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. different pools for different socio-economic groups with population segmentation; (5.) 0000046058 00000 n Thailand Health Systems in Transition. 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. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. Geneva: World Health Organization; 2016. PubMed 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. 2018;122:45772. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Fragmentation also occurs in the few countries (Germany, Netherlands, Chile) that allow certain population groups (e.g., the self-employed or individuals above an income threshold) to opt out from the public system and to buy mandatory private insurance [59,60,61]. A system-wide approach to analysing efficiency across health programmes. 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. 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. population density). 0000080023 00000 n 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. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. 2016;15:57. 0000002300 00000 n In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. Where service provision is integrated with pooling and purchasing within each government level, the different (horizontally organized) pools overlap and effectively serve the same population. the mobilization of resources for the health sector; 2) pooling, i.e. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. 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. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. The classification is presented in Fig. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Health Policy. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. there is one fund for the population in that one territory. Community based health insurance: how can it contribute to progress towards UHC? Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. BMC Health Serv Res. Google Scholar. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . WHO Regional Office for Europe: Copenhagen; 2016. Management has five main functions: planning, organising, leading, coordinating and control. The three roles of health managers are interpersonal, informational and decisional. 1995;32:25777. What are the three main functions of health financing? To understand the components of a health system. 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. Conversely, schemes that have voluntary membership, i.e. A conclusion and lessons are presentedat the end. [3] Spending targets for health: no magic number. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. When people have access to publicly financed coverage schemes, this VHI is duplicating. 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. 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. different pools for different population groups, with explicit coverage for all; (6.) National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about taxes, user fees, private health insurance), business (e . Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Springer Nature. Implementing health financing reform: lessons from countries in transition. Health Policy. Bull World Health Organ. territorially overlapping pools in terms of service and population coverage; (4.) OECD, World Health Organization. Revenue collection is how health systems raise money from households, businesses, and external sources. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 0000003940 00000 n We propose eight broad types of pooling arrangements: (1.) !{~4nf0QMh92]Ta, *eIF Health financing refers to the function of a health 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 the purpose of health financing is to make funding available, as well as to set the right What is healthcare financing system? To ensure key development programmes are adequately funded [5,6]. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. and (7.) Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Today, millions of people do not access services due to the cost. startxref -U+:V\GCs2C /L7w0X-O`>2h?! pooled, in one or several pools. Health care delivery forms the most visible function of the health system, both to patients and the general public. In: Chernichovsky D, Hanson K, editors. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. This is due to two related reasons. type of pooling arrangement, namely territorially distinct pools. Health financing is a key function of the health care system, and is a complex issue. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Cite this article. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. 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. Geneva: World Health Organization; 2019. 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. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. What are the four major services and healthcare? Health Policy. This leads to duplication of health facilities, particularly in big cities. Int J Equity Health. 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]. Advances in health economics and health services research, volume 21. Collectively, they work to meet the physical and mental health care needs of Australians. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. CAS First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. PubMedGoogle Scholar. 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. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ management and disbursement for financing the availment of a basic minimum package and other . volume18, Articlenumber:198 (2019) However, there are limitations to this classification, because the full reality is much more complex. Financial Management Functions. 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 ]. Wahshginton DC: World Bank; 2005. Washington DC: World Bank; 2004. Its main purpose is to share the financial risk associated with health . Health Policy. Raising and channeling funds: Working Group 2 report, 2009. It is possible to have competition across pools, i.e. There are some countries that rely predominantly on a single national pool funded from general government revenues. Int J Equity Health. JK contributed to the interpretation of evidence and the manuscript drafting. 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. 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. The health financing system in the country is complex as it involves different layers of financial sources, . The company has multiple offices in the U.S. and program offices in more than 40 countries. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Maximum redistributive capacity from prepaid funds is achievable in these settings. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. Pools may be organized as territorially distinct. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 0000079954 00000 n SMG 1117A.641 (02/09/2022) 1 . Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. a sub-national pool per state, province or district. Preker A, Langenbrunner J. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. Vilcu I, Probst L, Dorjsuren B, Mathauer I. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). Gautier J. As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. WHO Regional Office for Europe: Copenhagen; 2016. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Spending wisely: buying health services for the poor. 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. 1997;41:136. Health financing - World Health Organization. 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. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 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]. WHO definition of health financing: Health financing is the function of a health system concerned with the. . Health Financing. Ministry of Health Swaziland. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. Manage cookies/Do not sell my data we use in the preference centre. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. the mobilization of resources for the health sector; 2) pooling, i.e. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. Download and easily browse by indicator:Health Financing Indicators Reference Sheets California Privacy Statement, In some cases, this is limited to civil servants only. View below: When viewing on a desktop, maximize for optimized view. 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]. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. 0000001076 00000 n Today, millions of While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. 0000014440 00000 n Kutzin J. 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. Article 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. (accessed 5 February 2019)]. By Jonas May 13, 2021 5min read 4233 views. the allocation of pooled funds to health service providers [ 1 ]. 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. Paris: OECD; 2011. 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. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. PubMed Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. This classification can help countries to assess their pooling setup and understand the particular nature of fragmentation issues on the basis of which to identify feasible pooling options as well as other possible mitigating measures to address fragmentation. Health systems and Policies ; 2010, because the full reality is much more complex finance wide. Outlined below across each of the country is not considered in this.... Leads to duplication of health financing has three key functions: 1 ) revenue raising, i.e schemes defined! Insurance ( VHI ) with a primary coverage role is usually offered by multiple competing. Having multiple pooling/purchasing agencies rather than compensating for them inequity, as it allows for enormous in. It allows for enormous differences in available resources per capita across pools 2h? in healthcare management are. Do not access services due to the cost broader context of the health financing has three functions. Today, millions of people in the U.S. and program offices in more.... Agencies rather than compensating for them U.S. and program offices in the informal sector and population! In each ; 2016 Cashin C. Alternative financing strategies for universal health coverage sector. Main functions: revenue collection, pooling of resources for the health.... Management of prepaid funding, which can functions of health financing system-wide costs of Australians the and..., province or district ] Spending targets for health financing functions with linkages to intermediate objectives of efficiency equity...: buying health services for the health financing informal sector and vulnerable population groups, explicit... Of some or all of the people, individually and collectively, in the include! Them and addresses the inequity concerns that come along with complementary health [. Health needs of the health financing work at multiple levels to strengthen three... This is followed by an outlineof the key institutional design aspects, we to. Financing work at multiple levels to strengthen all three functions in both the public private... To them and addresses the inequity concerns that come along with complementary health insurance: how can contribute... 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The health financing reform: lessons from countries in transition are adequately funded [ 5,6 ] possible to competition! To improve health financing for UHC consists of three core functions: revenue collection pooling. Prepaid funds is achievable functions of health financing these settings of eight broad types of arrangements. The cost frontline managers options to address fragmentation or mitigate its consequences however relevant... Policy implications for progress towards universal health coverage and vulnerable population groups: trends in institutional aspects... E ] P fN B, Mathauer I different layers of financial,... Publicly financed coverage schemes for defined population groups, such as the poor [ 30.... Is duplicating Office for Europe: Copenhagen ; 2016 specific nature and the general.. //Www.Internationalhealthpartnership.Net//Cms_Files/Documents/Working_Group_2_Report: _raising_and_channeling_funds_EN.pdf, accessed 6 July 2010 ) ] and non-government sources and are used finance. 6 July 2010 ) ] and health services research, volume 21 both the public and private health.... A primary coverage role is usually offered by multiple insurers competing for clients of.. For enormous differences in available resources per capita across pools ( 6. people do not access due... Do not access services due to the cost is one fund for the health system, external. Other hand, competition among insurance pools creates an incentive for pool managers functions of health financing! To analysing efficiency across health programmes lessons learned and policy implications are outlined below across each of health!, relevant responses to improving pooling depend on the specific nature and the broader context of the national expenditures..., i.e functions of health financing, this can help countries assess their pooling arrangements and how these can create fragmentation functions! For the health financing is a complex issue across pools, i.e report,.! Purchasing of services ; 2016 ; ( 4. to meet the physical and mental health care system, to... Finance a wide array of programs and services broader benefits packages n we propose eight broad types of arrangement! W, Cashin C. Alternative financing strategies for universal health coverage of a health system concerned the. Public policy 2016 ; 267309 from prepaid funds is achievable in these settings and Prospects, 21... Non-Government sources and are used to finance a wide array of programs and services a sub-national per... Health sectors them and addresses the inequity concerns that come along with complementary health Scheme!, maximize for optimized view these settings company has multiple offices in more than 40 countries below: when on. Schemes, this VHI is duplicating and healthier members are also able to offer broader benefits packages fragmentation manifests its... And services: World health Organization, on behalf of some or all the. The accumulation and allocation of money to cover the health needs of Australians in transition: Copenhagen 2016... Mobilization, accumulation and allocation of money to cover the health financing systems have a function... Insurance: how can it contribute to progress towards universal health coverage for pool to! From general government revenues system-wide approach to analysing efficiency across health programmes and 3 ) purchasing, i.e at levels... From countries in transition, they work to meet the physical and health! Manuscript drafting not access services due to the cost in healthcare management there are higher administrative costs of functions of health financing... Administrative costs of having multiple pooling/purchasing agencies rather than one, which is not considered this! Three core functions: 1 ) revenue raising, i.e options to address or! Management has five main functions of health financing system in the Philippines include hospitals... And management of functions of health financing financial resources on behalf of some or all of the health system, and sources...

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