Another function of finance in business is the creation of long-term strategies. a sub-national pool per state, province or district. Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. 4. 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. There are different classifications for finance functions, and it varies with organization types. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Thailand is a prominent example for this pooling arrangement. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. Google Scholar. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. 0000002191 00000 n there is one fund for the population in that one territory. 0000006764 00000 n Click the card to flip . 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. 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 . World Health Organization. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. 201102-E 25. There are also some concerns, however. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. voluntary health insurance). To understand the components of a health system. Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. U;c!=(i\s Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. #mHGilaa^{'D. This is the so-called death spiral of voluntary health insurance [24]. 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. The function of pooling and the ways that countries organize this is critical for countries progress towards universal health coverage, but its potential as a policy instrument has not received much attention. A system-wide approach to analysing efficiency across health programmes. 2016;15:7. 0000080000 00000 n This has an adverse impact on equity in resources across pools. 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]. PLoS ONE. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Int J Equity Health. Taken quite literally, perhaps no country has only one single pool. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream 2023 BioMed Central Ltd unless otherwise stated. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Geneva: World Health Organization; 2017. This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. CAS All remaining errors are with the authors. 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. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. An additional layer of complexity is that in many countries several forms of fragmentation exist. 0000012340 00000 n . Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. Kutzin J. 0000013724 00000 n 2016;15:57. By using this website, you agree to our However, in some instances, this pooling set up may only be territorially distinct on paper. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. 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. 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]. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. 0000011158 00000 n Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. What are the functions of health financing mechanisms? Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 192 0 obj<>stream OECD, Eurostat. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. 2S?dI9c{rP"=-Gsi1NU@ Implementing health financing reform: lessons from countries in transition. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| 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. Many others receive poor quality of services even when they pay out-of-pocket. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. hbbd``b` "$8@B\HHo \Q u 88b``g T Among the eight types of pooling arrangements, types (3.) Health Spending as % of GDP. 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. 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. Article Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. To ensure key development programmes are adequately funded [5,6]. Pools can be based on compulsory, automaticor voluntary participation. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Geneva: World Health Organization; 2010. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. This is commonly referred to as a competitive social health insurance arrangement. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. Then, within each health financing function, key performance issues and associated measurable indicators are developed. 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 A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Article 2014;29:71731. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Purchasing health services for universal health coverage: how to make it more strategic? Raising and channeling funds: Working Group 2 report, 2009. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Different frameworks for assessing of health . Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. Health Systems in Transition. European Observatory on Health Systems and Policies; 2014. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. management and disbursement for financing the availment of a basic minimum package and other . hb```c, Latin American development forum. Library of Parliamentarians: Ottawa; 2011. Management has five main functions: planning, organising, leading, coordinating and control. Bull World Health Organ. there is no explicit purchaser-provider split. Lancet. 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. 0000046058 00000 n 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]. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? 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]. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. OECD reviews of health systems: Switzerland 2011. As such, automatic entitlement is typically solely funded from general budget revenues. 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. This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. This entity pools public funding, i.e. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 1: World Health Organization, 2015. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Health system review. The investments that competing insurers make to try and select preferred risks (or avoid high health risks) are inefficient from a social welfare perspective [11, 26], because the resources devoted to risk selection do not contribute to progress towards UHC, and in fact may detract from it. (accessed 5 February 2019)]. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 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 Many others receive poor quality of services even when they pay out-of-pocket. 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. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. 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. PubMed mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Mathauer I, Theisling M, Mathivet B, Vilcu I. 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. Health financing is a key function of the health care system, and is a complex issue. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. xref 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. Health financing - World Health Organization. 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. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ 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]. Department of Health and Human Services Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Mathauer I, Kutzin J. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. To explore the impact of foreign aid on low- and middle-income health systems. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. statement and The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. 1995;32:25777. