Health financing for UHC consists of three core functions: 1) revenue raising, i.e. PubMed 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. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Article <]>>
The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets 5. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. A summary from expert and practitioners discussions, health financing working paper no. Reforms in the pooling of funds. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 0000002191 00000 n
Explain the need for evidence pertaining to the cost of delivery of. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. xb```l hp`d,u){i7NY~GOC]TkT}
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2007;83(23):16279. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. . World Health Report 2010 Technical Brief Series - Technical Brief No. Figure 3.1 highlights these. What are the three main functions of health financing? 1: World Health Organization, 2015. Purchasing health services for universal health coverage: how to make it more strategic? The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. Each of the insurance schemes thus constitutes a separate pooling agency. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Formula funding of health services: learning from experience in some developed countries. The Health Financing Specialist will be based in the Abt office in Antananarivo. 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]. The third function of health care financing is purchasing of services. it is the function of a 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. family members). Cookies policy. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Part of Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. agencies that manage pools (typically insurance schemes) compete for members. a sub-national pool per state, province or district. Implementing health financing reform: lessons from countries in transition. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Provided by the Springer Nature SharedIt content-sharing initiative. Analysis was performed in line with the various NHA entities and health system financing functions. N4
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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. 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. Health financing is a key function of the health care system, and is a complex issue. 0000010246 00000 n
1). Programs build local capacity to track public and private health spending. 154 0 obj <>
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. 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]. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. 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]. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. 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. Google Scholar. 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. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. 1997;41:136. Smith PC, Witter SN. 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]. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 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. 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 . lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 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. Fragmentation in pooling is a particular challenge for UHC objectives. Function. In some cases, this is limited to civil servants only. Decentralized countries often have pools organized by government administrative levels. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Alternatively, in a non-competitive arrangement, people could be assigned to specific pools, with enrollment being based on explicit criteria, so that the different pools cannot compete for beneficiaries [11]. 0000007449 00000 n
In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. 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. 0000008860 00000 n
The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. Health Policy. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Wahshginton DC: World Bank; 2005. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. 0000006764 00000 n
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. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. Financial Management Functions. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. 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]. What does health care financing mean? The market for lemons: quality uncertainty and the market mechanism. Results The Kenyan health sector relies heavily on out-of-pocket payments. 0000008166 00000 n
there is no explicit purchaser-provider split. . Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Sparkes S, Durn A, Kutzin J. 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. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. 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]. the allocation of pooled funds to health service We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. 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. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. 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. %%EOF
To understand the components of a health system. the allocation of pooled funds to health service providers [ 1 ]. 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. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. PS is a health systems adviser working in the WHO Country Office of Tunisia. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. Table1 outlines the respective features under each. As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. 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. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. 0000005125 00000 n
poverty status) or costs of serving the population of a specific region (e.g. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. 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. Geneva: World Health Organization; 2008. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 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. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. 2014;29:71731. A conclusion and lessons are presentedat the end. 2011;13(7):1190. 0000000016 00000 n
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The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Google Scholar. In any country, prepaid health revenues may be held, i.e. 0000005327 00000 n
While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. ), (7.) health financing functions and objectives . Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. Collectively, they work to meet the physical and mental health care needs of Australians. 0000002097 00000 n
Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. It also describes Ghana's health financing system. Fragmentation is further aggravated, as a small part of the better-off population is often enrolled in commercial voluntary health insurance, whilst a small share of people in the informal sector may enroll in voluntary community-based health insurance schemes [41, 42]. 2023 BioMed Central Ltd unless otherwise stated. World Health Organization. Lancet. Definition. Thailand Health Systems in Transition. Cite this article. Its main purpose is to share the financial risk associated with health . The company has multiple offices in the U.S. and program offices in more than 40 countries. HdSK0sNH{`9i
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Implementing health financing reform: lessons from countries in transition. Advances in health economics and health services research, volume 21. Overview Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 2001;56(3):171204. Fragmentation in pooling arrangements. This entity pools public funding, i.e. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. 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. Figure 1. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 2019;97:33548. endstream
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Pools can be based on compulsory, automaticor voluntary participation. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 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. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Health Financing. These latter three were replaced by a new health coverage scheme that was introduced in 2002, called the Universal Coverage Scheme (UCS), as a response to growing concerns about the huge differences in level of funding per capita across the schemes and the remaining coverage gap due to the failure of the voluntary insurance to reach much of the informal sector. 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