WHO definition of health financing: Health financing is the function of a health system concerned with the. 2016;15(1):165. 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]. 1995;32:25777. 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. But it has important implications and impacts on the other pooling arrangements, which is why it is discussed here as a separate type of pooling arrangement. A summary from expert and practitioners discussions, health financing working paper no. different pools for different population groups, with explicit coverage for all; (6.) This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. 5. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Washington DC: World Bank; 2004. 0000003726 00000 n Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. Structured pluralism: towards an innovative model for health system reform in Latin America. It serves multiple purposes, e.g. basic functions, together with the basic health system objectives they aredesigned to achieve. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. Correspondence to taxes, user fees, private health insurance), business (e . Different frameworks for assessing of health . Google Scholar. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Health Spending as % of GDP. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. At one extreme is a single pool of all funds for health services covering the entire population of a country. 0000079931 00000 n People who have higher risks are just as covered as people who have lower risks. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. The third function of health care financing is purchasing of services. This entity pools public funding, i.e. Hatfield (South Africa): CMS; 2016. 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. Figure 1. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. 0000005327 00000 n Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 2. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Paris: OECD; 2011. 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. An appraisal of the health transformation Programme. This is commonly referred to as a competitive social health insurance arrangement. 2011;13(7):1190. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. Thomson S. What role for voluntary health insurance? 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. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. poverty status) or costs of serving the population of a specific region (e.g. 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. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. Mathauer I, Theisling M, Mathivet B, Vilcu I. 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. Self-paced (approximately 6 hours of course time) Click to enter this course Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. 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]. Google Scholar. 2019, 5/393(10166):75102. https://doi.org/10.1093/heapol/czt054. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. PubMed I'.1~)4CQ~u sd1$V0c: B' {09 This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. 2018;122:45772. 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]. 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. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 2016;15:7. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. 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 Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. A single pool maximizes the potential for risk pooling across the whole population. What are the four major services and healthcare? Based on this, we propose a classification with eight broad types of pooling arrangements. Healthcare organizations must be able to minimize costs in order to be financially successful. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). Community based health insurance: how can it contribute to progress towards UHC? Wahshginton DC: World Bank; 2005. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. The company has multiple offices in the U.S. and program offices in more than 40 countries. 2017;17(1):145. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. Health Policy. 2001;56(3):171204. Three key health financing system functions Resource Mobilization: However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Geneva: World Health Organization; 2008. 0000010947 00000 n [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 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. Article 1). 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. The complex structure of Australia's . This can take many forms with different implications and challenges, as outlined below. Health care delivery forms the most visible function of the health system, both to patients and the general public. ), (7.) Department of Health and Human Services Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 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. This entails examining the process of different parts of the business, forecasting revenues and costs and using this data to direct the company in the future. 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