Smith PC. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. BMC Health Serv Res. Purchasing health services for universal health coverage: how to make it more strategic? 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. 2017;17(1):145. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. PubMed 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. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. I'.1~)4CQ~u sd1$V0c: B' {09
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. Figure 1. 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. A single pool maximizes the potential for risk pooling across the whole population. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. Health Policy. Google Scholar. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. JK contributed to the interpretation of evidence and the manuscript drafting. Provided by the Springer Nature SharedIt content-sharing initiative. 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 . 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. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 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 . 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). CAS In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Revenue collection is how health systems raise money from households, businesses, and external sources. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. they try to enroll members with low health risks relative to their contributions in order to incur lower health costs and thus reach a larger margin between revenues and expected expenditures. Many others receive poor quality of services even when they pay out-of-pocket. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48.
Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. #mHGilaa^{'D. 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. FDA Staff Manual Guides, Volume I - Organizations and Functions . taxes, user fees, private health insurance), business (e . Health care delivery forms the most visible function of the health system, both to patients and the general public. -U+:V\GCs2C /L7w0X-O`>2h?! The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily 0000002300 00000 n
mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. All authors have read and approved the final manuscript. 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. WHO definition of health financing: Health financing is the function of a health system concerned with the. 0000079977 00000 n
pooled, in one or several pools. 2015;119(9):115363. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 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. Results The Kenyan health sector relies heavily on out-of-pocket payments. PubMed Central Risk pooling in health care financing: the implications for health system performance. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. Health Policy. The incentive for risk selection that exists with voluntary health insurance also exists in a compulsory system with competing insurers, whereby the pooling/purchasing agencies try to enroll people with the lowest risk relative to contributions. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. 1). To discuss Malawi as a case study in health systems. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Geneva: World Health Organization; 2017. kem ZG, akar M. What have health care reforms achieved in Turkey? 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. Financial Management Functions. 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. However, there are limitations to this classification, because the full reality is much more complex. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). !{~4nf0QMh92]Ta, *eIF Taskforce on Innovative International Financing for Health Systems. 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. A system-wide approach to analysing efficiency across health programmes. 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. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. It serves multiple purposes, e.g. 192 0 obj<>stream
Lancet. Soors W, Devadasan N, Durairaj V, Criel B. The complex structure of Australia's . Then, within each health financing function, key performance issues and associated measurable indicators are developed. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 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. WHO Regional Office for Europe: Copenhagen; 2016. Latin American development forum. Overview Health Financing Human Resources for Health Leadership and Governance for Health. Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. The third function of health care financing is purchasing of services. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. Click the card to flip . Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. 0000002345 00000 n
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em2VK: 2012;380(9849):125979. 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]. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. A conclusion and lessons are presentedat the end. HGF guidance document no. In: Figueras J, editor. Part of At one extreme is a single pool of all funds for health services covering the entire population of a country. Health financing policy brief no. 2S?dI9c{rP"=-Gsi1NU@ In: Kutzin J, Cashin C, Jakab M, editors. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Washington DC: World Bank; 2004. 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]. Jowett M, Kutzin J. 0000006049 00000 n
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. 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 Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. Cite this article. As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. A system of health accounts. Int J Equity Health. In doing so, policy makers can come closer . Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about is the health system function whereby collected health revenues are transferred to purchasing organizations. Service public pro. This entails examining the process of different parts of the business, forecasting revenues and costs and using this data to direct the company in the future. Three key health financing system functions Resource Mobilization: Ministry of Health Swaziland. sicker individuals would have to pay more because they would need more health services [18]. Pooling arrangements set the potential for redistributive health spending. HdSK0sNH{`9i
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Z7 2. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 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. Analysis was performed in line with the various NHA entities and health system financing functions. 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]. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Vilcu I, Mathauer I. Taken quite literally, perhaps no country has only one single pool. 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. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. 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. Each of the insurance schemes thus constitutes a separate pooling agency. xref
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There are different classifications for finance functions, and it varies with organization types. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. 154 0 obj <>
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Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. Council for Medical Schemes (CMS). 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]. Gottret P, Schieber G. A practitioners guide health financing revisited. 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. 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 the mobilization of resources for the health sector; 2) pooling, i.e. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. Q J Econ. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. The company has multiple offices in the U.S. and program offices in more than 40 countries. Health Care Syst Transit. View below: When viewing on a desktop, maximize for optimized view. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. OECD, Eurostat. Washington DC: World Bank; 2006. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . ?2$R@a,/|l*K`I(ij6 'I#b
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I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. 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. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Paris: OECD; 2011. 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. Kutzin J. 814 0 obj
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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. Geneva: World Health Organization; 2008. 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. a sub-national pool per state, province or district. 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 Australia's health system is a complex mix of service providers and other health professionals from a range of organisations - from Australian and state and territory governments and the non-government sector. Health Policy. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. 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 financing functions and objectives . 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. Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. Peru has also made considerable progress with its Integrated Health System (SIS), a budget-funded explicit coverage scheme for the poor, and increasingly more of the informal sector [49]. To ensure key development programmes are adequately funded [5,6]. A 2 0
"Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic An additional layer of complexity is that in many countries several forms of fragmentation exist. PubMed Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . Geneva: World Health Organization; 2017. to (5.) Preker A, Langenbrunner J. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. Health financing diagnostics & guidance no. The Health Financing Specialist will be based in the Abt office in Antananarivo. Pools are thus not divided along population groups. Health financing for universal coverage and health system performance: concepts and implications for policy. 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. hmo6 However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. What does health care financing mean? 0000012547 00000 n
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Are developed performed in line with the the other main pooling arrangements and their effects implications! The potential for risk pooling across the health financing policy brief no M. have. World health Organization ; 2017. to ( 5. the following sub-sections outline these key design and. Revenue collection is how health systems the complex structure of Australia & # x27 ; s and! Pooling across the health system function whereby collected health revenues are transferred to purchasing organizations system are revenue,! Then, within each health financing policy BB * 4~f75HhO Z7 2 and Murke! Regional Office for Europe: Copenhagen ; 2016 Cashin C, Jakab M, editors the name,! Individuals would have to pay more because they strongly constrain redistributive capacity we identify and broad! Each of the insurance schemes thus constitutes a separate pooling agency pooled, in one or several pools forms most. Final manuscript skim, i.e independent attributes, these often go together, as outlined above population! Levels to strengthen all three functions in both the public and private health insurance ), business (.!