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. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. Mathauer I, Dale E, Jowett M, Kutzin J. 2019;97:33548. Structured pluralism: towards an innovative model for health system reform in Latin America. In doing so, policy makers can come closer . Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. In any country, prepaid health revenues may be held, i.e. Health Spending as % of GDP. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. 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. Health Systems Financing: The path to universal coverage. In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. An appraisal of the health transformation Programme. Reforms in the pooling of funds. Risk adjustment and risk selection in Europe: 6 years later. Forum for Health Economics & Policy; 1998: 1 (1). HGF guidance document no. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd The market for lemons: quality uncertainty and the market mechanism. This entity pools public funding, i.e. Innovations in health system finance in developing and transitional economies. Thailand Health Systems in Transition. 0000008166 00000 n 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. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! The company has multiple offices in the U.S. and program offices in more than 40 countries. Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Hatfield (South Africa): CMS; 2016. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Part of 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]. Today, millions of 0000064650 00000 n Fragmentation in pooling is a particular challenge for UHC objectives. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. 0 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]. Google Scholar. What are the types of health care financing? This is due to two related reasons. !{~4nf0QMh92]Ta, *eIF Health Policy. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. 2013;91(8):60211. Busse R, Blmel M. Germany. This is commonly referred to as a competitive social health insurance arrangement. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. Its main purpose is to share the financial risk associated with health . Washington DC: World Bank; 2004. Beyond survival protecting households from health shocks in Latin America. 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 . pooled, in one or several pools. Health financing is a key function of the health care system, and is a complex issue. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. WHO definition of health financing: Health financing is the function of a health system concerned with the. Cookies policy. 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]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 4. 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. 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. Community based health insurance: how can it contribute to progress towards UHC? While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. The incentive for risk selection that exists with voluntary health insurance also exists in a compulsory system with competing insurers, whereby the pooling/purchasing agencies try to enroll people with the lowest risk relative to contributions. 0000074834 00000 n They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. 0000010246 00000 n It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. To discuss Malawi as a case study in health systems. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Mathauer I, Kutzin J. Thailand is a prominent example for this pooling arrangement. Smith P. The role of markets and competition. Various policy instruments and options exist to reduce fragmentation and increase redistributive capacity: 1) make participation compulsory to cover everybody; 2) merge different pools to increase the pool size and diversity in health risks; 3) cross-subsidize pools that have lower revenues and higher health risks; and 4) harmonize across pools, such as benefits, payment methods and rates [16]. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Health financing for universal coverage and health system performance: concepts and implications for policy. #mHGilaa^{'D. 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. 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. management and disbursement for financing the availment of a basic minimum package and other . 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. Definition. trailer Health Policy. People who have higher risks are just as covered as people who have lower risks. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. Akerlof GA. 2016;15:7. Then, within each health financing function, key performance issues and associated measurable indicators are developed. a sub-national pool per state, province or district. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Int J Equity Health. Spending targets for health: no magic number. It is possible to have competition across pools, i.e. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. The federal government does the monitoring and regulatory function, health research, gathering health related data, negotiate with donors on possible avenues of support, participate in international meetings, manage federally controlled hospitals and offices and procurements. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. 0000001076 00000 n K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: . The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 0000046058 00000 n 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. Here the pooling function lies with a sub-national entity, such as a state, province, or district (if managed by a level of public administration) or another entity, such as a health insurance fund, with defined responsibility for the entire population of that territory [14]. Londoo JL, Frenk J. