0000008166 00000 n The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. U;c!=(i\s Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 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]. Implementing health financing reform: lessons from countries in transition. PubMed Washington DC: World Bank; 2006. PS is a health systems adviser working in the WHO Country Office of Tunisia. 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. Thomson S. What role for voluntary health insurance? The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ 2007;83(23):16279. different pools for different population groups, with explicit coverage for all; (6.) 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. #mHGilaa^{'D. Health Systems in Transition. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. 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/. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Bingley: Emerald Group Publishing; 2009. p. 291312. 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]. 2016;15:57. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. 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. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. In doing so, policy makers can come closer . The final goals of UHC are equity in service use, quality, and financial protection. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. This is the so-called death spiral of voluntary health insurance [24]. 4. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. "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 arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Function. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd 0000013724 00000 n Int J Equity Health. 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 financing policy brief no. CAS As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. Community based health insurance: how can it contribute to progress towards UHC? However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. xref Background paper no. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. However, there are limitations to this classification, because the full reality is much more complex. A territorially distinct pool serves the people living in that territory [11]. Each of the insurance schemes thus constitutes a separate pooling agency. IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Spending targets for health: no magic number. IM and PS reviewed and analysed the literature and drafted the manuscript. . 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? 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. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 0000005327 00000 n Sparkes S, Durn A, Kutzin J. OECD, World Health Organization. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. territorially overlapping pools in terms of service and population coverage; (4.) Baeza CC, Packard TG. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 0000003726 00000 n Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Mathauer I, Mathivet B, Kutzin J. 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. Health financing - World Health Organization. Mathauer I, Kutzin J. A system-wide approach to analysing efficiency across health programmes. 0000080000 00000 n 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. The company has multiple offices in the U.S. and program offices in more than 40 countries. CAS 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. To cite variations across countries of different income levels. HGF guidance document no. Countries need to focus not on generic models but on. 6. and (7.) the allocation of pooled funds to health service providers [ 1 ]. But the key concern is that the existence of multiple pools implies fragmentation. 1997;41:136. It is possible to have competition across pools, i.e. 0000079954 00000 n 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]. 0000014993 00000 n 0000003940 00000 n Thailand is a prominent example for this pooling arrangement. Wahshginton DC: World Bank; 2005. In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. World Health Report 2010 Technical Brief Series - Technical Brief No. 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. 1995;32:25777. Today, millions of people do not access services due to the cost. Pettigrew LM, Mathauer I. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. Cite this article. -U+:V\GCs2C /L7w0X-O`>2h?! 8. Mathauer I, Dale E, Meessen B. 2012;380(9849):125979. Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . 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 As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Health financing for universal coverage and health system performance: concepts and implications for policy. 0000079977 00000 n there is one fund for the population in that one territory. Google Scholar. 2019;97:33548. 0000064650 00000 n Smith P. The role of markets and competition. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. To develop a health financing structure capable of addressing the challengesof the future. Hungary, Bull World Health Organ. Geneva: World Health Organization; 2017. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Spending wisely: buying health services for the poor. 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]. 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. Gottret P, Schieber G. A practitioners guide health financing revisited. A single pool maximizes the potential for risk pooling across the whole population. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. Also need to monitor cash on hand, businesses may be profitable have. Sector and vulnerable population groups: trends in institutional design in Asia funds arises how. 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functions of health financing