Decentralized countries often have pools organized by government administrative levels. 2017;17(1):145. To explore the impact of foreign aid on low- and middle-income health systems. To develop a health financing structure capable of addressing the challengesof the future. Service public pro. Jowett M, Kutzin J. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 To ensure key development programmes are adequately funded [5,6]. 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. Health Systems in Transition. agencies that manage pools (typically insurance schemes) compete for members. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Background paper no. Results The Kenyan health sector relies heavily on out-of-pocket payments. 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. Innovations in health system finance in developing and transitional economies. 3. 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]. It serves multiple purposes, e.g. Health Policy. Kutzin J. 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. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. 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. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. Geneva: World Health Organization; 2017. Frenk J. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Health financing involves not only methods of raising money for health care, but also allocation of those funds. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. the allocation of pooled funds to health service providers [1]. PubMed 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. Cite this article. 2019, 5/393(10166):75102. 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. 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. Collectively, they work to meet the physical and mental health care needs of Australians. Smith PC, Witter SN. 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. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. Department of Health and Human Services 0000005125 00000 n 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. Purchasing to improve health system performance. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. Int J Equity Health. 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]. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. 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). xref Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. health financing functions and objectives . In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. The third function of health care financing is purchasing of services. Library of Parliamentarians: Ottawa; 2011. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about However, in some instances, this pooling set up may only be territorially distinct on paper. 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. volume18, Articlenumber:198 (2019) 2013;91(8):60211. 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. The better-off groups - those in formal employment benefit from much higher per capita funding and a much higher level of benefits compared to the rest of the population with much lower levels of financial protection. In any country, prepaid health revenues may be held, i.e. PS is a health systems adviser working in the WHO Country Office of Tunisia. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. A conclusion and lessons are presentedat the end. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Smith PC. 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). different pools for different socio-economic groups with population segmentation; (5.) to (5.) 0000035307 00000 n The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. %PDF-1.4 % This is commonly referred to as a competitive social health insurance arrangement. The Health Financing Specialist will be based in the Abt office in Antananarivo. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. 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. <]>> 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. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Bingley: Emerald Group Publishing; 2009. p. 291312. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. 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. Figure 1. Part of hb```c, A system-wide approach to analysing efficiency across health programmes. Forum for Health Economics & Policy; 1998: 1 (1). Geneva: World Health Organization; 2008. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. What are the four major services and healthcare? U;c!=(i\s 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. 0000009066 00000 n Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. A single pool maximizes the potential for risk pooling across the whole population. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. Financial Management Functions. World Health Report 2010 Technical Brief Series - Technical Brief No. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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. 6. Many others receive poor quality of services even when they pay out-of-pocket. HGF guidance document no. WHO Regional Office for Europe: Copenhagen; 2016. Agency's Mandate and Functions Mandate. CAS https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Mathauer I, Dale E, Jowett M, Kutzin J. 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 0000014993 00000 n 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 ]. Gautier J. "Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic 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. Geneva: World Health Organization; 2017. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Privacy 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]. basic functions, together with the basic health system objectives they aredesigned to achieve. 2018;122:45772. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Therefore, maximizing the potential to redistribute from lower-need to higher-need individuals by de-linking contributions (of whatever form, such as taxes or insurance premiums) from their health risk is the central objective for pooling. 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. 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]. The company has multiple offices in the U.S. and program offices in more than 40 countries. 0000064650 00000 n At the sub-national and health facility levels, programs strengthen the capacity for budgeting and financial management to increase accountability, reduce waste, and ensure that provider incentives are aligned with improved health outcomes. 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. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 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. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Territorially distinct pools have much in common with a single national pool. 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. 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. 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. 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]. 0000002300 00000 n This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. World Health Organization. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. IM, PS and JK developed the outline and framework. Structured pluralism: towards an innovative model for health system reform in Latin America. Key facts 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. Article Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 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]. Insights into the structure of and mechanisms for pooling arrangements and how can! 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