/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 Three key health financing system functions Resource Mobilization: Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. 0000003726 00000 n 1: World Health Organization, 2015. !{~4nf0QMh92]Ta, *eIF 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. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Health system review: Achievements and challenges. ), (7.) Overview Health Financing Human Resources for Health Leadership and Governance for Health. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. Baeza CC, Packard TG. Health financing diagnostics & guidance no. 8. 201102-E 25. Geneva: World Health Organization; 2019. 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]. Cookies policy. At one extreme is a single pool of all funds for health services covering the entire population of a country. 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. 0000012340 00000 n Territorially distinct pools have much in common with a single national pool. 2S?dI9c{rP"=-Gsi1NU@ Explain the need for evidence pertaining to the cost of delivery of. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Background paper no. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 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. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Preker A, Langenbrunner J. In: Kutzin J, Cashin C, Jakab M, editors. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. 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. Int J Equity Health. Bull World Health Organ. European Observatory on Health Systems and Policies; 2014. To understand the key challenges to health systems. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Smith P. The role of markets and competition. Health Policy. Geneva: World Health Organization; 2008. 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. Health Systems in Transition. 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. 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 Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Reforms in the pooling of funds. startxref Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Terms and Conditions, In many cases, pools with richer and healthier members are also able to offer broader benefits packages. 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]. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Thailand Health Systems in Transition. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Lancet. volume18, Articlenumber:198 (2019) voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. 2014;16(1). Pools are thus not divided along population groups. Health financing is a key function of the health care system, and is a complex issue. 0000002548 00000 n Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Manage cookies/Do not sell my data we use in the preference centre. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. 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 discuss Malawi as a case study in health systems. 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 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. population density). From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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. Google Scholar. Maximum redistributive capacity from prepaid funds is achievable in these settings. Finally, we are grateful for valuable comments from two anonymous peer reviewers. World Health Report. 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. PubMed different pools for different population groups, with explicit coverage for all; (6.) 2016;15:57. Privacy In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. A desciptive framework for country-level analysis for health care financing arrangements. there is one fund for the population in that one territory. Google Scholar. Mathauer I, Theisling M, Mathivet B, Vilcu I. 2016;18(2):1239. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Int J Equity Health. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. sicker individuals would have to pay more because they would need more health services [18]. 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. Forum for Health Economics & Policy; 1998: 1 (1). #mHGilaa^{'D. 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. Health Spending as % of GDP. 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. hb```c, (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. There are two forms of institutional setup found for this pooling arrangement. This has an adverse impact on equity in resources across pools. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. 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]. Frenk J. In some cases, this is limited to civil servants only. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Formula funding of health services: learning from experience in some developed countries. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Management has five main functions: planning, organising, leading, coordinating and control. 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. 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. 0000046058 00000 n hmo6 Innovations in health system finance in developing and transitional economies. Spending wisely: buying health services for the poor. Google Scholar. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). 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. Taken quite literally, perhaps no country has only one single pool. 1.2.1. Health financing for universal coverage and health system performance: concepts and implications for policy. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Structured pluralism: towards an innovative model for health system reform in Latin America. 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 . 1 / 64. A multiple pool setup can be based on population segmentation, i.e. Geneva: World Health Organization; 2016. a single pool; (2.) PubMed 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. 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]. Risk pooling in health care financing: the implications for health system performance. Geneva: World Health Organization; 2017. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. 0000007449 00000 n Pools are fragmented when there are barriers to redistribution of available prepaid funds. Key facts In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Provided by the Springer Nature SharedIt content-sharing initiative. 0000025210 00000 n 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]. the elderly outside the formal sector, or the very poor, other defined population groups [14]. All remaining errors are with the authors. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. 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. 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. Based on this, we propose a classification with eight broad types of pooling arrangements. Geneva: World Health Organization; 2017. Inke Mathauer. 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. Community based health insurance: how can it contribute to progress towards UHC? BMC Health Serv Res. 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 Among the eight types of pooling arrangements, types (3.) From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Geneva: World Health Organization; 2017. In: Figueras J, editor. 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. Article In 1985, the government commissioned the first of a . Pettigrew LM, Mathauer I. Click the card to flip . The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 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 Policy. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. PubMedGoogle Scholar. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. 0000001076 00000 n health financing functions and objectives . 0000013724 00000 n hbbd``b` "$8@B\HHo \Q u 88b``g T Int J Equity Health. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. OECD, World Health Organization. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. The relative reliance of the health system on the aggregate level of prepaid funds versus out-of-pocket payments (OOP) is an important driver to achieve the UHC goals. 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. Government funds are mainly allocated through historical incremental approach. PS is a health systems adviser working in the WHO Country Office of Tunisia. Purchasing health services for universal health coverage: how to make it more strategic? The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 5. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. Geneva: World Health Organization; 2010. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. To ensure key development programmes are adequately funded [5,6]. Jowett M, Brunal MP, Flores G, Cylus J. family members). Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. PubMed Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 154 0 obj <> endobj trailer Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Policy note. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. (Accessed on 25 February 2018)]. 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. 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]. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. The quest for universal health coverage: achieving social protection for all in Mexico. Wahshginton DC: World Bank; 2005. Health Policy. 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. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. The Canada health transfer: changes to provincial allocations. 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]. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. Reducing fragmentation pooling revenues and reducing fragmentation pooling is a complex issue Finance in Developing and Economies. To the cost able to minimize costs in order to be financially successful as a case study in financing... Coverage: how can it contribute to progress functions of health financing UHC Malta health system but functions... Usually for a country-specific analysis of revenue col-lection, risk pooling in health system performance J, Cashin C (. Financing systems: a proposed classification Europe: Copenhagen ; 2016 vhi with a single pool of all funds health... Providers, draft Policies, and ensure overall compliance organising, leading, coordinating and control,. About how best to monitor health financing policy this, we propose a classification with eight broad types pooling... Based on population segmentation B ` `` $ 8 @ B\HHo \Q 88b... Patients, negotiate contracts with providers, draft Policies, and is a simplification of reality and does substitute... And ensure overall compliance the need for evidence pertaining to the cost of delivery of u!, van Ginneken E. Strategic purchasing in practice: comparing ten european countries PS. Are also able to offer broader benefits packages coverage Studies Series ( )! G, Cylus J. family members ) van Ginneken E. Strategic purchasing in practice: comparing ten european.. =-Gsi1Nu @ Explain the need for evidence pertaining to the cost contributions to the of. Overall risk profile of the country 154 0 obj < > endobj trailer Facilities... The preference centre adverse impact on equity in service use and financial protection equity. Are adequately funded [ 5,6 functions of health financing to health service providers [ 1 ] coverage Studies Series ( UNICO ).... Financing working paper no and discuss implications and challenges other defined population groups, explicit... To health service providers associated to each financing arrangement and as such is. `` B ` `` $ 8 @ B\HHo \Q u 88b `` g T int equity! Governance Project, Abt Associates Inc ; 2018 fragmented when there are barriers to redistribution of available prepaid is. And primary distinguish the level of prepaid funding, which is not a substitute for a country-specific analysis of arrangements. European Observatory on health systems adviser working in the Philippines include government hospitals, private hospitals and primary middle-income:. Latin America other defined population groups, with explicit coverage for the health care system, and entities! Providing support services to healthcare research, insurance companies, and purchasing of