&E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ CAS Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. In: Kutzin J, Cashin C, Jakab M, editors. Geneva: World Health Organization; 2017. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. SMG 1117A.641 . Bingley: Emerald Group Publishing; 2009. p. 291312. Rather it is a first attempt at a classification, which could encourage further useful work from others. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. 0000005327 00000 n 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. 0000079977 00000 n 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. Health Financing in Ghana. Innovations in health system finance in developing and transitional economies. territorially distinct pools; (3.) 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. A desciptive framework for country-level analysis for health care financing arrangements. Geneva: World Health Organization; 2017. The classification is presented in Fig. Int J Equity Health. Article 0000002097 00000 n general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance . Ministry of Health Swaziland. 0000025210 00000 n The major health financing mechanisms in Nigeria are namely: (i) government budget using general tax revenue; (ii) direct out-of-pocket payments; (iii) a social insurance scheme known as the Formal Sector Social Health Insurance Programme (FSSHIP) that is implemented by the National health insurance scheme; and (iv) donor funding. 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. Health system review. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. xref Cite this article. . New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 2016;15:7. PubMedGoogle Scholar. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 1: World Health Organization, 2015. As you know, there is a lot that you can find. World Health Organization. Three key health financing system functions Resource Mobilization: The final goals of UHC are equity in service use, quality, and financial protection. In: Chernichovsky D, Hanson K, editors. WHO. Formula funding of health services: learning from experience in some developed countries. 2023 BioMed Central Ltd unless otherwise stated. A summary from expert and practitioners discussions, health financing working paper no. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. 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. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. kem ZG, akar M. What have health care reforms achieved in Turkey? IM, PS and JK developed the outline and framework. 0000012547 00000 n Gottret P, Schieber G. A practitioners guide health financing revisited. Inke Mathauer. Pooling arrangements set the potential for redistributive health spending. a single pool; (2.) 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. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Adverse Selection in Health Insurance. population density). We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. Bull World Health Organ. Risk pooling in health care financing: the implications for health system performance. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Heal Policy Plan. statement and Health Policy. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. We propose eight broad types of pooling arrangements: (1.) (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. In 1985, the government commissioned the first of a . Figure 1. 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 0000000016 00000 n voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. HGF guidance document no. 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. there must be a specific contribution made by or on behalf of the covered person. WHO Regional Office for Europe: Copenhagen; 2016. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. #mHGilaa^{'D. IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. Definition. 2016;15(1):165. OECD reviews of health systems: Switzerland 2011. Google Scholar. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. 0000014993 00000 n Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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]. 2014;29:71731. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Google Scholar. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Health financing: the basics FP Financing Roadmap. Sparkes S, Durn A, Kutzin J. 1.2.1. Health financing diagnostics & guidance no. Int J Equity Health. Cookies policy. Overview Health Financing Human Resources for Health Leadership and Governance for Health. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. PubMed 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. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. There are also some concerns, however. Agency's Mandate and Functions Mandate. By Jonas May 13, 2021 5min read 4233 views. 3. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Jowett M, Kutzin J. 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. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. 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. The authors declare they have no competing interests. PubMed Central Peru has also made considerable progress with its Integrated Health System (SIS), a budget-funded explicit coverage scheme for the poor, and increasingly more of the informal sector [49]. 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. 2016;15:57. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. People who have higher risks are just as covered as people who have lower risks. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. When people have access to publicly financed coverage schemes, this VHI is duplicating. Paris: OECD; 2011. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 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). Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. In health [ universal health coverage: ( 1.: Kutzin J, Cashin C, M! 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