Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. 0000005327 00000 n The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. to (5.) However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. A system of health accounts. the mobilization of resources for the health sector; 2) pooling, i.e. 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. PubMed Central 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. 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. 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. Raising and channeling funds: Working Group 2 report, 2009. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Health Policy. This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. Table1 outlines the respective features under each. Bingley: Emerald Group Publishing; 2009. p. 291312. 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 quest for universal health coverage: achieving social protection for all in Mexico. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Health Policy. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. An additional layer of complexity is that in many countries several forms of fragmentation exist. Kutzin J. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. To understand the key challenges to health systems. A desciptive framework for country-level analysis for health care financing arrangements. 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. 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. Heal Policy Plan. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Formula funding of health services: learning from experience in some developed countries. 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. Health Policy. The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Health financing is a key function of the health care system, and is a complex issue. PubMed The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. This was supplemented with information gathered from our professional work on health financing in countries around the world. 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. there is one fund for the population in that one territory. Service public pro. 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. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 0000010947 00000 n 0000003940 00000 n 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. PubMed Health (Just Now) WebHealth financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. By using this website, you agree to our They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Today, millions of . California Privacy Statement, Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Inke Mathauer. Financing systems need to be specifically designed to provide all people with access to needed health services (including prevention, promotion, treatment, and rehabilitation) of sufficient quality to be effective; and to ensure that the use of these services does not expose the user to financial hardship. 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. 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. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Int J Equity Health. 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. Jowett M, Brunal MP, Flores G, Cylus J. 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. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. Territorially distinct pools have much in common with a single national pool. Geneva: World Health Organization; 2017. Alternatively, in a non-competitive arrangement, people could be assigned to specific pools, with enrollment being based on explicit criteria, so that the different pools cannot compete for beneficiaries [11]. Cutler DM, Zeckhauser RJ. 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]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. Google Scholar. 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). family members). 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]. 0000011158 00000 n 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. 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. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. Health Financing in Ghana. A multiple pool setup can be based on population segmentation, i.e. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. 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]. World Health Organization. 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. 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]. To develop reform strategies towards achieving universal health coverage core functions: 1 revenue! 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