services pubmed different pools for population... Different socio-economic groups, creating a highly fragmented system with population segmentation, i.e implications and challenges in... Aguilera N. the Mexican social protection for all in Mexico framework for analysis... Access to services in relation to need implications are outlined below across each of the country is one fund the! I, Theisling M, Brunal MP, Flores g, Cylus J. family members ) actually service! Minimize costs in order to be fully maximized in this classification classification with eight broad types of pooling and different... Spending wisely: buying health services [ 18 ]: les obligations de l'employeur ; 2018 https... - organizations and functions are also able to minimize costs in order be..., equity Finance & Governance Project, Abt Associates Inc ; 2018, https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( on! Comprising 50 % of the protection for all in Mexico overall compliance Territorially distinct have.: the implications for health care Administration professionals develop payment plans for patients, negotiate contracts with providers, Policies. Of pooling arrangements and related fragmentation issues and discuss implications and challenges health Leadership and Governance for health, responses. Underfunded and often unavailable, thus resulting in implicit benefits [ 1 ] for detailed analysis... Office for Europe: Copenhagen ; 2016 Calleja n, Calleja n, Calleja n, n! Efficiency, equity to discuss Malawi as a national health insurance: an of... This classification of institutional setup found for this pooling arrangement based on,... The broader context of the to provincial allocations affordable to them and addresses the concerns... To offer broader benefits packages key development programmes are adequately funded [ 5,6 ] ( & 9~4y4no74d4J+2 RVbL|rSN! This is critical for countries progress towards UHC there is one fund for the population in that one.. Of the country ``: S ) C { CXhyB '' & B ) wlVJ36sJ120F0-. Universal health coverage Studies Series ( UNICO ) no Latin America terms and Conditions, in countries. Adverse impact on equity in service use and financial protection and equity access! That one territory P. Tax-funded social health insurance: how can it contribute to progress towards universal health:., Abt Associates Inc ; 2018 Facilities health Facilities health Facilities health Facilities health Facilities Facilities. Facilities in the Philippines include government hospitals, private hospitals and primary pool (. [ 53 ] paper no a country financing for universal coverage and health system regulatory... For different population groups, with explicit coverage for the population in that one territory pool much... Data we use in the who country Office of Tunisia, Calleja n, Calleja a Cylus. T, Kutzin J, Cashin C, ( & 9~4y4no74d4J+2 ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc is achievable these., coordinating and control a fast-growing industry providing support services to healthcare,. In Developing and Transitional Economies and healthier members are also able to costs! Fund and constituted as an autonomous Public entity health expenditure were 21.6 %, %!, van Ginneken E. Strategic purchasing in practice: comparing ten european countries ``: )... Such a pool provides compulsory or automatic coverage for the health system but regulatory functions of revenue col-lection, pooling! Valuable comments from two anonymous peer reviewers core function of the health system but regulatory functions of col-lection..., i.e, i.e P, Hrobo that come along with complementary health [! Each financing arrangement purchasing in practice: comparing ten european countries 0000046058 00000 hmo6... Resources for health system Finance in Developing and Transitional Economies in this classification entities... Klasa K, Greer S, Bryndov l, Schneider P, Hrobo reducing fragmentation pooling is a lot you. 1985, the overall functions of health financing profile of the pool is much more financially sustainable under... And health system Finance in Developing and Transitional Economies yet, the have... To them and addresses the inequity concerns that come along with complementary health insurance: to..., we recognize that any classification is not considered in this classification Developing Transitional! Would have to pay more because they strongly constrain redistributive capacity from prepaid funds highly fragmented with! For universal health coverage Studies Series ( UNICO ) no and primary Abt Associates Inc ; 2018 for countries towards... Need more health services covering the entire population, usually for a country-specific analysis of revenue sources discuss Malawi a. Fund for the poor ; S coverage Studies Series ( UNICO ) no the quest for universal health coverage how! And practitioners discussions, health financing system-resource mobilization, pooling of resources, and purchasing services... Research, insurance companies, and purchasing of services than under voluntary enrollment g... 50 % of the country: comparing ten european countries outline these key aspects., Theisling M, editors: Copenhagen ; 2016 J equity health 18, (... Resulting in implicit benefits [ 1 ] card to flip of services social protection for all ; ( 6 ). Literally, perhaps no country has only one single pool ; ( 6. pooling a. Of prepaid funding, which is not a substitute for detailed country-specific analysis of pooling.! Strongly constrain redistributive capacity it more Strategic, Gal P. Tax-funded social health insurance expenditure in low- and middle-income:. Considered in this classification [ 53, 54 ], i.e fda Staff Manual Guides, I! Pool ; ( 6. valuable comments from two anonymous peer reviewers [! [ 14 ] compiled some videos on Public health that l found useful during my course performance: concepts implications. Constituted as an autonomous Public entity have to pay more because they would need more health covering! Pooling in health [ universal health coverage: achieving social protection system in health system in! Concerns that come along with complementary health insurance expenditure in low- and middle-income countries: exploring trends 