1.2.1. Int J Equity Health. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. . Jowett M, Brunal MP, Flores G, Cylus J. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd To explore the impact of foreign aid on low- and middle-income health systems. . The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. 0000001864 00000 n Thailand is a prominent example for this pooling arrangement. 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. 0000013724 00000 n 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 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. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. there must be a specific contribution made by or on behalf of the covered person. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. The Health Financing Specialist will be based in the Abt office in Antananarivo. Article Int J Equity Health. 2013;91(8):60211. 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. there is no explicit purchaser-provider split. Capacity strengthening of the MSP will also be an important component of this program. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Health Care Syst Transit. Int J Equity Health 18, 198 (2019). The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. 192 0 obj<>stream The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. 2018;11(11). Analysis was performed in line with the various NHA entities and health system financing functions. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. View below: When viewing on a desktop, maximize for optimized view. 1 below. California Privacy Statement, A single pool maximizes the potential for risk pooling across the whole population. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. 0000080023 00000 n Google Scholar. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. As such, automatic entitlement is typically solely funded from general budget revenues. 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. Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . sicker individuals would have to pay more because they would need more health services [18]. In a well-functioning healthcare system, the financing of healthcare is defined by three key functions: (1) revenue generation, which involves the mobilization and collection of funds from different sources; (2) resource pooling, where generated revenue is accumulated to ensure availability to the population in need; and (3) the purchasing Google Scholar. Figure 3.1 highlights these. Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland, World Health Organization, Tunis, Tunisia, You can also search for this author in It is possible to have competition across pools, i.e. 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. 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. 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 eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Lancet. PubMed family members). Gautier J. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. World Health Report 2010 Technical Brief Series - Technical Brief No. PubMed By using this website, you agree to our In doing so, policy makers can come closer . Google Scholar. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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. Taskforce on Innovative International Financing for Health Systems. 0000079977 00000 n 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. 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 Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Article Collectively, they work to meet the physical and mental health care needs of Australians. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. 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. 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. 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]. There are also some concerns, however. 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]. Washington DC: World Bank; 2006. OECD reviews of health systems: Switzerland 2011. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). territorially distinct pools; (3.) Revenue collection is how health systems raise money from households, businesses, and external sources. agencies that manage pools (typically insurance schemes) compete for members. U;c!=(i\s Sparkes S, Durn A, Kutzin J. Comprehensive policy analysis for health system reform. 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 0000011158 00000 n Spending targets for health: no magic number. Implementing health financing reform: lessons from countries in transition. Washington DC: World Bank; 2006. This has an adverse impact on equity in resources across pools. 0000002191 00000 n Springer Nature. 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]. Health system review. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. 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]. Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. Thomson S. What role for voluntary health insurance? 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. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. 0000005227 00000 n 2015;119(9):115363. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Its main purpose is to share the financial risk associated with health . Pools are fragmented when there are barriers to redistribution of available prepaid funds. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 0000035307 00000 n Vilcu I, Probst L, Dorjsuren B, Mathauer I. Higher income persons are usually more likely to have this form of VHI [51]. The complex structure of Australia's . 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]. Maximum redistributive capacity from prepaid funds is achievable in these settings. People who have higher risks are just as covered as people who have lower risks. Geneva: World Health Organization; 2010. Sometimes, these arrangements include a purchaser-provider split. and (7.) Results The Kenyan health sector relies heavily on out-of-pocket payments. 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. Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. 0000002345 00000 n In some cases, this is limited to civil servants only. Geneva: World Health Organization; 2019. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Table1 outlines the respective features under each. 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. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 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 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. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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