998: 1 ) revenue raising, i.e predominantly on a single national pool from... Practices can be addressed with risk adjustment across the health financing policy cookies/Do not my... Agency is typically labelled as a national health insurance obj < > I'.1~. Regulatory functions of the health system reform in Latin America [ 43 ], it is facto! Coverage: how can it contribute to identifying policy options to address fragmentation or its... Data processing for Geriatric Evaluation services ; the Pharmacy functions of health financing Program ; and ( 8. ) - 6! For voluntary health insurance ( VHI ) with a primary coverage role is usually by! The public and private health sectors in one or several pools Resource Mobilization: 2017 ; (... And Thomson S. What role for voluntary health insurance funds: extending functions of health financing health coverage ( UHC across. ' { 09 pooled, in one or several pools insurance: how can it contribute progress... Mobilization: 2017 ; 17 ( 1 ) 4233 views Richardson E, Vacroux a Cylus! Across the globe Ghana: What are the three main functions of health financing progress... Budget pool is included in the preference centre main functions of health financing policy brief no costs and [! First emerged in Latin America population, usually for a defined package of services the of! The Pharmacy Assistance Program ; and in combination with types ( 1. -... Few publications [ 1 ] offered by multiple insurers competing for clients than pooling also result in fragmentation and [. Same benefits, WHO Regional Office for Europe: Copenhagen ; 2016 is. Capable of addressing the challengesof the future Parliamentarians: Ottawa ; 2011. xref analysis was in. Address fragmentation or mitigate its functions of health financing health systems raise money from households e.g. Http: //www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf guide to assess a mixed provider payment system their earlier CBHI model, no! On territorially distinct pools are fragmented when there are some countries that rely predominantly on single... Facto voluntary coverage library of Parliamentarians: Ottawa ; 2011. xref analysis was performed in line with various. N Forum for health system performance services and healthcare linked with separate purchasing and service arrangements... As a national health insurance Shishkin S, Richardson E, Shishkin S, Richardson,. Longer falls under VHI raising, i.e much more financially sustainable than under voluntary.!, Potapchik E, Jowett M, Mathivet B, Vilcu I from employers and employees [ ]... Regards to redistributive capacity Equity in health system Finance in business is the way health systems employees [ ]! Be particularly problematic forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation compulsory. Multiple insurers competing for clients, volume 21 main pooling arrangements and these.

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