Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. 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. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Formula funding of health services: learning from experience in some developed countries. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. To understand the components of a health system. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. -U+:V\GCs2C /L7w0X-O`>2h?! general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. 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. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. 1970;84(3):488500. Purchasing health services for universal health coverage: how to make it more strategic? Health Systems in Transition. 1: World Health Organization, 2015. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. World Health Report 2010 Technical Brief Series - Technical Brief No. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. Maximum redistributive capacity from prepaid funds is achievable in these settings. Health Policy. Policy note. SMG 1117A.641 . !{~4nf0QMh92]Ta, *eIF 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]. (accessed 5 February 2019)]. %%EOF Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. Each of the insurance schemes thus constitutes a separate pooling agency. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. 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. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. To discuss Malawi as a case study in health systems. 1995;32:25777. Frenk J. CAS 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 ]. the allocation of pooled funds to health service To explore the impact of foreign aid on low- and middle-income health systems. Table1 outlines the respective features under each. Pooling arrangements set the potential for redistributive health spending. 2. Conversely, schemes that have voluntary membership, i.e. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 2014;16(1). 0000080000 00000 n 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 Annual report 20152016. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. A system of health accounts. 4. By Jonas May 13, 2021 5min read 4233 views. #mHGilaa^{'D. 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. 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]. https://doi.org/10.1093/heapol/czt054. Washington DC: World Bank; 2006. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Advances in health economics and health services research, volume 21. 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. Article WHO Regional Office for Europe: Copenhagen; 2016. Innovations in Health System Finance in Developing and Transitional Economies. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Geneva: World Health Organization; 2017. At one extreme is a single pool of all funds for health services covering the entire population of a country. Then, within each health financing function, key performance issues and associated measurable indicators are developed. 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. 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. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. Three key health financing system functions Resource Mobilization: the allocation of pooled funds to health service providers [1]. This was supplemented with information gathered from our professional work on health financing in countries around the world. Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . Adverse Selection in Health Insurance. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. But the key concern is that the existence of multiple pools implies fragmentation. Innovations in health system finance in developing and transitional economies. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 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. International Journal for Equity in Health Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Int J Equity Health. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. 0000006049 00000 n sicker individuals would have to pay more because they would need more health services [18]. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. Sometimes, these arrangements include a purchaser-provider split. 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]. 2016;18(2):1239. 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. 0000000016 00000 n RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. ), (7.) Geneva: World Health Organization; 2019. For any given level of prepaid funds in a health system, the specific features in these two key design aspects determine the redistributive capacity of those funds to support access to needed services with financial protection, and they have important implications for efficiency. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Figure 1. 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. management and disbursement for financing the availment of a basic minimum package and other . Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. Lancet. 0000002345 00000 n 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. It is possible to have competition across pools, i.e. 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. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. there must be a specific contribution made by or on behalf of the covered person. World Health Organization. Baeza CC, Packard TG. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. 2019;97:33548. 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. to (5.) Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. 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. 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. a sub-national pool per state, province or district. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. Department of Health and Human Services The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. WHO. 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. Health Policy. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Management has five main functions: planning, organising, leading, coordinating and control. Article As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? 3. 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. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. 0000010246 00000 n Taken quite literally, perhaps no country has only one single pool. 2S?dI9c{rP"=-Gsi1NU@ 0000074834 00000 n Geneva: World Health Organization; 2017. 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