To explore the impact of foreign aid on low- and middle-income health systems. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. 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. 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. Raising and channeling funds: Working Group 2 report, 2009. 2011;13(7):1190. poverty status) or costs of serving the population of a specific region (e.g. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 0000002097 00000 n Pools may be organized as territorially distinct. 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 . Baeza CC, Packard TG. 0000005327 00000 n In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Results The Kenyan health sector relies heavily on out-of-pocket payments. 2. 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. Sparkes S, Durn A, Kutzin J. the allocation of pooled funds to health service providers [ 1 ]. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. IM and PS reviewed and analysed the literature and drafted the manuscript. Correspondence to 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]. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. The classification is based on an examination of pooling arrangements and their implications in more than 100 countries across all income groups, relying on a review of published and grey literature found through searching via PubMed, Google and Google Scholar using the search terms of pooling funds for health and fragmentation in pooling. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 2019;97:33548. Part of Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. 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. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. (accessed 5 February 2019)]. 1). there must be a specific contribution made by or on behalf of the covered person. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Washington DC: World Bank; 2004. A system-wide approach to analysing efficiency across health programmes. Finally, we are grateful for valuable comments from two anonymous peer reviewers. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Explain the need for evidence pertaining to the cost of delivery of. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. 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. Geneva: World Health Organization; 2017. 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. Community based health insurance: how can it contribute to progress towards UHC? Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. endstream endobj startxref 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]. 0000006049 00000 n Paris: OECD; 2011. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. 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. As you know, there is a lot that you can find. 2013;91(8):60211. 192 0 obj<>stream Geneva: World Health Organization; 2017. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. 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 When people have access to publicly financed coverage schemes, this VHI is duplicating. U;c!=(i\s Article Health financing diagnostics & guidance no. Definition. Health Systems in Transition. As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. 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. Pools are thus not divided along population groups. Gautier J. The company has multiple offices in the U.S. and program offices in more than 40 countries. Int J Equity Health 18, 198 (2019). . In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. 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. What are the three main functions of health financing? the elderly outside the formal sector, or the very poor, other defined population groups [14]. Figure 3.1 highlights these. Health financing policy brief no. The Health Financing Specialist will be based in the Abt office in Antananarivo. Frenk J. 0000002300 00000 n 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. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. 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. Innovations in health system finance in developing and transitional economies. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. What are the types of health care financing? 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]. The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. Table1 outlines the respective features under each. European Observatory on Health Systems and Policies; 2014. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. 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. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. 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. PubMed Central Pettigrew LM, Mathauer I. The UCS pooled together all of those revenues plus increased budget allocations. and (7.) To ensure key development programmes are adequately funded [5,6]. PubMed 0 Its main purpose is to share the financial risk associated with Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. There are some countries that rely predominantly on a single national pool funded from general government revenues. Cuba, with a much larger population, also has this setup, as does Sri Lanka, where financial protection performance is relatively good despite a high share of OOP [29]. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. The purpose of pooling is to spread financial risk across the population so that no individual carries the full burden of paying for health care. 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]. 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]. 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. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. 2S?dI9c{rP"=-Gsi1NU@ The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 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. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Smith PC. Cutler DM, Zeckhauser RJ. 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. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. 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]. Among the eight types of pooling arrangements, types (3.) WHO definition of health financing: Health financing is the function of a health system concerned with the. startxref 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. Territorially distinct a lot that you can find funded from general government revenues large countries, as. Improving pooling depend on the specific nature and the broader context of the population ; and 3 ),! Equity of access to services in relation to need Ginneken E. strategic purchasing Making the purchasing of health financing health! 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