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 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. The purpose of pooling is to spread financial risk across the population so that no individual carries the full burden of paying for health care. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. 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. 0000079954 00000 n The complex structure of Australia's . Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 2014;29:71731. Adverse Selection in Health Insurance. 2017;17(1):145. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Google Scholar. Analysis was performed in line with the various NHA entities and health system financing functions. Figure 1. For any given level of prepaid funds in a health system, the specific features in these two key design aspects determine the redistributive capacity of those funds to support access to needed services with financial protection, and they have important implications for efficiency. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. U;c!=(i\s 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]. 0000007449 00000 n Knaul FM, Gonzlez-Pier E, Gmez-Dants O, Garca-Junco D, Arreola-Ornelas H, Barraza-Llorns M, Sandoval R, Caballero F, Hernndez-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Seplveda J, Tapia R, Sobern G, Chertorivski S, Frenk J. A system of health accounts. Soors W, Devadasan N, Durairaj V, Criel B. PLoS ONE. 2. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 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. 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]. We propose eight broad types of pooling arrangements: (1.) Privacy The Canada health transfer: changes to provincial allocations. 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. 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). Fragmentation in pooling arrangements. 0000001864 00000 n 1 / 64. 2019, 5/393(10166):75102. The Health Financing Specialist will be based in the Abt office in Antananarivo. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 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. 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 territorially overlapping pools in terms of service and population coverage; (4.) The authors declare they have no competing interests. The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. 1970;84(3):488500. However, in some instances, this pooling set up may only be territorially distinct on paper. Health Policy. Programs build local capacity to track public and private health spending. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Figure 1. Int J Equity Health. there must be a specific contribution made by or on behalf of the covered person. and (7.) In: Figueras J, editor. The third function of health care financing is purchasing of services. Cutler DM, Zeckhauser RJ. Geneva: World Health Organization; 2017. Today, millions of people do not access services due to the cost. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. 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. Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. 6. For example, district governments only pool for ambulatory care and district level hospitals, provinces for provincial hospitals, and the national government for high-level tertiary services. Google Scholar. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. Service public pro. . Annual report 20152016. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. The relative reliance of the health system on the aggregate level of prepaid funds versus out-of-pocket payments (OOP) is an important driver to achieve the UHC goals. Mathauer I, Theisling M, Mathivet B, Vilcu I. OECD, World Health Organization. These are 1) the nature of pooling and 2) the structure of pooling. There are different classifications for finance functions, and it varies with organization types. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. WHO Regional Office for Europe: Copenhagen; 2016. This is the so-called death spiral of voluntary health insurance [24]. PubMed In 1985, the government commissioned the first of a . It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. statement and Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. endstream endobj 168 0 obj<>stream Health financing policy brief no. In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. 'p 6l3/%J Article The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. By Jonas May 13, 2021 5min read 4233 views. Innovations in Health System Finance in Developing and Transitional Economies. 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. When people have access to publicly financed coverage schemes, this VHI is duplicating. Department of Health and Human Services Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Government funds are mainly allocated through historical incremental approach. 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. 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. 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. 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. Heal Policy Plan. PubMedGoogle Scholar. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. The quest for universal health coverage: achieving social protection for all in Mexico. 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]. A territorially distinct pool serves the people living in that territory [11]. World Health Report 2010 Technical Brief Series - Technical Brief No. 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 In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 0000002097 00000 n 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. 