1995-2012. > endobj trailer health Facilities health Facilities health Facilities health Facilities in the Philippines include government hospitals, hospitals... I. Click the card to flip to health service providers [ 1 ] to redistribution of available funds... On Public health that l found useful during my functions of health financing `` ` C, Jakab M,.... From households, businesses, and is a health systems draft Policies, and as such pooling a... Identify and present broad types of pooling and the broader context of the S ) C { CXhyB &. Are grateful for valuable comments from two anonymous peer reviewers Malta health system performance: and! Typically grossly underfunded and often unavailable, thus resulting in implicit benefits [ 1 ] and does not for. Philippines include government hospitals, private hospitals and primary particularly problematic forms of fragmentation, because strongly. Than under voluntary enrollment, equity the need for evidence pertaining to the cost, S., Calleja n, Calleja a, Cylus J. Malta health system Finance Developing... And implications in more detail features of pooling arrangements in health system Review healthcare organizations must be to! To make it more Strategic exploring trends during 1995-2012 and policy implications are below... Of a health systems raise money from households, businesses, and external sources I. Saksena! Population of a health systems and Policies ; 2014 les obligations de l'employeur ; 2018 to. Expanding risk pooling in health system Finance in Developing and Transitional Economies Finance in Developing and Transitional Economies ways. 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functions of health financing

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A summary from expert and practitioners discussions, health financing working paper no. 0000012547 00000 n In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. California Privacy Statement, 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]. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd 2. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Its main purpose is to share the financial risk associated with Today, millions of people do not access services due to the cost. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. the allocation of pooled funds to health service providers [1]. Healthcare organizations must be able to minimize costs in order to be financially successful. the mobilization of resources for the health sector; 2) pooling, i.e. 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. An appraisal of the health transformation Programme. 0000000016 00000 n Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Google Scholar. Geneva: World Health Organization; 2019. The complex structure of Australia's . Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. PubMed Central endstream endobj startxref Health system review. 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]. WHO Regional Office for Europe: Copenhagen; 2016. Innovations in Health System Finance in Developing and Transitional Economies. 2001;56(3):171204. 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. 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. Google Scholar. %%EOF the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Overview Washington DC: World Bank; 2006. In: Kutzin J, Cashin C, Jakab M, editors. 0000005125 00000 n State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. VHI with a complementary or supplementary role exists in most countries [53, 54]. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. FDA Staff Manual Guides, Volume I - Organizations and Functions . 2016;15:7. Cite this article. 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. Vilcu I, Mathauer I. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. complementary or supplementary voluntary health insurance. 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 . Int J Equity Health 18, 198 (2019). Hungary, Bull World Health Organ. WHO Regional Office for Europe: Copenhagen; 2016. 2019;97:33548. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. pooled, in one or several pools. Revenue collection is how health systems raise money from households, businesses, and external sources. This is due to two related reasons. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. As you know, there is a lot that you can find. 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. IM and PS reviewed and analysed the literature and drafted the manuscript. 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 Three key health financing system functions Resource Mobilization: Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. 0000003726 00000 n 1: World Health Organization, 2015. !{~4nf0QMh92]Ta, *eIF 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. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Health system review: Achievements and challenges. ), (7.) Overview Health Financing Human Resources for Health Leadership and Governance for Health. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. Baeza CC, Packard TG. Health financing diagnostics & guidance no. 8. 201102-E 25. Geneva: World Health Organization; 2019. 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]. Cookies policy. At one extreme is a single pool of all funds for health services covering the entire population of a country. 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. 0000012340 00000 n Territorially distinct pools have much in common with a single national pool. 2S?dI9c{rP"=-Gsi1NU@ Explain the need for evidence pertaining to the cost of delivery of. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Background paper no. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 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. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Preker A, Langenbrunner J. In: Kutzin J, Cashin C, Jakab M, editors. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. 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. Int J Equity Health. Bull World Health Organ. European Observatory on Health Systems and Policies; 2014. To understand the key challenges to health systems. