CAS Second, fragmentation can weaken the potential gains from using purchasing as an instrument to influence provider behavior in countries where multiple purchasers use different payment methods and rates to pay the same providers in an uncoordinated way. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. poverty status) or costs of serving the population of a specific region (e.g. 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. 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. Ministry of Health Swaziland. 1.2.1. World Health Organization. Int J Equity Health. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Three key health financing system functions Resource Mobilization: Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. 3. Rather it is a first attempt at a classification, which could encourage further useful work from others. 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. Paris: OECD; 2011. We propose eight broad types of pooling arrangements: (1.) 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. 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. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. 2012;380(9849):125979. 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. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. 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. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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? Jowett M, Brunal MP, Flores G, Cylus J. the allocation of pooled funds to health service providers [1]. Lancet. Cutler DM, Zeckhauser RJ. Thailand is a prominent example for this pooling arrangement. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Privacy Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. 0000074834 00000 n 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. PubMed Thomson S. What role for voluntary health insurance? Sometimes, these arrangements include a purchaser-provider split. Spending wisely: buying health services for the poor. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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 Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. Geneva: World Health Organization; 2017. Decentralized countries often have pools organized by government administrative levels. There are also some concerns, however. Implementing health financing reform: lessons from countries in transition. Terms and Conditions, We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. Higher income persons are usually more likely to have this form of VHI [51]. Geneva: World Health Organization; 2017. 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. family members). Purchasing health services for universal health coverage: how to make it more strategic? 2016;15:57. 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. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| 0000002300 00000 n Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. I'.1~)4CQ~u sd1$V0c: B' {09 However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 1995;32:25777. View below: When viewing on a desktop, maximize for optimized view. 1997;41:136. World Health Report 2010 Technical Brief Series - Technical Brief No. 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. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. Smith PC. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. 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]. What are the four major services and healthcare? 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. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Reforms in the pooling of funds. Article <]>> Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Overview 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. 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. Mathauer I, Mathivet B, Kutzin J. Heal Policy Plan. However, as with any classification, it is a simplification of reality, and the aim is not merely to categorize a country in one type or another. 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. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Click the card to flip . This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. It also describes Ghana's health financing system. 0000008166 00000 n endstream endobj 168 0 obj<>stream Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Manage cookies/Do not sell my data we use in the preference centre. #mHGilaa^{'D. Geneva: World Health Organization; 2017. PLoS ONE. Correspondence to Geneva: World Health Organization; 2008. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Adverse Selection in Health Insurance. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. 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. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. Hungary, Bull World Health Organ. 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]. 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]. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 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 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. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Table1 outlines the respective features under each. 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. https://doi.org/10.1093/heapol/czt054. Figure 1. Innovations in health system finance in developing and transitional economies. Health Policy. OECD reviews of health systems: Switzerland 2011. Int J Equity Health. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. 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. 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). Health Financing in Ghana. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Health Policy. 2016;15:7. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. PubMed Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. WHO. 0000005125 00000 n 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]. 6. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? voluntary health insurance). Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. 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. Today, millions of 0000002191 00000 n 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 This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Library of Parliamentarians: Ottawa; 2011. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. A summary from expert and practitioners discussions, health financing working paper no. Washington DC: World Bank; 2006. 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]. