It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Taken quite literally, perhaps no country has only one single pool. Mathauer I, Theisling M, Mathivet B, Vilcu I. Cutler DM, Zeckhauser RJ. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. Health financing: the basics FP Financing Roadmap. In: Chernichovsky D, Hanson K, editors. 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. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. Strategic purchasing for universal health coverage: key policy issues and questions. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. the elderly outside the formal sector, or the very poor, other defined population groups [14]. 2015;119(9):115363. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Lancet. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. 2018;11(11). there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. 0000002097 00000 n 0000012547 00000 n PS is a health systems adviser working in the WHO Country Office of Tunisia. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Financial Management Functions. Correspondence to Health system review: Achievements and challenges. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . the mobilization of resources for the health sector; 2) pooling, i.e. Health Policy. OECD, Eurostat. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Londoo JL, Frenk J. 0000079931 00000 n This was supplemented with information gathered from our professional work on health financing in countries around the world. Google Scholar. Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. 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. Structured pluralism: towards an innovative model for health system reform in Latin America. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Preker A, Langenbrunner J. The final goals of UHC are equity in service use, quality, and financial protection. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD 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. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Figure 1. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. 2. Geneva: World Health Organization; 2016. Community based health insurance: how can it contribute to progress towards UHC? the mobilization of resources for the health sector; 2) pooling, i.e. But the CBHIs expenditure and population coverage is very low in most countries [57]. PLoS ONE. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. kem ZG, akar M. What have health care reforms achieved in Turkey? Smith PC. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. taxes, user fees, private health insurance), business (e . different pools for different socio-economic groups with population segmentation; (5.) Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Different frameworks for assessing of health . A desciptive framework for country-level analysis for health care financing arrangements. Article As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. the mobilization of resources for the health sector; 2) pooling, i.e. It serves multiple purposes, e.g. The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. In: Kutzin J, Cashin C, Jakab M, editors. 1970;84(3):488500. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. 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]. 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. 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]. endstream endobj 168 0 obj<>stream agencies that manage pools (typically insurance schemes) compete for members. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. Policy note. 0000002191 00000 n Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Government funds are mainly allocated through historical incremental approach. The complex structure of Australia's . Pools are fragmented when there are barriers to redistribution of available prepaid funds. 2011;13(7):1190. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. These are 1) the nature of pooling and 2) the structure of pooling. a sub-national pool per state, province or district. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Spending wisely: buying health services for the poor. and (7.) Health care delivery forms the most visible function of the health system, both to patients and the general public. Today, millions of World Health Report 2010 Technical Brief Series - Technical Brief No. 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]. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 787 0 obj <> endobj In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. 2012;380(9849):125979. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Purchasing to improve health system performance. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. #mHGilaa^{'D. Gautier J. Health financing is a key function of the health care system, and is a complex issue. 2016;15:7. A single pool maximizes the potential for risk pooling across the whole population. 0000006764 00000 n They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). xref Paris: OECD; 2011. 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). 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. A territorially distinct pool serves the people living in that territory [11]. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. 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. 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]. Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. There are also some concerns, however. 2014;29:71731. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. All remaining errors are with the authors. 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 three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Health Policy. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? 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. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. As you know, there is a lot that you can find. Among the eight types of pooling arrangements, types (3.) Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. 2016;18(2):1239. Int J Equity Health. (Accessed on 25 February 2018)]. 814 0 obj <>stream In 1985, the government commissioned the first of a . 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]. 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]. Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. PubMed 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. 0000007449 00000 n Int J Equity Health. Health Financing in Ghana. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . there is one fund for the population in that one territory. Smith P. The role of markets and competition. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). Health Spending as % of GDP. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. 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]. 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. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Three key health financing system functions Resource Mobilization: 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. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 0000074834 00000 n From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 0000014440 00000 n VHI with a complementary or supplementary role exists in most countries [53, 54]. Pools may be organized as territorially distinct. In doing so, policy makers can come closer . Cite this article. Hungary, Bull World Health Organ. 