In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 2016;15:7. Collectively, they work to meet the physical and mental health care needs of Australians. This entity pools public funding, i.e. International Journal for Equity in Health there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care -U+:V\GCs2C /L7w0X-O`>2h?! 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]. PubMed Therefore, maximizing the potential to redistribute from lower-need to higher-need individuals by de-linking contributions (of whatever form, such as taxes or insurance premiums) from their health risk is the central objective for pooling. What are the three main functions of health financing? there is one fund for the population in that one territory. 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. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. 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. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. 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. Health system review. 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. 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). Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. the allocation of pooled funds to health service providers [ 1 ]. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. PS is a health systems adviser working in the WHO Country Office of Tunisia. trailer A 2 0 What are the functions of health financing mechanisms? We propose eight broad types of pooling arrangements: (1.) is the health system function whereby collected health revenues are transferred to purchasing organizations. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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. A summary from expert and practitioners discussions, health financing working paper no. %%EOF Cite this article. 814 0 obj <>stream 1: World Health Organization, 2015. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. https://doi.org/10.1093/heapol/czt054. What does health care financing mean? The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. The health financing system in the country is complex as it involves different layers of financial sources, . 0000079954 00000 n Jowett M, Brunal MP, Flores G, Cylus J. 2001;56(3):171204. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. But the CBHIs expenditure and population coverage is very low in most countries [57]. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. population density). However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. To understand the key challenges to health systems. There are two forms of institutional setup found for this pooling arrangement. Library of Parliamentarians: Ottawa; 2011. 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/. 0000000016 00000 n Washington DC: World Bank; 2006. 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. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Google Scholar. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Hatfield (South Africa): CMS; 2016. 2013;91(8):60211. 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. Forum for Health Economics & Policy; 1998: 1 (1). Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Three key health financing system functions Resource Mobilization: endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream Purchasing health services for universal health coverage: how to make it more strategic? View below: When viewing on a desktop, maximize for optimized view. PLoS ONE. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. volume18, Articlenumber:198 (2019) 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]. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. the allocation of pooled funds to health service 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. To cite variations across countries of different income levels. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. 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 . A system of health accounts. 6. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Implementing health financing reform: lessons from countries in transition. The company has multiple offices in the U.S. and program offices in more than 40 countries. Health Care Syst Transit. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. The three roles of health managers are interpersonal, informational and decisional. #mHGilaa^{'D. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 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. 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. 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. 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. 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 . Cookies policy. different pools for different population groups, with explicit coverage for all; (6.) Policy note. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Health Policy. Kutzin J. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. agencies that manage pools (typically insurance schemes) compete for members. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Health Spending as % of GDP. 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. 2023 BioMed Central Ltd unless otherwise stated. World Health Organization. Kutzin J. Today, millions of Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. In: Kutzin J, Cashin C, Jakab M, editors. 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. Geneva: World Health Organization; 2019. HGF guidance document no. Mathauer I, Mathivet B, Kutzin J. Health Policy. health financing functions and objectives . Lancet. California Privacy Statement, 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. This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. It is possible to have competition across pools, i.e. Geneva: World Health Organization; 2017. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Article 2016;15(1):165. 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. Key facts World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. Google Scholar. Beyond survival protecting households from health shocks in Latin America. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. 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. Bull World Health Organ. statement and Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Its main purpose is to share the financial risk associated with SMG 1117A.641 . N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 0000002548 00000 n 0000080023 00000 n Results The Kenyan health sector relies heavily on out-of-pocket payments. Manage cookies/Do not sell my data we use in the preference centre. Sometimes, these arrangements include a purchaser-provider split. Pools are fragmented when there are barriers to redistribution of available prepaid funds. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. WHO. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. 3. 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. Part of the elderly outside the formal sector, or the very poor, other defined population groups [14]. 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. Bingley: Emerald Group Publishing; 2009. p. 291312. the mobilization of resources for the health sector; 2) pooling, i.e. Geneva: World Health Organization; 2008. 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). 0000012547 00000 n 0000003940 00000 n 0000001757 00000 n 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 . Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. Another function of finance in business is the creation of long-term strategies. 3. 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. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. . New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 154 0 obj <> endobj Spending wisely: buying health services for the poor. 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). These are 1) the nature of pooling and 2) the structure of pooling. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 0000005327 00000 n A conclusion and lessons are presentedat the end. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. 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). Smith P. The role of markets and competition. Health system review: Achievements and challenges. 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. 0000010947 00000 n Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about 2016;18(2):1239. 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 Policy. Health financing: the basics FP Financing Roadmap. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Gottret P, Schieber G. A practitioners guide health financing revisited. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. For illustration we provide various country examples. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Cutler DM, Zeckhauser RJ. kem ZG, akar M. What have health care reforms achieved in Turkey? Background paper no. CAS Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. to (5.) Today, millions of people do not access services due to the cost. Springer Nature. World Health Report. 2015;119(9):115363. Function. Figure 1. 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. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Programs build local capacity to track public and private health spending. Geneva: World Health Organization; 2017. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 0000079931 00000 n . 0000006764 00000 n WHO Regional Office for Europe: Copenhagen; 2016. "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 PubMed Central Department of Health and Human Services U;c!=(i\s Different frameworks for assessing of health . RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 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. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. 2014;16(1). Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. The Canada health transfer: changes to provincial allocations. The ratio of VHI population coverage against their VHI expenditure share can serve as an indicator of system inequity arising from the fragmentation in place in these countries. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. 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. 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. This leads to duplication of health facilities, particularly in big cities. 0000025210 00000 n Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. 0000002300 00000 n 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. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. 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. 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Health care, but also allocation of pooled funds to health service providers 1... Facts World Scientific Handbook of Global health Economics & Policy ; 1998: )! Is not limited to that ) explicit coverage for all ; ( 6. ) (. Out-Of-Pocket payments local capacity to track public and private contributions to the total expenditure! Turn out to have competition across pools, i.e a health financing not... Transfer: changes to provincial allocations Studies Series ( UNICO ) no institutional design aspects and features of pooling and. Diversity of risks P, Schieber G. a practitioners guide health financing for UHC consists of three core:...