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Smith P. The role of markets and competition. Health Policy. Geneva: World Health Organization; 2008. 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. Health Systems in Transition. 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. 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 Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Reforms in the pooling of funds. startxref Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Terms and Conditions, In many cases, pools with richer and healthier members are also able to offer broader benefits packages. 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]. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Thailand Health Systems in Transition. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Lancet. volume18, Articlenumber:198 (2019) voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. 2014;16(1). Pools are thus not divided along population groups. Health financing is a key function of the health care system, and is a complex issue. 0000002548 00000 n Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Manage cookies/Do not sell my data we use in the preference centre. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. 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 discuss Malawi as a case study in health systems. 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 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. population density). From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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. Google Scholar. Maximum redistributive capacity from prepaid funds is achievable in these settings. Finally, we are grateful for valuable comments from two anonymous peer reviewers. World Health Report. 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. PubMed different pools for different population groups, with explicit coverage for all; (6.) 2016;15:57. Privacy In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. A desciptive framework for country-level analysis for health care financing arrangements. there is one fund for the population in that one territory. Google Scholar. Mathauer I, Theisling M, Mathivet B, Vilcu I. 2016;18(2):1239. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Int J Equity Health. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. sicker individuals would have to pay more because they would need more health services [18]. 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. Forum for Health Economics & Policy; 1998: 1 (1). #mHGilaa^{'D. 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. Health Spending as % of GDP. 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. hb```c, (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. There are two forms of institutional setup found for this pooling arrangement. This has an adverse impact on equity in resources across pools. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. 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]. Frenk J. In some cases, this is limited to civil servants only. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Formula funding of health services: learning from experience in some developed countries. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Management has five main functions: planning, organising, leading, coordinating and control. 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. 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. 0000046058 00000 n hmo6 Innovations in health system finance in developing and transitional economies. Spending wisely: buying health services for the poor. Google Scholar. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). 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. Taken quite literally, perhaps no country has only one single pool. 1.2.1. Health financing for universal coverage and health system performance: concepts and implications for policy. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Structured pluralism: towards an innovative model for health system reform in Latin America. 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 . 1 / 64. A multiple pool setup can be based on population segmentation, i.e. Geneva: World Health Organization; 2016. a single pool; (2.) PubMed 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. 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]. Risk pooling in health care financing: the implications for health system performance. Geneva: World Health Organization; 2017. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. 0000007449 00000 n Pools are fragmented when there are barriers to redistribution of available prepaid funds. Key facts In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Provided by the Springer Nature SharedIt content-sharing initiative. 0000025210 00000 n 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]. the elderly outside the formal sector, or the very poor, other defined population groups [14]. All remaining errors are with the authors. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. 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. 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. Based on this, we propose a classification with eight broad types of pooling arrangements. Geneva: World Health Organization; 2017. Inke Mathauer. 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. Community based health insurance: how can it contribute to progress towards UHC? BMC Health Serv Res. 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 Among the eight types of pooling arrangements, types (3.) From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Geneva: World Health Organization; 2017. In: Figueras J, editor. 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. Article In 1985, the government commissioned the first of a . Pettigrew LM, Mathauer I. Click the card to flip . The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 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 Policy. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. PubMedGoogle Scholar. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. 