Risk pooling in health care financing: the implications for health system performance. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 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]. 0000005327 00000 n
basic functions, together with the basic health system objectives they aredesigned to achieve. territorially distinct pools; (3.) World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 8. Cookies policy. Moreover, in France, there is a shift towards compulsory complementary coverage, which employers have to buy for their employees since 2016 (with exceptions for various employee groups) [56]. In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Wahshginton DC: World Bank; 2005. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. 0
2014;29:71731. Sparkes S, Durn A, Kutzin J. International Journal for Equity in Health lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Health system review: Achievements and challenges. However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. Mathauer I, Kutzin J. 0000079977 00000 n
Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. trailer
Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. 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 Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Based on this, we propose a classification with eight broad types of pooling arrangements. 6. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Many others receive poor quality of services even when they pay out-of-pocket. Click the card to flip . 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. The authors declare they have no competing interests. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Higher income persons are usually more likely to have this form of VHI [51]. 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. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Innovations in health system finance in developing and transitional economies. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. To discuss Malawi as a case study in health systems. Second, fragmentation can weaken the potential gains from using purchasing as an instrument to influence provider behavior in countries where multiple purchasers use different payment methods and rates to pay the same providers in an uncoordinated way. 0000079954 00000 n
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the allocation of pooled funds to health service providers [ 1 ]. Int J Equity Health 18, 198 (2019). PubMed Central Smith P. The role of markets and competition. Google Scholar. Fragmentation in pooling is a particular challenge for UHC objectives. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. xb```l hp`d,u){i7NY~GOC]TkT}
h$*M^ixD#UNm| National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. . 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. Google Scholar. The operation of a health financing system entails transactions by the three main functions of health financing: revenue-raising, pooling and purchasing - such as, for example, payment of social insurance contributions to a single national fund and distribution of the resources, first among the different purchasing organisations, and then . 0000000016 00000 n
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. BMC Health Serv Res. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Today, millions of people do not access services due to the cost. 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. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. 192 0 obj<>stream
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co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. 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. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. 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. 2019, 5/393(10166):75102. 0000002345 00000 n
As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. SMG 1117A.641 (02/09/2022) 1 . Health financing - World Health Organization. 0000010947 00000 n
Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. Book PubMed Central Lancet. 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. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Thailand Health Systems in Transition. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. 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. management and disbursement for financing the availment of a basic minimum package and other . Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Cutler DM, Zeckhauser RJ. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. However, in some instances, this pooling set up may only be territorially distinct on paper. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Frenk J. 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. Function. Google Scholar. Definition. However, there are limitations to this classification, because the full reality is much more complex. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. 0000002300 00000 n
Akerlof GA. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. When people have access to publicly financed coverage schemes, this VHI is duplicating. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. Automatic participation is typically based on legal or constitutional obligations, and the basis for entitlement is non-contributory, deriving from citizenship, residence or other factors such as poverty status, etc. Google Scholar. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. hbbd``b` "$8@B\HHo \Q u 88b``g T
Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. Gautier J. An appraisal of the health transformation Programme. Innovations in Health System Finance in Developing and Transitional Economies. Many others receive poor quality of services even when they pay out-of-pocket. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Each of the insurance schemes thus constitutes a separate pooling agency. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. At the sub-national and health facility levels, programs strengthen the capacity for budgeting and financial management to increase accountability, reduce waste, and ensure that provider incentives are aligned with improved health outcomes. OECD reviews of health systems: Switzerland 2011. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Download and easily browse by indicator:Health Financing Indicators Reference Sheets This can take many forms with different implications and challenges, as outlined below. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. This is commonly referred to as a competitive social health insurance arrangement. 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. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. PubMed In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Community based health insurance: how can it contribute to progress towards UHC? The Canada health transfer: changes to provincial allocations. Health Systems in Transition. Lancet. N4
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^`^^ AHjX FqtHI(@[10*i. population density). For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. 2011;13(7):1190. 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. In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). voluntary health insurance). Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 0000006049 00000 n
Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. 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]. Mathauer I, Dale E, Meessen B. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. Library of Parliamentarians: Ottawa; 2011. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. ?2$R@a,/|l*K`I(ij6 'I#b
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Q J Econ. CAS What are the four major services and healthcare? 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. World Health Organization. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. Washington DC: World Bank; 2004. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. Article Health (Just Now) WebHealth financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. A system of health accounts. Terms and Conditions, For any given level of prepaid funds in a health system, the specific features in these two key design aspects determine the redistributive capacity of those funds to support access to needed services with financial protection, and they have important implications for efficiency. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. This is the so-called death spiral of voluntary health insurance [24]. Geneva: World Health Organization; 2017. 814 0 obj
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Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. Preker A, Langenbrunner J. In: Chernichovsky D, Hanson K, editors. 2. 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. Jowett M, Kutzin J. 0000080000 00000 n
IM and PS reviewed and analysed the literature and drafted the manuscript. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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]. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. There are different classifications for finance functions, and it varies with organization types. 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 . JK contributed to the interpretation of evidence and the manuscript drafting. We propose eight broad types of pooling arrangements: (1.) Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Instead, they usually follow a countrys territorial structure, i.e. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. Figure 1. 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 2016;15:67. 0000013724 00000 n
World Health Organization. Paris: OECD; 2011. By Jonas May 13, 2021 5min read 4233 views. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. The complex structure of Australia's . %PDF-1.4
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Background paper no. Figure 3.1 highlights these. PubMed 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 . 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). Health financing refers to the function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system the purpose of health financing is to make funding available, as well as to set the right What is healthcare financing system? Health Policy. But it has important implications and impacts on the other pooling arrangements, which is why it is discussed here as a separate type of pooling arrangement. 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. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 0000002191 00000 n
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Article a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Council for Medical Schemes (CMS). 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. HGF guidance document no. 3. 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. To ensure key development programmes are adequately funded [5,6]. Taskforce on Innovative International Financing for Health Systems. There are two forms of institutional setup found for this pooling arrangement. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Health care delivery forms the most visible function of the health system, both to patients and the general public. Figure 1. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 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