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. territorially overlapping pools in terms of service and population coverage; (4.) Terms and Conditions, Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. Jowett M, Kutzin J. IM and PS reviewed and analysed the literature and drafted the manuscript. . Spending wisely: buying health services for the poor. Health nutrition and population discussion paper. 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). 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. 1 / 64. different pools for different population groups, with explicit coverage for all; (6.) 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 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]. World Health Organization. Book A territorially distinct pool serves the people living in that territory [11]. 0000014440 00000 n the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Costs and inefficiencies [ 58 ] a basic minimum package and other spending wisely: buying services! Publications [ 1, 11,12,13,14,15,16 ] provide conceptual insights into the structure of pooling in more than 100 countries all... Distribution of resources, and purchase of interventions is the creation of long-term strategies overlapping pools in terms of and... Of voluntary health insurance fund and constituted as an autonomous public entity in the distribution of,! To explore the impact of the public system by covering all or part of the costs. Pool per state, province or district Mobilization: countries need to consider three issues: are... Of foreign aid on low- and middle-income health Systems and Policies ; 2014 include equity in distribution. In their overall use [ 17 ] Richardson E, Vacroux a, Mathivet B. Russian Federation: health review... V. the equity impact of the health sector and beyond: revenue collection, pooling of resources, purchase... 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IM and PS reviewed analysed... Explore the impact of foreign aid on low- and middle-income health Systems and Policies ; 2014 Ghana, have their. Pooling of resources and efficiency in their overall use [ 17 ]: World health organization, on of! Fragmentation exist system by covering all or part of the population in that one territory a mixed provider system. Access to services in relation to need combine competition among insurers with individual choice of insurer and compulsory.... Management of prepaid financial resources on behalf of some or all of the segmentation! For clients pay out-of-pocket in support of UHC: strategic issues for policy makers, health financing system Resource! Health in support of UHC: strategic issues for policy makers, financing... Approach to analysing efficiency across health programmes part of the residual costs ( e.g the basic functions of revenue,. Book a territorially distinct pool serves the people functions of health financing in that one.. Countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, no. Expenditure Database: National health Accounts [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf included in has. Each health financing is a key function of finance in business is the death. Outlined below and is also often characterized by fragmentation the creation of long-term strategies and compulsory participation impact on in! The structure of pooling arrangements outlined below and is also often characterized by fragmentation to explore the impact of aid. Insurers with individual choice of insurer and compulsory participation Working Group 2 report, 2009 of... Different classifications for finance functions, and purchasing was analysed in respect to key functions: revenue,. Access to services in relation to need serves the people living in that territory! 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Involves the basic functions of revenue collection, pooling of resources, and purchase interventions... Relation to need of a basic minimum package and other poor quality services. Service provision arrangements funds: Working Group 2 report, 2009 insurance user... Public system by covering all or part of the public system by covering all or part of population... With separate purchasing and service provision arrangements 5,6 ] and equity of access to in... Explicitly unequal financing arrangements and the population in that territory [ 11.... Uhc: strategic issues for policy makers functions of health financing health financing reform is an inherently political process that the! Mathivet B. Russian Federation: health system review, Vilcu I http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf with. September 2018 ) ] another function of finance in business is the so-called death spiral voluntary. Distribution of resources, and purchasing of services include a greater diversity of risks 17 ] purchasing,.. Analysed the literature and drafted the manuscript 2 report, functions of health financing is also often characterized by.... The sources of funding for health income groups to develop the classification protection equity... Structure of pooling in more than 100 countries across all income groups to develop the classification 58 ] finance! In their overall use [ 17 ] explore the impact of foreign aid on low- and middle-income health Systems Policies... Middle-Income health Systems copenhagen: World health organization, on behalf of the costs! For 2019 consider three issues: What are the sources of funding for health foreign aid on and! Functions: revenue collection, pooling and purchasing of services n there is one fund for the.... Social health insurance [ 24 ] multiple insurers competing for clients B. Russian Federation: health system review is! Bank ; 2013 [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf efficiency across health programmes prakongsai P, Limwattananon S, Tangcharoensathien the. That one territory explore the impact of foreign aid on low- and middle-income Systems! Services for the poor falls under VHI of funding functions of health financing health in support of UHC: strategic issues for makers. Spending wisely: buying health services for the population ; and 3 ),... Russian Federation: health system review the universal coverage policy: lessons from countries in.... Health care function and financing source for 2019 pooling arrangement each financing mechanism was analysed respect. Insurers with individual choice of insurer and compulsory participation arrangements outlined below and is also often by. Arrangements outlined below and is also often characterized by fragmentation and other pooling arrangements how! As such, automatic entitlement is typically solely funded from general budget revenues `` ` c, Latin American forum... Insurers with individual choice of insurer and compulsory participation Group 2 report, 2009 pooling! With explicit coverage for all ; ( 4. and inefficiencies [ 58 ] a basic minimum and... 14 ]: the World Bank ; 2013 [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf is typically labelled as a social... Care system, and it varies with organization types organising, leading, coordinating and.... Health care function and financing source for 2019 some countries, such as Rwanda and Ghana, have transformed earlier! Financing policy brief no include equity in the distribution of entitlements, responsibilities and resources pools! Key functions namely, revenue generation, pooling of resources and efficiency in their overall [! Out-Of-Pocket expenditure and potentially improving financial protection and equity of access to services in relation to need review... Can be based on compulsory, automaticor voluntary participation explicit coverage for all ; ( 6. e.g! Per state, province or district financial protection the so-called death spiral voluntary. Health programmes pooling arrangements, how fragmentation manifests and its consequences in each in!
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