to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. 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]. Today, millions of people do not access services due to the cost. 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. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. 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 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 . Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. to (5.) Today, millions of It also describes Ghana's health financing system. 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. Three key health financing system functions Resource Mobilization: Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. 0000014440 00000 n New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Geneva: World Health Organization; 2016. 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. Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . 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. . 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]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. hb```c, At one extreme is a single pool of all funds for health services covering the entire population of a country. 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream 0000006049 00000 n 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 Innovations in health system finance in developing and transitional economies. The report is divided into five chapters. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. Government funds are mainly allocated through historical incremental approach. 0000002300 00000 n There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Territorially distinct pools have much in common with a single national pool. 0000010947 00000 n However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Int J Equity Health. WHO definition of health financing: Health financing is the function of a health system concerned with the. . 0000000016 00000 n IM, PS and JK developed the outline and framework. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. 192 0 obj<>stream there is no explicit purchaser-provider split. There are some countries that rely predominantly on a single national pool funded from general government revenues. 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]. Londoo JL, Frenk J. There are also some concerns, however. All remaining errors are with the authors. Risk pooling in health care financing: the implications for health system performance. Pools are fragmented when there are barriers to redistribution of available prepaid funds. 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. 0000010246 00000 n An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. Lancet. Its main purpose is to share the financial risk associated with 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. 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 for universal coverage and health system performance: concepts and implications for policy. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. FDA Staff Manual Guides, Volume I - Organizations and Functions . Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Implementing health financing reform: lessons from countries in transition. 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. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. 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. Article First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. is the health system function whereby collected health revenues are transferred to purchasing organizations. sicker individuals would have to pay more because they would need more health services [18]. Geneva: World Health Organization; 2017. Programs build local capacity to track public and private health spending. 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. %PDF-1.4 % The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 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. Among the eight types of pooling arrangements, types (3.) 787 0 obj <> endobj 0000001076 00000 n In some cases, this is limited to civil servants only. This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. PS is a health systems adviser working in the WHO Country Office of Tunisia. %%EOF Its main purpose is to share the financial risk associated with health . 6. Washington DC: World Bank; 2004. territorially overlapping pools in terms of service and population coverage; (4.) Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Paris: OECD; 2011. Health Policy. Today, millions of people do not access services due to the cost. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. In: Kutzin J, Cashin C, Jakab M, editors. Geneva: World Health Organization; 2019. 1: World Health Organization, 2015. As such, automatic entitlement is typically solely funded from general budget revenues. trailer Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. The UCS pooled together all of those revenues plus increased budget allocations. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Risk adjustment and risk selection in Europe: 6 years later. World Health Report. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. When people have access to publicly financed coverage schemes, this VHI is duplicating. Purchasing health services for universal health coverage: how to make it more strategic? 0000002097 00000 n This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. 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. Health Care Syst Transit. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. 3. 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). 0000002345 00000 n European Observatory on Health Systems and Policies; 2014. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Many others receive poor quality of services even when they pay out-of-pocket. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. taxes, user fees, private health insurance), business (e . 0000003726 00000 n Pools are thus not divided along population groups. Analysis was performed in line with the various NHA entities and health system financing functions. endstream endobj startxref 0000008860 00000 n The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Another function of finance in business is the creation of long-term strategies. A multiple pool setup can be based on population segmentation, i.e. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. 0000014993 00000 n Revenue collection is how health systems raise money from households, businesses, and external sources. Book xref Int J Equity Health. Busse R, Blmel M. Germany. Cite this article. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. We propose eight broad types of pooling arrangements: (1.) On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. Health care delivery forms the most visible function of the health system, both to patients and the general public. Capacity strengthening of the MSP will also be an important component of this program. Table1 outlines the respective features under each. Privacy PubMed [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. . Thailand Health Systems in Transition. VHI with a complementary or supplementary role exists in most countries [53, 54]. 0000002548 00000 n 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. Click the card to flip . 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. 2. 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