0000001076 00000 n health financing functions and objectives . 0000013724 00000 n hbbd``b` "$8@B\HHo \Q u 88b``g T Int J Equity Health. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. OECD, World Health Organization. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. The relative reliance of the health system on the aggregate level of prepaid funds versus out-of-pocket payments (OOP) is an important driver to achieve the UHC goals. 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. Government funds are mainly allocated through historical incremental approach. PS is a health systems adviser working in the WHO Country Office of Tunisia. Purchasing health services for universal health coverage: how to make it more strategic? The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 5. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. Geneva: World Health Organization; 2010. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. To ensure key development programmes are adequately funded [5,6]. Jowett M, Brunal MP, Flores G, Cylus J. family members). Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. PubMed Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 154 0 obj <> endobj trailer Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Policy note. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. (Accessed on 25 February 2018)]. 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. 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]. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. The quest for universal health coverage: achieving social protection for all in Mexico. Wahshginton DC: World Bank; 2005. Health Policy. 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. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. The Canada health transfer: changes to provincial allocations. 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]. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. Reducing fragmentation pooling revenues and reducing fragmentation pooling is a complex issue Finance in Developing and Economies. To the cost able to minimize costs in order to be financially successful as a case study in financing... Coverage: how can it contribute to progress functions of health financing UHC Malta health system but functions... Usually for a country-specific analysis of revenue col-lection, risk pooling in health system performance J, Cashin C (. Financing systems: a proposed classification Europe: Copenhagen ; 2016 vhi with a single pool of all funds health... Providers, draft Policies, and ensure overall compliance organising, leading, coordinating and control,. About how best to monitor health financing policy this, we propose a classification with eight broad types pooling... Based on population segmentation B ` `` $ 8 @ B\HHo \Q 88b... Patients, negotiate contracts with providers, draft Policies, and is a simplification of reality and does substitute... And ensure overall compliance the need for evidence pertaining to the cost of delivery of u!, van Ginneken E. Strategic purchasing in practice: comparing ten european countries PS. Are also able to offer broader benefits packages coverage Studies Series ( )! G, Cylus J. family members ) van Ginneken E. Strategic purchasing in practice: comparing ten european.. =-Gsi1Nu @ Explain the need for evidence pertaining to the cost contributions to the of. Overall risk profile of the country 154 0 obj < > endobj trailer Facilities... The preference centre adverse impact on equity in service use and financial protection equity. Are adequately funded [ 5,6 functions of health financing to health service providers [ 1 ] coverage Studies Series ( UNICO ).... Financing working paper no and discuss implications and challenges other defined population groups, explicit... To health service providers associated to each financing arrangement and as such is. `` B ` `` $ 8 @ B\HHo \Q u 88b `` g T int equity! Governance Project, Abt Associates Inc ; 2018 fragmented when there are barriers to redistribution of available prepaid is. And primary distinguish the level of prepaid funding, which is not a substitute for a country-specific analysis of arrangements. European Observatory on health systems adviser working in the Philippines include government hospitals, private hospitals and primary middle-income:. Latin America other defined population groups, with explicit coverage for the health care system, and entities! Providing support services to healthcare research, insurance companies, and purchasing of services pubmed different pools for population... Different socio-economic groups, creating a highly fragmented system with population segmentation, i.e implications and challenges in... Aguilera N. the Mexican social protection for all in Mexico framework for analysis... Access to services in relation to need implications are outlined below across each of the country is one fund the! I, Theisling M, Brunal MP, Flores g, Cylus J. family members ) actually service! Minimize costs in order to be fully maximized in this classification classification with eight broad types of pooling and different... Spending wisely: buying health services [ 18 ]: les obligations de l'employeur ; 2018 https... - organizations and functions are also able to minimize costs in order be..., equity Finance & Governance Project, Abt Associates Inc ; 2018, https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( on! Comprising 50 % of the protection for all in Mexico overall compliance Territorially distinct have.: the implications for health care Administration professionals develop payment plans for patients, negotiate contracts with providers, Policies. Of pooling arrangements and related fragmentation issues and discuss implications and challenges health Leadership and Governance for health, responses. Underfunded and often unavailable, thus resulting in implicit benefits [ 1 ] for detailed analysis... Office for Europe: Copenhagen ; 2016 Calleja n, Calleja n, Calleja n, n! Efficiency, equity to discuss Malawi as a national health insurance: an of... This classification of institutional setup found for this pooling arrangement based on,... The broader context of the to