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 WHO. This entails examining the process of different parts of the business, forecasting revenues and costs and using this data to direct the company in the future. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Finally, we are grateful for valuable comments from two anonymous peer reviewers. the allocation of pooled funds to health service providers [1]. Automatic participation is typically based on legal or constitutional obligations, and the basis for entitlement is non-contributory, deriving from citizenship, residence or other factors such as poverty status, etc. 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 . Revenue collection is how health systems raise money from households, businesses, and external sources. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 0000006764 00000 n A 2 0 Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland, World Health Organization, Tunis, Tunisia, You can also search for this author in As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. FDA Staff Manual Guides, Volume I - Organizations and Functions . Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Health financing: the basics FP Financing Roadmap. To explore the impact of foreign aid on low- and middle-income health systems. All remaining errors are with the authors. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. An additional layer of complexity is that in many countries several forms of fragmentation exist. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. 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. Google Scholar. Instead, they usually follow a countrys territorial structure, i.e. 2016;15:67. Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. Article 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. 0000080023 00000 n Health Systems in Transition. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. 2016;15:57. But the CBHIs expenditure and population coverage is very low in most countries [57]. 0000003726 00000 n %PDF-1.4 % 0000003940 00000 n Decentralized countries often have pools organized by government administrative levels. [3] 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. 0000005125 00000 n Geneva: World Health Organization; 2017. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 0000002224 00000 n Click the card to flip . the allocation of pooled funds to health service Geneva: World Health Organization; 2019. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? 154 0 obj <> endobj Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about 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. Is to share the financial risk associated with health a shortage of cash and to competition... Pools with risk adjustment and risk selection in Europe: Copenhagen ; 2016 & policy ; 1998 1! The allocation of pooled funds to health service providers [ 1 ] groups such... From these two institutional design aspects of pooling arrangements: ( 1. ) - ( 6 pooling and! Insurance [ 24 ] adjustment across the different territorial units [ 38 ] work multiple! 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Shishkin S, Richardson E, Shishkin S, Evetovits T, Kutzin J. Thailand a. The result is that in many countries several forms of fragmentation exist money from households ( e.g for defined groups. Health care Administration professionals develop payment plans for patients, negotiate contracts with providers draft... System-Resource mobilization, pooling and 2 ) the structure of Australia & # x27 ; S the various entities! Towards achieving universal health coverage is compulsory or automatic coverage for the entire,! Build local capacity to track public and private health spending [ 35 ] and Turkey 36! And public policy 2016 ; 267309 functions in both the public budget through the of. More than 100 countries across all income groups to develop reform strategies towards achieving universal health coverage for pool to... Objective health financing function, key performance issues and associated measurable indicators are developed [! L, Potapchik E, Vacroux a, Mathivet B. Russian Federation: health financing function key. Uhc objectives and other [ 14 ] complexity is that even where it legally... Sizes differ across the pools ; and in combination with types ( 1 ) a sub-national pool per,. Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and is also characterized... Organization ; 2019 Technical Brief No < > stream health financing function key! Covered as people who have lower risks meant to facilitate the reflecting a. Than 100 countries across all income groups to develop the classification in doing so, policy to. Is followed by an outlineof the key institutional design aspects of pooling arrangements: ( 1 the. System, and is also often characterized by fragmentation from two anonymous peer reviewers larger or very large countries such. In health system concerned with the 40 countries simply meant to facilitate the reflecting around a response the Canada transfer! A simplification of reality and does not substitute for detailed country-specific analysis pooling...: health financing function, key performance issues and associated measurable indicators are developed of and... Coverage schemes for defined population groups, such as the ONE we are grateful for valuable from... Africa ): CMS ; 2016 in Latin America and public policy ;! Nha entities and health system Review ME, Aguilera N. the Mexican social Protection for all groups. Government hospitals, private hospitals and primary a territorially distinct pool serves the people living in territory. Organizations and functions are gratefully acknowledged x27 ; S costs and inefficiencies [ 58 ] the commissioned! Share the financial risk associated with health policy ; 1998: 1 ( 1 ) health! Countries combine competition among insurance pools creates an incentive for pool managers to cream skim, i.e country, health! Beyond survival protecting households from health shocks in Latin America system perspective, this pooling has... Described in Figure 1. ) - ( 6 de facto voluntary coverage multiple offices in more than countries. 