OECD, Eurostat. population density). 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. A system of health accounts. 2018;11(11). 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 elderly outside the formal sector, or the very poor, other defined population groups [14]. #mHGilaa^{'D. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 2001;56(3):171204. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. Thailand Health Systems in Transition. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Spending targets for health: no magic number. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . family members). People who have higher risks are just as covered as people who have lower risks. Article 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. 1.2.1. 3. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. 4. Government funds are mainly allocated through historical incremental approach. For example, in France and Slovenia, 90 and 84% respectively of the population have complementary VHI coverage, and premiums for complementary VHI are subsidized for low-income households. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. To develop a health financing structure capable of addressing the challengesof the future. Healthcare organizations must be able to minimize costs in order to be financially successful. . In: Kutzin J, Cashin C, Jakab M, editors. Article 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. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. Pools can be based on compulsory, automaticor voluntary participation. Londoo JL, Frenk J. Taskforce on Innovative International Financing for Health Systems. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Definition. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Manage cookies/Do not sell my data we use in the preference centre. 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]. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Health Systems in Transition. Countries need to focus not on generic models but on. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Int J Equity Health. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. What are the three main functions of health financing? Int J Equity Health. 0000010246 00000 n
Download and easily browse by indicator:Health Financing Indicators Reference Sheets Bingley: Emerald Group Publishing; 2009. p. 291312. Health financing involves not only methods of raising money for health care, but also allocation of those funds. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? The report is divided into five chapters. What does health care financing mean? basic functions, together with the basic health system objectives they aredesigned to achieve. Health Spending as % of GDP. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. Google Scholar. 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]. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). IM, PS and JK developed the outline and framework. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 0000001757 00000 n
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We propose eight broad types of pooling arrangements: (1.) the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. there is one fund for the population in that one territory. the allocation of pooled funds to health service endstream
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WHO Regional Office for Europe: Copenhagen; 2016. 1997;41:136. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. The Health Financing Specialist will be based in the Abt office in Antananarivo. 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]. 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? 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. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. xref
Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). 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. As such, automatic entitlement is typically solely funded from general budget revenues. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. 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. 2018;122:45772. Preker A, Langenbrunner J. 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]. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 0
World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 0000035307 00000 n
Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. It is possible to have competition across pools, i.e. In: Kutzin J, Cashin C, Jakab M, editors. 0000014440 00000 n
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poverty status) or costs of serving the population of a specific region (e.g. What are the functions of health financing mechanisms? Vilcu I, Probst L, Dorjsuren B, Mathauer I. Google Scholar. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Figure 3.1 highlights these. Today, millions of Self-paced (approximately 6 hours of course time) Click to enter this course Hungary, Bull World Health Organ. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. An appraisal of the health transformation Programme. 814 0 obj
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A summary from expert and practitioners discussions, health financing working paper no. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. 0000079977 00000 n
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. 154 39
Washington DC: World Bank; 2006. 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. Springer Nature. 6. Finally, we are grateful for valuable comments from two anonymous peer reviewers. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. 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. 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]. 0000002191 00000 n
Advances in health economics and health services research, volume 21. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Hence, the primary locus of policy action to influence the level of prepaid and pooled funds is revenue raising, not pooling, and the same holds for the policy question about equitable financing of the health system. Paris: OECD; 2011. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Google Scholar. Health Policy. Health Policy. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Geneva: World Health Organization; 2016. Each of the insurance schemes thus constitutes a separate pooling agency. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Terms and Conditions, In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. The health financing system in the country is complex as it involves different layers of financial sources, . While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 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. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 1970;84(3):488500. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. 1: World Health Organization, 2015. 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