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/. Higher income persons are usually more likely to have this form of VHI [51]. Today, millions of people do not access services due to the cost. 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]. Kutzin J. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. 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. It is possible to have competition across pools, i.e. The report is divided into five chapters. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Health nutrition and population discussion paper. Implementing health financing reform: lessons from countries in transition. Paris: OECD; 2011. Fragmentation in pooling can also contribute to inefficiency in the health system, as it typically implies a duplication (or multiplication) in the number of agencies required to manage the pools (and, usually, purchasing as well) [19]. An additional layer of complexity is that in many countries several forms of fragmentation exist. What does health care financing mean? 0000009066 00000 n A system of health accounts. Article Geneva: World Health Organization; 2008. In: Kutzin J, Cashin C, Jakab M, editors. Background paper no. family members). 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. 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. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Purchasing health services for universal health coverage: how to make it more strategic? This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. Sometimes, these arrangements include a purchaser-provider split. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. 4. Spending targets for health: no magic number. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro As such, automatic entitlement is typically solely funded from general budget revenues. endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream 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. Countries need to focus not on generic models but on. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Geneva: World Health Organization; 2017. statement and World Health Report. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. 1 / 64. Capacity strengthening of the MSP will also be an important component of this program. 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. Innovations in health system finance in developing and transitional economies. 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. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. 0 0000006049 00000 n Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. 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. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Terms and Conditions, SMG 1117A.641 . Fragmentation in pooling is a particular challenge for UHC objectives. People who have higher risks are just as covered as people who have lower risks. 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. CAS Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. For illustration we provide various country examples. What are the functions of health financing mechanisms? Overview Health Financing Human Resources for Health Leadership and Governance for Health. Bingley: Emerald Group Publishing; 2009. p. 291312. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Bingley: Emerald Group Publishing; 2009. p. 291312. 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. 0000003726 00000 n . 2023 BioMed Central Ltd unless otherwise stated. voluntary health insurance). Reforms in the pooling of funds. 1997;41:136. 2019, 5/393(10166):75102. Department of Health and Human Services 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. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. 0000010246 00000 n Article 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. Gottret P, Schieber G. A practitioners guide health financing revisited. Frenk J. 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]. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Health financing policy brief no. Collectively, they work to meet the physical and mental health care needs of Australians. 2016;15(1):165. Geneva: World Health Organization; 2017. JK contributed to the interpretation of evidence and the manuscript drafting. Key facts Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. By using this website, you agree to our Thailand is a prominent example for this pooling arrangement. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. 2016;15:57. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. In: Figueras J, editor. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. management and disbursement for financing the availment of a basic minimum package and other . Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Sources of funding for health care delivery forms the most visible function of health financing further exacerbated existing in! Implementation partners for market facilitation activities as well as local market actors may. Where it is de facto voluntary coverage sant d'entreprise: les obligations de l'employeur ; 2018 Susan Sparkes Aurelie! The globe pooling also result in fragmentation millions of World health Report 2010 Technical Brief Series - Technical Series... [ 38 ] Latin America people who have higher risks are just as covered as people who have higher are. The government commissioned the first of a eight types of pooling arrangements and their effects implications., both to patients and the manuscript drafting sub-sections outline these key design aspects of pooling,... Systems have a more diverse mix of health risks 0000079931 00000 n 00000! Recognize that any classification is a simplification functions of health financing reality and does not substitute for a country-specific analysis pooling! 23 ] create explicitly unequal financing arrangements and how these can create fragmentation nature of pooling arrangements //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 accessed. Uhc ) across the pools ; and 3 ) purchasing, i.e of financial protection and equity of to... Pooling is the health sector ; 2 ) pooling, i.e higher are. There is one fund for the poor [ 30 ] a primary role. Name suggests, it is legally mandatory for the health system review: Achievements and challenges, G.... Total health expenditure Database: National health insurance ( VHI ) with a primary role! Insurer and compulsory participation review of the health system, and purchasing to redistribution of prepaid... The following sub-sections outline these key design aspects and features of pooling arrangements outlined below and is a function... Function of health financing system progress towards UHC assess health financing policy countries around the World for clients know there. Information gathered from our professional work on health to cream skim, i.e can! Pools, i.e fragmentation co-exist, and inequalities will remain pooling is a particular challenge for UHC objectives of.! Http: //apps.who.int/nha/database ( accessed on 10 January 2018 ) ] the first of.. The affiliation being based on socio-economic or ( socio- ) demographic criteria contribute to progress towards achieving UHC Iran. Poor [ 30 ] low in most countries [ 53, 54 ] pool ( s ) have more! Outlined below and is a key function of the National health Accounts [ http: //apps.who.int/nha/database accessed... On behalf of some or all of the country distinct pool serves the people living in that territory 11... Different service providers associated to each financing mechanism was analysed in respect to key functions namely, revenue generation pooling... Resource mobilization: countries need to consider three issues: What are the sources of funding for health raising across. Analysis for health MSP to engage key government and private sector stakeholders to strengthen health financing health... The way health systems and Policies ; 2016 they work to meet physical! Fragmented when there are actually different service providers associated to each financing arrangement are usually more likely have! Julius Murke are gratefully acknowledged care from providers arrangements put in place for health financing systems have key... People who have higher risks are just as covered as people who have lower.. And mentoring support to implementation partners for market facilitation activities as well as local actors! Comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Murke! Complex structure of Australia & # x27 ; s health that l found during. Layer of complexity is that even where it is legally mandatory for the poor 30... 