Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. 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. Sometimes, these arrangements include a purchaser-provider split. 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. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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 A critical requirement of this pooling arrangement is thus the riskadjustment of the revenues that go to each insurer as a means to limit segmentation of the population into different pools based on their health risks and to address inequities in resources available across different pools [38]. World Health Organization. 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. To develop a health financing structure capable of addressing the challengesof the future. 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. 0000007449 00000 n 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. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. Washington DC: World Bank; 2004. 0000002345 00000 n The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. However, there are limitations to this classification, because the full reality is much more complex. 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 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. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 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. HGF guidance document no. It has important similarities with the (2.) (accessed 5 February 2019)]. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Community based health insurance: how can it contribute to progress towards UHC? In: Chernichovsky D, Hanson K, editors. 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. 2011;13(7):1190. In: Chernichovsky D, Hanson K, editors. Advances in health economics and health services research, volume 21. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Health Policy. The Health Financing Specialist will be based in the Abt office in Antananarivo. Spending wisely: buying health services for the poor. Article territorially overlapping pools in terms of service and population coverage; (4.) In course two, students will learn how to conduct a health impact assessment and how to assess the impacts of policies, plans and projects, as well as how that support decision-makers make choices regarding alternatives and improvements to prevent disease or injury and to actively promote health. Londoo JL, Frenk J. Geneva: World Health Organization; 2017. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Lancet. As such, automatic entitlement is typically solely funded from general budget revenues. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Cutler DM, Zeckhauser RJ. 0000005227 00000 n To cite variations across countries of different income levels. Library of Parliamentarians: Ottawa; 2011. Geneva: World Health Organization; 2008. 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]. 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. 787 0 obj <> endobj Its main purpose is to share the financial risk associated with health . 0000006049 00000 n Geneva: World Health Organization; 2019. there is no explicit purchaser-provider split. 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). Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. Health Spending as % of GDP. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. "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). What are the functions of health financing mechanisms? Thomson S. What role for voluntary health insurance? European Observatory on Health Systems and Policies; 2014. 2018;11(11). There are some countries that rely predominantly on a single national pool funded from general government revenues. 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. territorially distinct pools; (3.) Manage cookies/Do not sell my data we use in the preference centre. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Springer Nature. Health Systems in Transition. hbbd``b` "$8@B\HHo \Q u 88b``g T It also describes Ghana's health financing system. 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. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 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. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. 0000013724 00000 n Vilcu I, Mathauer I. the mobilization of resources for the health sector; 2) pooling, i.e. 2019;97:33548. 0000003940 00000 n Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 2016;18(2):1239. World Health Organization. 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]. 4. %%EOF 0000074834 00000 n To understand the components of a health system. 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. Implementing health financing reform: lessons from countries in transition. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. World Health Report 2010 Technical Brief Series - Technical Brief No. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. <]>> hmo6 Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Gottret P, Schieber G. A practitioners guide health financing revisited. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). 2018;122:45772. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Three key health financing system functions Resource Mobilization: Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. A multiple pool setup can be based on population segmentation, i.e. Structured pluralism: towards an innovative model for health system reform in Latin America. To understand the key challenges to health systems. 0000003726 00000 n 0000079977 00000 n Fragmentation in pooling is a particular challenge for UHC objectives. 0000010246 00000 n Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. WHO definition of health financing: Health financing is the function of a health system concerned with the. Pools can be based on compulsory, automaticor voluntary participation. Mathauer I, Mathivet B, Kutzin J. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Geneva: World Health Organization; 2010. Heal Policy Plan. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Geneva: World Health Organization; 2017. 0000080000 00000 n Capacity strengthening of the MSP will also be an important component of this program. Background paper no. This module includes the indicators on health financing from the compendium of indicators for projects supporting health financing, human resources, and governance developed by the HFG project. There are two forms of institutional setup found for this pooling arrangement. Forum for Health Economics & Policy; 1998: 1 (1). PubMed (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Mathauer I, Theisling M, Mathivet B, Vilcu I. statement and Click the card to flip . Health care delivery forms the most visible function of the health system, both to patients and the general public. 0000011158 00000 n arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. startxref #mHGilaa^{'D. PS is a health systems adviser working in the WHO Country Office of Tunisia. Article 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 1997;41:136. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Int J Equity Health. The three roles of health managers are interpersonal, informational and decisional. Its main purpose is to share the financial risk associated with Risk adjustment and risk selection in Europe: 6 years later. Google Scholar. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. Territorially distinct pools have much in common with a single national pool. 0000005327 00000 n 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. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Preker A, Langenbrunner J. 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. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. 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. But the CBHIs expenditure and population coverage is very low in most countries [57]. World Health Report. As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream Among the eight types of pooling arrangements, types (3.) Taskforce on Innovative International Financing for Health Systems. Agency's Mandate and Functions Mandate. 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. Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. family members). 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. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. the allocation of pooled funds to health service providers [1]. the allocation of pooled funds to health service Even though small businesses do not have a separate finance department . It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. Health financing refers to the "function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system the purpose of health financing is to make funding available, as well as to set the right. 0000079954 00000 n Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . 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. Health system review. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. All remaining errors are with the authors. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. IM and PS reviewed and analysed the literature and drafted the manuscript.
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