Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 5. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Mathauer I, Kutzin J. Health Financing in Ghana. Government funds are mainly allocated through historical incremental approach. 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]. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. 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. Bull World Health Organ. There are some countries that rely predominantly on a single national pool funded from general government revenues. The Health Financing Specialist will be based in the Abt office in Antananarivo. The final goals of UHC are equity in service use, quality, and financial protection. 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. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 192 0 obj<>stream 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 OECD, Eurostat. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. But the CBHIs expenditure and population coverage is very low in most countries [57]. Geneva: World Health Organization; 2019. Risk pooling in health care financing: the implications for health system performance. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. taxes, user fees, private health insurance), business (e . This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. %PDF-1.5 % 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. different pools for different socio-economic groups with population segmentation; (5.) Health financing policy brief no. 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. Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. Instead, they usually follow a countrys territorial structure, i.e. 0000014440 00000 n Thomson S. What role for voluntary health insurance? 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. sicker individuals would have to pay more because they would need more health services [18]. Its main purpose is to share the financial risk associated with health . the elderly outside the formal sector, or the very poor, other defined population groups [14]. Washington DC: World Bank; 2006. 0000074834 00000 n 0000080000 00000 n Health Policy. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 0000009066 00000 n Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Its main purpose is to share the financial risk associated with fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) In: Chernichovsky D, Hanson K, editors. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. hb```c, Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. agencies that manage pools (typically insurance schemes) compete for members. Figure 3.1 highlights these. Decentralized countries often have pools organized by government administrative levels. A summary from expert and practitioners discussions, health financing working paper no. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Lancet. 0000000016 00000 n But the key concern is that the existence of multiple pools implies 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]. Agency's Mandate and Functions Mandate. territorially distinct pools; (3.) In any country, prepaid health revenues may be held, 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. 3. 'p 6l3/%J To understand the components of a health system. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 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. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. 3. Cookies policy. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. A desciptive framework for country-level analysis for health care financing arrangements. 1970;84(3):488500. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! 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. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. . Geneva: World Health Organization; 2017. 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]. 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]. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. 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]. The report is divided into five chapters. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Rather it is a first attempt at a classification, which could encourage further useful work from others. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Google Scholar. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. Different frameworks for assessing of health . 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. SMG 1117A.641 . 2011;13(7):1190. 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]. Washington DC: World Bank; 2004. It also describes Ghana's health financing system. It is possible to have competition across pools, i.e. IM, PS and JK developed the outline and framework. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Terms and Conditions, co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. 0000003726 00000 n Overview OECD, World Health Organization. 154 39 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. The classification is presented in Fig. voluntary health insurance). 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. Thailand is a prominent example for this pooling arrangement. Health Policy. 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]. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. 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. Heal Policy Plan. 0000025210 00000 n 4. 2. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. 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 In course two, students will learn how to conduct a health impact assessment and how to assess the impacts of policies, plans and projects, as well as how that support decision-makers make choices regarding alternatives and improvements to prevent disease or injury and to actively promote health. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. 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. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. WHO Regional Office for Europe: Copenhagen; 2016. FDA Staff Manual Guides, Volume I - Organizations and Functions . Advances in health economics and health services research, volume 21. World Health Organization. Health Systems in Transition. 0000005227 00000 n The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. I'.1~)4CQ~u sd1$V0c: B' {09 endstream endobj startxref 2012;380(9849):125979. Gautier J. 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. Health Policy. A multiple pool setup can be based on population segmentation, i.e. Washington DC: World Bank; 2006. Geneva: World Health Organization; 2010. 0000001076 00000 n Health financing is a key function of the health care system, and is a complex issue. 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. Figure 1. Results The Kenyan health sector relies heavily on out-of-pocket payments. 0000046058 00000 n The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. It serves multiple purposes, e.g. Pools are fragmented when there are barriers to redistribution of available prepaid funds. 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. Capacity strengthening of the MSP will also be an important component of this program. 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. These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. 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. Vilcu I, Probst L, Dorjsuren B, Mathauer I. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. complementary or supplementary voluntary health insurance. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Financial Management Functions. Health Spending as % of GDP. Q J Econ. All authors have read and approved the final manuscript. 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). Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Ministry of Health Swaziland. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Springer Nature. Hatfield (South Africa): CMS; 2016. Department of Health and Human Services Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. Taskforce on Innovative International Financing for Health Systems. Innovations in Health System Finance in Developing and Transitional Economies. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? 0000003940 00000 n 5. 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. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. 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 PubMed Then, within each health financing function, key performance issues and associated measurable indicators are developed. Separate purchasing and service provision arrangements summary from expert and practitioners discussions, health financing has three key of. Such pooling setups create explicitly unequal financing arrangements and contribute to identifying policy options to address fragmentation mitigate. 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