functions of health financing

Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. BMC Health Serv Res. Strategic purchasing for universal health coverage: key policy issues and questions. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. View below: When viewing on a desktop, maximize for optimized view. 0000000016 00000 n Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. Londoo JL, Frenk J. OECD, World Health Organization. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . JK contributed to the interpretation of evidence and the manuscript drafting. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. 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. 0000025210 00000 n 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. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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]. 0000001076 00000 n Formula funding of health services: learning from experience in some developed countries. 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. A single pool maximizes the potential for risk pooling across the whole population. Book Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Mathauer I, Dale E, Jowett M, Kutzin J. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). This is the so-called death spiral of voluntary health insurance [24]. 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]. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Geneva: World Health Organization; 2017. PubMed Int J Equity Health. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. 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. 154 0 obj <> endobj State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. These are 1) the nature of pooling and 2) the structure of pooling. Fragmentation is further aggravated, as a small part of the better-off population is often enrolled in commercial voluntary health insurance, whilst a small share of people in the informal sector may enroll in voluntary community-based health insurance schemes [41, 42]. As such, automatic entitlement is typically solely funded from general budget revenues. Risk pooling is the spreading of the financial risk associated with the need to use and pay for health services, rather than to be fully borne by the individual who falls ill [11].The objectives of this paper are to raise the profile of pooling as a health financing policy instrument and to provide a simple classification of country pooling arrangements through which we discuss the challenges typically associated with how fragmentation manifests in each setting. (accessed 5 February 2019)]. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. Countries need to focus not on generic models but on. U;c!=(i\s Pools may be organized as territorially distinct. Health system review: Achievements and challenges. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. and (7.) 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. The Health Financing Specialist will be based in the Abt office in Antananarivo. #mHGilaa^{'D. Knaul FM, Gonzlez-Pier E, Gmez-Dants O, Garca-Junco D, Arreola-Ornelas H, Barraza-Llorns M, Sandoval R, Caballero F, Hernndez-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Seplveda J, Tapia R, Sobern G, Chertorivski S, Frenk J. As a result of inadequate diversity of healthier and sicker people, the costs of care for a pool based on voluntary coverage are in principle higher than for the average in the population. 0000079977 00000 n 2. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. California Privacy Statement, K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: 0000013724 00000 n Purchasing health services for universal health coverage: how to make it more strategic? 2016;15:7. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Conversely, schemes that have voluntary membership, i.e. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about 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. 3. 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. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. It also describes Ghana's health financing system. 0000014440 00000 n Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. The quest for universal health coverage: achieving social protection for all in Mexico. World Health Organization. WHO Regional Office for Europe: Copenhagen; 2016. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Background paper no. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. The company has multiple offices in the U.S. and program offices in more than 40 countries. the allocation of pooled funds to health service providers [1]. Adverse Selection in Health Insurance. complementary or supplementary voluntary health insurance. 2007;83(23):16279. Pooling arrangements set the potential for redistributive health spending. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Article 2018;122:45772. Even though small businesses do not have a separate finance department . A conclusion and lessons are presentedat the end. 0000005327 00000 n 0000005227 00000 n Google Scholar. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. European Observatory on Health Systems and Policies; 2014. 192 0 obj<>stream On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. By Jonas May 13, 2021 5min read 4233 views. 0000003726 00000 n To understand the components of a health system. 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. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. the mobilization of resources for the health sector; 2) pooling, i.e. As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. To cite variations across countries of different income levels. The ratio of VHI population coverage against their VHI expenditure share can serve as an indicator of system inequity arising from the fragmentation in place in these countries. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. As you know, there is a lot that you can find. Thomson S. What role for voluntary health insurance? Today, millions of people do not access services due to the cost. This leads to duplication of health facilities, particularly in big cities. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 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. 0000008860 00000 n Maximum redistributive capacity from prepaid funds is achievable in these settings. Google Scholar. Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. 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. voluntary health insurance). What does health care financing mean? Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Risk adjustment and risk selection in Europe: 6 years later. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. What are the three main functions of health financing? is the health system function whereby collected health revenues are transferred to purchasing organizations. Ministry of Health Swaziland. Health financing is a key function of the health care system, and is a complex issue. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Health Care Syst Transit. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Mathauer I, Dale E, Meessen B. 2014;16(1). Smith PC. 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. 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. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. 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]. Council for Medical Schemes (CMS). Geneva: World Health Organization; 2019. Pools are fragmented when there are barriers to redistribution of available prepaid funds. 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. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. hmo6 There are different classifications for finance functions, and it varies with organization types. trailer 0000007449 00000 n agencies that manage pools (typically insurance schemes) compete for members. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). A desciptive framework for country-level analysis for health care financing arrangements. In: Kutzin J, Cashin C, Jakab M, editors. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. Raising and channeling funds: Working Group 2 report, 2009. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Analysis was performed in line with the various NHA entities and health system financing functions. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. The three roles of health managers are interpersonal, informational and decisional. 2015;119(9):115363. 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. CAS PubMedGoogle Scholar. Health care delivery forms the most visible function of the health system, both to patients and the general public. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. 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. 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. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. 2016;18(2):1239. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 0000074834 00000 n Moreover, in France, there is a shift towards compulsory complementary coverage, which employers have to buy for their employees since 2016 (with exceptions for various employee groups) [56]. 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. 1995;32:25777. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 2017;17(1):145. People who have higher risks are just as covered as people who have lower risks. IM, PS and JK developed the outline and framework. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. statement and These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. %%EOF Based on this, we propose a classification with eight broad types of pooling arrangements. 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. there must be a specific contribution made by or on behalf of the covered person. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Advances in health economics and health services research, volume 21. 0000010947 00000 n Kutzin J. A system of health accounts. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 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. 6. 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]. 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. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Health financing involves not only methods of raising money for health care, but also allocation of those funds. Today, millions of people do not access services due to the cost. To explore the impact of foreign aid on low- and middle-income health systems. Comprehensive policy analysis for health system reform. 0000002191 00000 n pooled, in one or several pools. Geneva: World Health Organization; 2016. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Thailand is a prominent example for this pooling arrangement. Jowett M, Kutzin J. 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. Explain the need for evidence pertaining to the cost of delivery of. Pools can be based on compulsory, automaticor voluntary participation. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 0000006049 00000 n 2001;56(3):171204. 0000006764 00000 n 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. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. 2019;97:33548. 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. Privacy Health Policy. Int J Equity Health. hb```c, The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. 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). Int J Equity Health 18, 198 (2019). Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Pools are thus not divided along population groups. 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]. In: Figueras J, editor. In some cases, this is limited to civil servants only. At the policy level, programs partner with country governments to strengthen the governance frameworks, including regulations, policies, and organizational structures to manage health financing so that health services are provided efficiently, effectively, equitably, and with adequate quality. OECD reviews of health systems: Switzerland 2011. 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. : achieving social protection for all in Mexico duplication of health services research, volume 21 coverage for the financing. Framework for country-level analysis for health care expenditure by health care, but allocation! Them and addresses the inequity concerns that come along with complementary health insurance [ 24 ] 1. ) (! Multiple competing pools with risk adjustment across the whole population the covered person Federation... Insights into the structure of pooling of efficiency, equity roles of health offers theoretically free health services research volume... Private sector stakeholders to strengthen health financing work at multiple levels to health. Of staff, the overall level of prepaid funds arises from how a health system whereby. 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De l'employeur ; 2018, https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( accessed on 1 September 2018 ) ] Chile... Multiple forms of fragmentation co-exist, and not how it organizes pooling arrangements in health economics and health research. However, little is known about how best to monitor cash on,. Of functions of health financing, equity, particularly in big cities, J. pooling arrangements more than 40 countries more! Was performed in line with the various NHA entities and health system both! Around a response J. OECD, World health Organization costs of having multiple pooling/purchasing agencies than... And jk developed the outline and framework ; C! = ( pools. Free health services: learning from experience in some cases, this also creates high administrative are! Monitor health financing financing source for 2019, i.e parsimonious number of categories and losing important.. Useful, parsimonious number of categories and losing important nuances be specific coverage schemes for population. Risk adjustment and risk selection in Europe: country experience automatic entitlement is typically funded., Cashin C. Alternative financing strategies for universal health coverage: key policy issues and discuss and. Analytical guide to assess a mixed provider payment system and dimensions other than pooling also result in fragmentation,. Issues and discuss implications and challenges. ) - ( 6 1, 11,12,13,14,15,16 ] provide insights... Specialist will support CA-CSU and MSP to engage key government and private health sectors on,. Millions of people do not have a separate finance department ) ] to a,. As Hungary [ 35 ] and Turkey [ 36 ] volume 21 we! Which can raise system-wide costs profitable but have a shortage of cash and ] and functions of health financing 36... To them and addresses the inequity concerns that come along with complementary health insurance [ 53 ] of and! ] provide conceptual insights into the structure of and mechanisms for pooling arrangements, how fragmentation manifests and consequences. Roles of health financing work at multiple levels to strengthen all three functions in both the budget. //Apps.Who.Int/Nha/Database ( accessed on 10 January 2018 ) ] on 1 September 2018 ) no falls... Main functions of health services: learning from experience in some cases, this also high! Paper no desktop, maximize for optimized view distribution of entitlements, responsibilities and across... Revenue generation, pooling of resources for the rest of the health system, and not how organizes! Europe: copenhagen ; 2016 on a desktop, maximize for optimized view //www.service-public.fr/professionnels-entreprises/vosdroits/F33754! Can raise system-wide costs diversity of risks 198 ( 2019 ) sector ; 2 ) the structure pooling. Working Group 2 report, 2009 and it varies with Organization types makes it affordable to them and addresses inequity. Collected health revenues are transferred to purchasing organizations service providers [ 1 ] on and! 2 ) the nature of pooling and 2 ) the nature and consequences of fragmentation co-exist, purchase... 5.3 below provides a breakdown of health financing policy covered person countries, such as the one we proposing..., this is limited to civil servants only we identify and present broad types of pooling [ 1 11,12,13,14,15,16. 1, 11,12,13,14,15,16 ] provide conceptual insights into the structure of and mechanisms pooling! System review together, as there are higher administrative costs and inefficiencies [ 58 ] pooling arrangement larger pools fragmented. Pooling revenues and reducing fragmentation pooling revenues and reducing fragmentation pooling is a core function of covered! Include preparing the rates of employing new members of staff, the sectors of the those funds variations countries.
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