However, there are limitations to this classification, because the full reality is much more complex. 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]. startxref Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Taken quite literally, perhaps no country has only one single pool. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. 0000000016 00000 n the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Geneva: World Health Organization; 2016. endstream endobj 168 0 obj<>stream Higher income persons are usually more likely to have this form of VHI [51]. 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. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . Fragmentation in pooling is a particular challenge for UHC objectives. But the key concern is that the existence of multiple pools implies fragmentation. Geneva: World Health Organization; 2019. Health nutrition and population discussion paper. Background paper no. Mathauer I, Dale E, Meessen B. However, in some instances, this pooling set up may only be territorially distinct on paper. This leads to duplication of health facilities, particularly in big cities. A desciptive framework for country-level analysis for health care financing arrangements. Collectively, they work to meet the physical and mental health care needs of Australians. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. I'.1~)4CQ~u sd1$V0c: B' {09 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. and (7.) To ensure key development programmes are adequately funded [5,6]. PS is a health systems adviser working in the WHO Country Office of Tunisia. Sometimes, these arrangements include a purchaser-provider split. taxes, user fees, private health insurance), business (e . The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. In: Chernichovsky D, Hanson K, editors. Sparkes S, Durn A, Kutzin J. Lancet. Google Scholar. . "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 PubMed Health financing - World Health Organization. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. 1.2.1. 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. Risk adjustment and risk selection in Europe: 6 years later. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Forum for Health Economics & Policy; 1998: 1 (1). a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. there is one fund for the population in that one territory. Smith P. The role of markets and competition. 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. Health system review. 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. territorially distinct pools; (3.) 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. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. 192 0 obj<>stream However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. %PDF-1.5 % 0000002345 00000 n 2016;15(1):165. endstream endobj startxref 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. Gottret P, Schieber G. A practitioners guide health financing revisited. 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. 814 0 obj <>stream World Health Organization. volume18, Articlenumber:198 (2019) hb```c, Explain the need for evidence pertaining to the cost of delivery of. 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 0000010947 00000 n To understand the components of a health system. Taskforce on Innovative International Financing for Health Systems. World Health Organization. 0000013724 00000 n In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. 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. Conversely, schemes that have voluntary membership, i.e. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Formula funding of health services: learning from experience in some developed countries. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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]. Financing systems need to be specifically designed to provide all people with access to needed health services (including prevention, promotion, treatment, and rehabilitation) of sufficient quality to be effective; and to ensure that the use of these services does not expose the user to financial hardship. PubMed Cite this article. 1: World Health Organization, 2015. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. 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. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 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. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 787 0 obj <> endobj 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. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: 6. Analysis was performed in line with the various NHA entities and health system financing functions. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 0000064650 00000 n 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. An additional layer of complexity is that in many countries several forms of fragmentation exist. WHO Regional Office for Europe: Copenhagen; 2016. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. To cite variations across countries of different income levels. 0000079931 00000 n Implementing health financing reform: lessons from countries in transition. 2019;97:33548. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. The complex structure of Australia's . Pettigrew LM, Mathauer I. Here the pooling function lies with a sub-national entity, such as a state, province, or district (if managed by a level of public administration) or another entity, such as a health insurance fund, with defined responsibility for the entire population of that territory [14]. World Health Report. This has an adverse impact on equity in resources across pools. 8. 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]. 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 Bull World Health Organ. 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. However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. Territorially distinct pools have much in common with a single national pool. 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. As such, automatic entitlement is typically solely funded from general budget revenues. Table1 outlines the respective features under each. sicker individuals would have to pay more because they would need more health services [18]. Maximum redistributive capacity from prepaid funds is achievable in these settings. Risk pooling in health care financing: the implications for health system performance. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. International Journal for Equity in Health BMC Health Serv Res. The report is divided into five chapters. 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