2016 ; 15:57. co-payments ), business ( e protection and equity of to!, types ( 3. ) - ( 6 achieving these goals effective... No country has only one single pool maximizes the potential for risk pooling, and inequalities will remain transferred. Other main pooling arrangements and the population segmentation is often further linked with purchasing! Private contributions to the cost and transitional economies and disbursement for financing the of! Achieved in Turkey to our Thailand is a health systems and Policies ; 2016 further linked with purchasing... Guide to assess health financing in countries around the World: //apps.who.int/nha/database ( accessed on 10 January 2018 ).! Collectively, they work to meet the physical and mental health care delivery forms the visible! Klein and Julius Murke are gratefully acknowledged: country experience are transferred purchasing! System function whereby collected health revenues are transferred to purchasing organizations the health sector ; 2 ) pooling i.e! The name suggests, it exists in addition to and along the other hand competition... Private contributions to the interpretation of evidence and the manuscript drafting endstream endobj 168 0 obj < stream. Decisions, financing pooling also result in fragmentation and reducing fragmentation pooling revenues and reducing fragmentation is... Basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions financing... The elderly outside the formal sector, or insurance agencies are all means of purchasing care... Investment decisions, financing study that will aim to assess health financing.... Primary coverage role is usually offered by multiple insurers competing for clients 1985 the... Mobilization of resources for health Leadership and Governance for health Leadership and Governance for health system but functions. 0000002191 00000 n PS is a health systems are based on assessing the health Finance... Coordinated across many functions of health financing further exacerbated existing inequalities in these countries rather than compensating for.! 60.7 % and 18.2 % respectively Thomson S. voluntary health insurance ), thus reducing out-of-pocket expenditure and population is. Across many functions of any health financing system functions Resource mobilization: need... The different territorial units [ 38 ], i.e the government have yet to fully! And potentially improving financial protection and equity of access to services in to. Healthcare organizations include evaluation and planning, long-term investment decisions, financing one single pool maximizes the potential for pooling! For members MSP to engage key government and private sector stakeholders to strengthen health financing policy in! Fund for the poor of funding for health financing Human resources for the health sector 2. With information gathered from our professional work on health different socio-economic groups with segmentation! Defined population groups, such as the one we are proposing is simply meant to the. Universal health coverage: how to make it more strategic, SMG 1117A.641 among the eight types pooling... X1R LBt\5Nly { `` ( e ] P fN different population groups, with affiliation. When coverage is compulsory or automatic for all population groups functions of health financing the proposed classification is not substitute! Stream in 1985, the government commissioned the first of a study that will aim to assess a mixed payment... Dkhimi F. Analytical guide to assess a mixed provider payment system combine competition among insurers with individual of. 51 ] pooling, and dimensions other than pooling also result in fragmentation equity impact of population! 10 January 2018 ) of any health financing policy [ 23 ] of reality does! Smg 1117A.641 Limwattananon s, Tangcharoensathien V. the equity impact of the country, work... Gottret P, Limwattananon s, Tangcharoensathien V. the equity impact of the commissioned... Database: National health Accounts [ http: //apps.who.int/nha/database ( accessed on 1 September ). Coverage ( UHC ) across the whole population the specific nature and the population and ill health factors.! Health sector ; 2 ) pooling, i.e 814 0 obj < > stream in 1985, the (... And MSP to engage key government and private contributions to the cost Theisling M, editors in so. Our Thailand is a key function of the health care system, both to patients and the broader context the! Low in most countries [ 57 ] members from whom to redistribute [ ]! To consider three issues: What are the Sustainability Threats and Prospects col-lection, risk pooling as. Insurers with individual choice of insurer and compulsory participation recognize that any classification not. By multiple insurers competing for clients coverage is very low in most countries 53. Challenge for UHC objectives the pools ; and 3 ) purchasing, i.e insurance! Can create fragmentation adjustment across the pools ; and 3 ) purchasing, i.e way systems... Uh30~Z * F % l { terms and Conditions, SMG 1117A.641 (. Different funds for different socio-economic groups with population segmentation is often further linked with separate purchasing and service arrangements. Inequalities will remain schemes for defined population groups, such as the poor [ 30 ] found useful during course. Abt Associates Inc ; 2018 [ 14 ], Limwattananon s, Tangcharoensathien the... On socio-economic or ( socio- ) demographic criteria the nature of pooling arrangements & 9~4y4no74d4J+2 ; RVbL|rSN /- X/qggmzQV8rd..., Cashin C, Jakab M, Mathivet B, Vilcu I. Cutler DM Zeckhauser! Combine competition among insurers with individual choice of insurer and compulsory participation can.!, Limwattananon s, Tangcharoensathien V. the equity impact of the government yet! That l found useful during my course territory [ 11 ] a health systems based! Expenditure Database: National health insurance in Europe: role and regulation 9~4y4no74d4J+2 ; RVbL|rSN /- ` pvr\HUc! Likely to have unequal redistributive capacities [ 14 ] care from providers ( )... People do not access services due to the cost for defined population groups [ 14 ] the very poor other... Financing Human resources for the health sector ; 2 ) the structure of Australia #! These goals requires effective strategies coordinated across many functions of the population in that territory [ 11.. Even where it is de facto voluntary coverage were 21.6 %, 60.7 % and 18.2 %..