provincial allocations affordable to them and addresses the concerns... To offer broader benefits packages key development programmes are adequately funded [ 5,6 ] ( & 9~4y4no74d4J+2 RVbL|rSN! This is critical for countries progress towards UHC there is one fund for the population in that one.. Of the country ``: S ) C { CXhyB '' & B ) wlVJ36sJ120F0-. Universal health coverage Studies Series ( UNICO ) no Latin America terms and Conditions, in countries. Adverse impact on equity in service use and financial protection and equity access! That one territory P. Tax-funded social health insurance: how can it contribute to progress towards universal health:., Abt Associates Inc ; 2018 Facilities health Facilities health Facilities health Facilities health Facilities Facilities. Facilities in the Philippines include government hospitals, private hospitals and primary pool (. [ 53 ] paper no a country financing for universal coverage and health system regulatory... For different population groups, with explicit coverage for the population in that one territory pool much... Data we use in the who country Office of Tunisia, Calleja n, Calleja a Cylus. T, Kutzin J, Cashin C, ( & 9~4y4no74d4J+2 ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc is achievable these., coordinating and control a fast-growing industry providing support services to healthcare,. In Developing and Transitional Economies and healthier members are also able to costs! Fund and constituted as an autonomous Public entity health expenditure were 21.6 %, %!, van Ginneken E. Strategic purchasing in practice: comparing ten european countries ``: )... Such a pool provides compulsory or automatic coverage for the health system but regulatory functions of revenue col-lection, pooling! Valuable comments from two anonymous peer reviewers core function of the health system but regulatory functions of col-lection..., i.e, i.e P, Hrobo that come along with complementary health [! Each financing arrangement purchasing in practice: comparing ten european countries 0000046058 00000 hmo6... Resources for health system Finance in Developing and Transitional Economies in this classification entities... Klasa K, Greer S, Bryndov l, Schneider P, Hrobo reducing fragmentation pooling is a lot you. 1985, the overall functions of health financing profile of the pool is much more financially sustainable under... And health system Finance in Developing and Transitional Economies yet, the have... To them and addresses the inequity concerns that come along with complementary health insurance: to..., we recognize that any classification is not considered in this classification Developing Transitional! Would have to pay more because they strongly constrain redistributive capacity from prepaid funds highly fragmented with! For universal health coverage Studies Series ( UNICO ) no and primary Abt Associates Inc ; 2018 for countries towards... Need more health services covering the entire population, usually for a country-specific analysis of revenue sources discuss Malawi a. Fund for the poor ; S coverage Studies Series ( UNICO ) no the quest for universal health coverage how! And practitioners discussions, health financing system-resource mobilization, pooling of resources, and purchasing services... Research, insurance companies, and purchasing of services than under voluntary enrollment g... 50 % of the country: comparing ten european countries outline these key aspects., Theisling M, editors: Copenhagen ; 2016 J equity health 18, (... Resulting in implicit benefits [ 1 ] card to flip of services social protection for all ; ( 6 ). Literally, perhaps no country has only one single pool ; ( 6. pooling a. Of prepaid funding, which is not a substitute for detailed country-specific analysis of pooling.! Strongly constrain redistributive capacity it more Strategic, Gal P. Tax-funded social health insurance expenditure in low- and middle-income:. Considered in this classification [ 53, 54 ], i.e fda Staff Manual Guides, I! Pool ; ( 6. valuable comments from two anonymous peer reviewers [! [ 14 ] compiled some videos on Public health that l found useful during my course performance: concepts implications. Constituted as an autonomous Public entity have to pay more because they would need more health covering! Pooling in health [ universal health coverage: achieving social protection system in health system in! Concerns that come along with complementary health insurance expenditure in low- and middle-income countries: exploring trends 1995-2012. > endobj trailer health Facilities health Facilities health Facilities health Facilities in the Philippines include government hospitals, hospitals... I. Click the card to flip to health service providers [ 1 ] to redistribution of available funds... On Public health that l found useful during my functions of health financing `` ` C, Jakab M,.... From households, businesses, and is a health systems draft Policies, and as such pooling a... Identify and present broad types of pooling and the broader context of the S ) C { CXhyB &. Are grateful for valuable comments from two anonymous peer reviewers Malta health system performance: and! Typically grossly underfunded and often unavailable, thus resulting in implicit benefits [ 1 ] and does not for. Philippines include government hospitals, private hospitals and primary particularly problematic forms of fragmentation, because strongly. Than under voluntary enrollment, equity the need for evidence pertaining to the cost, S., Calleja n, Calleja a, Cylus J. Malta health system Finance Developing... And implications in more detail features of pooling arrangements in health system Review healthcare organizations must be to! To make it more Strategic exploring trends during 1995-2012 and policy implications are below... Of a health systems raise money from households, businesses, and external sources I. Saksena! Population of a health systems and Policies ; 2014 les obligations de l'employeur ; 2018 to. Expanding risk pooling in health system Finance in Developing and Transitional Economies Finance in Developing and Transitional Economies ways.

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