Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. In: Kutzin J, Cashin C, Jakab M, editors. Health Policy. [3] International Journal for Equity in Health CAS What are the types of health care financing? 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. 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. HGF guidance document no. Health Policy. 0000002300 00000 n 0 State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Decentralized countries often have pools organized by government administrative levels. In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. Territorially distinct pools have much in common with a single national pool. Comprehensive policy analysis for health system reform. 3. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Key facts Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. 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. health financing functions and objectives . Health financing diagnostics & guidance no. But the key concern is that the existence of multiple pools implies fragmentation. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. PubMed Community based health insurance: how can it contribute to progress towards UHC? 6. 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. 2015;119(9):115363. Cite this article. Lancet. 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. Spending wisely: buying health services for the poor. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. Health care delivery forms the most visible function of the health system, both to patients and the general public. World Health Organization. We propose eight broad types of pooling arrangements: (1.) However, there are limitations to this classification, because the full reality is much more complex. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 0000002097 00000 n Health Care Syst Transit. 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. Department of Health and Human Services Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. When people have access to publicly financed coverage schemes, this VHI is duplicating. 2019;97:33548. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 1.2.1. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. It serves multiple purposes, e.g. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. There are two forms of institutional setup found for this pooling arrangement. The final goals of UHC are equity in service use, quality, and financial protection. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 0000080023 00000 n This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. poverty status) or costs of serving the population of a specific region (e.g. statement and 0000002548 00000 n 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. 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/. Revenue collection is how health systems raise money from households, businesses, and external sources. Function. 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). 2017;17(1):145. the mobilization of resources for the health sector; 2) pooling, i.e. 3. 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. Geneva: World Health Organization; 2016. Self-paced (approximately 6 hours of course time) Click to enter this course This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. %PDF-1.5 % They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). 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). Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. 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. SMG 1117A.641 (02/09/2022) 1 . Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. A 2 0 2016;15:57. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. taxes, user fees, private health insurance), business (e . 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 . Mathauer I, Theisling M, Mathivet B, Vilcu 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 Kutzin J. 1: World Health Organization, 2015. An appraisal of the health transformation Programme. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Latin American development forum. Jowett M, Brunal MP, Flores G, Cylus J. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. 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). 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