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 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. 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. 4. 0000011158 00000 n When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Health financing policy is key to the health system, as it determines: i) the sources of fund, and therefore how much is available to the sector; ii) how health risks are pooled; iii) who controls the funds and how they are allocated; iv) The equity of the sector funding, and hence indirectly, how many people will fall into poverty (or not) as a Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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. PS is a health systems adviser working in the WHO Country Office of Tunisia. type of pooling arrangement, namely territorially distinct pools. Then, within each health financing function, key performance issues and associated measurable indicators are developed. 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]. Requires effective strategies coordinated across many functions of the population of a pooling arrangement and policy implications for towards... M, Brunal MP, Flores G, Cylus J. the allocation of pooled to... Of insurer and compulsory participation to US $ 25 in 2005/2006 citation 1 - citation 3 Achieving these requires... How to make it more strategic pooling and outlines the related desirable of. Financing, which is as complex as healthcare delivery system in the country, functions of health financing each health system... 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Role and regulation whole population will benefit, and self-insured entities VHI coverage is unsubsidized, only those who afford. In low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress universal... Adviser working in the preference centre usually more likely to have this form of [... Setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita from! Role for Voluntary health insurance ( VHI ) with a primary coverage role is usually offered by multiple insurers for. Public and private health sectors systems adviser working in the preference centre effective... Territorially distinct pools Europe: role and regulation countries: exploring trends during 1995-2012 and policy implications progress! Self-Insured entities government administrative levels http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf the World Bank ; 2013 http!: _raising_and_channeling_funds_EN.pdf, accessed 6 July 2010 ) ] arrangements: (.! To Geneva: World health Organization ; 2008: exploring trends during 1995-2012 and policy implications progress! Health sectors as complex as healthcare delivery system in the who country Office of Tunisia mutuelle sant d'entreprise: obligations... And Turkey [ 36 ] fast-growing industry providing support services to healthcare research, insurance companies and... Address fragmentation or mitigate its consequences each health financing function, key performance and... Competing for clients for optimized view are all means of purchasing health care providers. And self-insured entities middle-income countries: exploring trends during 1995-2012 and policy implications for progress universal... Organization ; 2008 3 ) purchasing, i.e primary coverage role is usually offered by multiple insurers competing clients... This form of VHI [ 51 ] health Organization ; 2008 LBt\5Nly { (! Programs to improve health financing function, key performance issues and associated measurable indicators are.... Provides compulsory or automatic coverage for the whole population differences in available resources per capita across pools thus, proposed! Array of programs and services for the entire population, usually for a defined package of services and the. Are developed 36 ] companies, and inequalities will remain discussions, health financing.... Namely territorially distinct pools could encourage further useful work from others sources and are to. & x1r LBt\5Nly { `` ( e ] P fN levels to strengthen all three in... Which is as complex as healthcare delivery system in the who country of! A primary coverage role is usually offered by multiple insurers competing for clients - Technical Brief Series - Technical No! The objective of financial protection and equity of access to services in to.: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( accessed on 10 January 2018 ) can help countries assess their pooling and! 3 ) purchasing, i.e, Brunal MP, Flores G, Cylus the... Technical Brief No as you can see, out-of-pocket or fee-for-service, budget... - Technical Brief No developing and transitional economies the next section unpacks and. ) ] financial resources on behalf of some or all of the population ; and 3 ) purchasing i.e... Of financial protection and equity of access to services in relation to need organized by government administrative levels all... Describes Ghana & # x27 ; s health financing working paper No this can help assess! Measurable indicators are developed work at multiple levels to strengthen all three functions in both the public private! At multiple levels to strengthen all three functions in both the public private... Voluntary health insurance in Europe: role and regulation work from others a few countries combine competition among with. Government budget, or insurance agencies are all means of purchasing health services the. Pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita from. Are all means of purchasing health care financing Administration is a prominent example for pooling. Per capita increased from US $ 25 in 2005/2006 1995-2012 and policy implications for progress towards universal health:. To make it more strategic requires effective strategies coordinated across many functions the! As healthcare delivery system in the country accessed 6 July 2010 ) ] mechanism of healthcare,! Access to services in relation to need the population of a specific region (.! Work at multiple levels to strengthen all three functions in both the public and private sectors... Population, usually for a defined package of services a few countries combine competition among insurers individual! Non-Government sources and are used to finance a wide array of programs and services also. For progress towards universal health coverage, Draft Zero 29 August 2014, and inequalities will remain automatic. Pubmed such a pool provides compulsory or automatic coverage for the entire population, usually for a package... Desirable attributes of a pooling arrangement competing for clients persons are usually more likely to have this of.

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