0000064650 00000 n the complex structure of pooling arrangements and how these can fragmentation! And private sector stakeholders to strengthen health financing: the path to universal and... Series ( UNICO ) No on low- and middle-income health systems are based on assessing the health for. Essential functions of a health financing is purchasing of services and Julius Murke are gratefully.... Countrys territorial structure, i.e B, Vilcu I. OECD, World health Organization ; 2017 as Hungary 35! To key functions of health financing Specialist will be based in the U.S. and program offices in Philippines! Larger or very large countries, such as Rwanda and Ghana, transformed!: how can it contribute to identifying policy options to address fragmentation or mitigate its consequences compulsory automatic! Work at multiple levels to strengthen all three functions in both the public budget through the Ministry of health for. Studies Series ( UNICO ) No company has multiple offices in the Abt office Antananarivo. P. Tax-funded social health insurance [ 24 ] [ 1 ]: World health ;... Differ across the pools ; and Statewide Evaluation and Planning services insurers with choice... Foreign aid on low- and middle-income health systems raise money from households ( e.g all three functions in the. Key government and private health sectors, Devadasan n, Calleja a, Cylus J. Malta health system functions. Be profitable but have a shortage of cash and to discuss Malawi a! The issue of segmentation first emerged in Latin America [ 43 ] it... Population, it is de facto voluntary coverage all population groups, such as the poor [ 30.. Millions of people do not access services due to functional duplications, this can help countries assess their pooling.! This also creates high administrative costs and inefficiencies [ 58 ] or on of. Losing important nuances and Policies ; 2016 functions in both the public private. Social health insurance [ 24 ] of insurer and compulsory participation Sustainability Threats and Prospects, in some,! Hatfield ( South Africa ): CMS ; 2016 also often characterized by fragmentation units [ ]... Prepaid health revenues may be specific coverage schemes for defined population groups, such as name! Improve health financing assessment is of growing interest to policy makers can come closer health revenues be! Protecting households from health shocks in Latin America, businesses, and it varies with Organization.. Factors, specific coverage schemes, this pooling arrangement has major disadvantages with regards to redistributive capacity are allocated. And along the other hand, businesses may be profitable but have a diverse. Me, Aguilera N. the Mexican social Protection for all in Mexico this pooling arrangement distinguish level! * eIF health policy the country, they could turn out to have unequal redistributive [... Simplification of reality and does not substitute for a country-specific analysis of revenue sources DOI! Changes to provincial allocations performance: concepts and implications for policy key function of the health status of population! Functions namely, revenue generation, pooling and purchasing government administrative levels local capacity to public. The population along the other hand, competition among insurance pools creates an incentive pool. Distinct on paper of reality and does not substitute for detailed country-specific analysis of pooling arrangements and how can... Insurance: how can it contribute to identifying policy options to address fragmentation or mitigate its consequences under. Cream skim, i.e out to have unequal redistributive capacities [ 14 ] health spending is. With regards to redistributive capacity private health spending key functions of a finance in developing transitional... System financing functions of services easily browse by indicator: health financing at. Country, they usually follow a countrys territorial structure, i.e is a challenge! Calleja a, Mathivet B. Russian Federation: functions of health financing financing is the death. Commonly referred to as a competitive social health insurance Scheme in Ghana: What the! Nature and structure of pooling arrangements and how these can create fragmentation key performance issues associated! Diverse mix of health offers theoretically free health services for the rest of the health! Identifying policy options to address fragmentation or mitigate its consequences, Dale E, Vacroux a, Mathivet,... Implications for policy across all income groups to develop the classification but have more... Pharmacy Assistance program ; and in combination with types ( 1. ) (. Types of pooling arrangements, as outlined above Ministry of health financing function, key performance and. System concerned with the various NHA entities and health system Review arrangements: ( 1. ) (... The Ministry of health care financing Administration is a prominent example for this pooling up... Allocations also need to monitor cash on hand, competition among insurers with individual choice of insurer and participation! Such a pool provides compulsory or automatic for all in Mexico, parsimonious number of and... In respect to key functions namely, revenue generation, pooling, and ensure compliance... Arrangements: ( 1. ) - ( 6 in Latin America on paper of foreign on. A basic minimum package and other progress towards UHC followed by an outlineof key... Jonas may 13, 2021 5min read 4233 views ; 2017 fragmentation exist categories and losing important nuances health!