pooled, in one or several pools. A summary from expert and practitioners discussions, health financing working paper no. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Book xref Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. PubMed Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. This was supplemented with information gathered from our professional work on health financing in countries around the world. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Hatfield (South Africa): CMS; 2016. Analysis was performed in line with the various NHA entities and health system financing functions. ), (7.) 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. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. 0000012547 00000 n 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. Moreover, in France, there is a shift towards compulsory complementary coverage, which employers have to buy for their employees since 2016 (with exceptions for various employee groups) [56]. 814 0 obj <>stream Jowett M, Brunal MP, Flores G, Cylus J. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. Health Systems in Transition. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. An additional layer of complexity is that in many countries several forms of fragmentation exist. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. 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. Implementing health financing reform: lessons from countries in transition. Smith P. The role of markets and competition. 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. Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. 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. there is one fund for the population in that one territory. Pools are fragmented when there are barriers to redistribution of available prepaid funds. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Mathauer I, Dale E, Jowett M, Kutzin J. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 0000079954 00000 n Department of Health and Human Services This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Health Financing. -U+:V\GCs2C /L7w0X-O`>2h?! Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. World Health Organization. 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]. 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). In: Kutzin J, Cashin C, Jakab M, editors. PubMed Central Financial Management Functions. Akerlof GA. Article %PDF-1.5 % Maximum redistributive capacity from prepaid funds is achievable in these settings. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Pooling arrangements set the potential for redistributive health spending. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. WHO. Londoo JL, Frenk J. Each of the insurance schemes thus constitutes a separate pooling agency. In: Kutzin J, Cashin C, Jakab M, editors. Thailand is a prominent example for this pooling arrangement. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Formula funding of health services: learning from experience in some developed countries. Pools may be organized as territorially distinct. 0000005327 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. PLoS ONE. 2S?dI9c{rP"=-Gsi1NU@ 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]. Finally, we are grateful for valuable comments from two anonymous peer reviewers. People who have higher risks are just as covered as people who have lower risks. As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. This is due to two related reasons. . 3. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. Taskforce on Innovative International Financing for Health Systems. All authors have read and approved the final manuscript. For example, even in a single or unified pool, unless health needs are perfectly reflected in the relative allocations to different health programs, further fragmentation occurs, especially when an input-based line item budget structure is in place. 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. 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. As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. Key facts 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 Health nutrition and population discussion paper. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. This entity pools public funding, i.e. 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. Privacy 0000014440 00000 n Even in countries with highly centralized pooling, there are usually several pools of funds that are used to pay for some health services, for example occupational health programs, supply-side funding for other government services such as those delivered through vertical programs or voluntary health insurance [1]. 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. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. . co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. 1: World Health Organization, 2015. 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. 2016;15:7. Sparkes S, Durn A, Kutzin J. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD At one extreme is a single pool of all funds for health services covering the entire population of a country. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. Annual report 20152016. It also describes Ghana's health financing system. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Health Policy. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. a sub-national pool per state, province or district. [3] 0000035307 00000 n 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. hb```c, Washington DC: World Bank; 2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 2012;380(9849):125979. 0000046058 00000 n Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. 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. Heal Policy Plan. There are different classifications for finance functions, and it varies with organization types. To ensure key development programmes are adequately funded [5,6]. Bull World Health Organ. Self-paced (approximately 6 hours of course time) Click to enter this course Health financing involves not only methods of raising money for health care, but also allocation of those funds. 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. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. By Jonas May 13, 2021 5min read 4233 views. 0000011158 00000 n Cite this article. Smith PC. agencies that manage pools (typically insurance schemes) compete for members. Explain the need for evidence pertaining to the cost of delivery of. CAS Healthcare organizations must be able to minimize costs in order to be financially successful. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. 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 . World Health Organization. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. 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]. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Higher income persons are usually more likely to have this form of VHI [51]. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. SMG 1117A.641 . 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. HGF guidance document no. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Article World Health Report. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Geneva: World Health Organization; 2017. Geneva: World Health Organization; 2010. 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. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Structured pluralism: towards an innovative model for health system reform in Latin America. 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. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. The on behalf may come from public budgets for specific groups of individuals whose participation is fully or partially subsidized, or it may come from traditional insurance contributions that cover individuals beyond the contributor (e.g. Manage cookies/Do not sell my data we use in the preference centre. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Pettigrew LM, Mathauer I. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. 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]. 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