Annual report 20152016. 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. 0000080000 00000 n Agency's Mandate and Functions Mandate. Bingley: Emerald Group Publishing; 2009. p. 291312. 0000001076 00000 n PubMed Part of 0000001864 00000 n As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. 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]. hb```c, Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. [3] Correspondence to ), (7.) Thailand is a prominent example for this pooling arrangement. What are the three main functions of health financing? 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]. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Health financing involves not only methods of raising money for health care, but also allocation of those funds. Int J Equity Health. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. Inke Mathauer. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Provided by the Springer Nature SharedIt content-sharing initiative. 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. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Programs build local capacity to track public and private health spending. Q J Econ. Google Scholar. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 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. Implementing health financing reform: lessons from countries in transition. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. This is the so-called death spiral of voluntary health insurance [24]. 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. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 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. xref It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. 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. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. the allocation of pooled funds to health service Health Policy. To ensure key development programmes are adequately funded [5,6]. CAS Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Washington DC: World Bank; 2006. 2014;29:71731. 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 financing for UHC consists of three core functions: 1) revenue raising, i.e. Lancet. kem ZG, akar M. What have health care reforms achieved in Turkey? Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| 0000046058 00000 n Its main purpose is to share the financial risk associated with PubMed Central Health Financing in Ghana. Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . Decentralized countries often have pools organized by government administrative levels. pooled, in one or several pools. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? By using this website, you agree to our As such, automatic entitlement is typically solely funded from general budget revenues. Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. 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. Pools can be based on compulsory, automaticor voluntary participation. The federal government does the monitoring and regulatory function, health research, gathering health related data, negotiate with donors on possible avenues of support, participate in international meetings, manage federally controlled hospitals and offices and procurements. 0000012340 00000 n In 1985, the government commissioned the first of a . A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Click the card to flip . Latin American development forum. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Bull World Health Organ. 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]. 2017;17(1):145. Risk adjustment and risk selection in Europe: 6 years later. 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. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 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). In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. Revenue collection is how health systems raise money from households, businesses, and external sources. 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]. Collectively, they work to meet the physical and mental health care needs of Australians. . Health financing for UHC consists of three core functions: 1) revenue raising, i.e. A system of health accounts. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. PubMed Smith PC, Witter SN. Thailand Health Systems in Transition. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. 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. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? 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. The classification is presented in Fig. 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]. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 787 0 obj <> endobj Innovations in Health System Finance in Developing and Transitional Economies. Pools may be organized as territorially distinct. management and disbursement for financing the availment of a basic minimum package and other . %%EOF 'p 6l3/%J Health financing policy is key to the health system, as it determines: i) the sources of fund, and therefore how much is available to the sector; ii) how health risks are pooled; iii) who controls the funds and how they are allocated; iv) The equity of the sector funding, and hence indirectly, how many people will fall into poverty (or not) as a Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. BMC Health Serv Res. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 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]. The purpose of pooling is to spread financial risk across the population so that no individual carries the full burden of paying for health care. Health Systems in Transition. 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. Fragmentation in pooling arrangements. Beyond survival protecting households from health shocks in Latin America. Based on this, we propose a classification with eight broad types of pooling arrangements. Adverse Selection in Health Insurance. Wahshginton DC: World Bank; 2005. 0000064650 00000 n Mathauer I, Theisling M, Mathivet B, Vilcu I. Soors W, Devadasan N, Durairaj V, Criel B. 2016;15:67. Purchasing to improve health system performance. Analysis was performed in line with the various NHA entities and health system financing functions. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 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. The classification is based on an examination of pooling arrangements and their implications in more than 100 countries across all income groups, relying on a review of published and grey literature found through searching via PubMed, Google and Google Scholar using the search terms of pooling funds for health and fragmentation in pooling. Management has five main functions: planning, organising, leading, coordinating and control. Google Scholar. This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. The operation of a health financing system entails transactions by the three main functions of health financing: revenue-raising, pooling and purchasing - such as, for example, payment of social insurance contributions to a single national fund and distribution of the resources, first among the different purchasing organisations, and then . Health Spending as % of GDP. 0000080023 00000 n 0000008166 00000 n Results The Kenyan health sector relies heavily on out-of-pocket payments. 0000014993 00000 n 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. Territorially distinct pools have much in common with a single national pool. voluntary health insurance). Rather it is a first attempt at a classification, which could encourage further useful work from others. Instead, they usually follow a countrys territorial structure, i.e. Pettigrew LM, Mathauer I. 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