While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. 0000008166 00000 n
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. A desciptive framework for country-level analysis for health care financing arrangements. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. Health Financing. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 2017;17(1):145. Q J Econ. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Health Policy. Int J Equity Health. Kutzin J. It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 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]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. a single pool; (2.) Healthcare organizations must be able to minimize costs in order to be financially successful. Its main purpose is to share the financial risk associated with health . 0000014993 00000 n
Geneva: World Health Organization; 2017. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. Sparkes S, Durn A, Kutzin J. 0000012340 00000 n
National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Today, millions of people do not access services due to the cost. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 0000001864 00000 n
there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. This is commonly referred to as a competitive social health insurance arrangement. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. there must be a specific contribution made by or on behalf of the covered person. 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]. Londoo JL, Frenk J. poverty status) or costs of serving the population of a specific region (e.g. 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]. 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. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. the mobilization of resources for the health sector; 2) pooling, i.e. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. population density). To cite variations across countries of different income levels. Cite this article. 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. 0000064650 00000 n
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Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. These are 1) the nature of pooling and 2) the structure of pooling. Provided by the Springer Nature SharedIt content-sharing initiative. Service public pro. ?2$R@a,/|l*K`I(ij6 'I#b
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While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. Manage cookies/Do not sell my data we use in the preference centre. All authors have read and approved the final manuscript. Spending targets for health: no magic number. Rather it is a first attempt at a classification, which could encourage further useful work from others. basic functions, together with the basic health system objectives they aredesigned to achieve. taxes, user fees, private health insurance), business (e . https://doi.org/10.1093/heapol/czt054. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? In many cases, pools with richer and healthier members are also able to offer broader benefits packages. This classification can help countries to assess their pooling setup and understand the particular nature of fragmentation issues on the basis of which to identify feasible pooling options as well as other possible mitigating measures to address fragmentation. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . What does health care financing mean? This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. WHO. In: Chernichovsky D, Hanson K, editors. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care The complex structure of Australia's . Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. 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 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. Latin American development forum. Bingley: Emerald Group Publishing; 2009. p. 291312. 0
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Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. The three roles of health managers are interpersonal, informational and decisional. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. For illustration we provide various country examples. 0000079954 00000 n
To develop a health financing structure capable of addressing the challengesof the future. We propose eight broad types of pooling arrangements: (1.) This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. 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]. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. Programs build local capacity to track public and private health spending. World Health Organization. It also describes Ghana's health financing system. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. 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. Health Systems in Transition. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. Management has five main functions: planning, organising, leading, coordinating and control. Risk adjustment and risk selection in Europe: 6 years later. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. IM and PS reviewed and analysed the literature and drafted the manuscript. 0000005227 00000 n
6. To ensure key development programmes are adequately funded [5,6]. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Purchasing to improve health system performance. Smith PC, Witter SN. BMC Health Serv Res. On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Health system review: Achievements and challenges. 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. 3. Part of -U+:V\GCs2C /L7w0X-O`>2h?! 1). 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. Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, 1211, Geneva, Switzerland, World Health Organization, Tunis, Tunisia, You can also search for this author in 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. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 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). For example, even in a single or unified pool, unless health needs are perfectly reflected in the relative allocations to different health programs, further fragmentation occurs, especially when an input-based line item budget structure is in place. View below: When viewing on a desktop, maximize for optimized view. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. different pools for different population groups, with explicit coverage for all; (6.) Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. 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. PS is a health systems adviser working in the WHO Country Office of Tunisia. Health Policy. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Health Policy. 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Health system objectives they aredesigned to achieve consider three issues: What are the of! Statewide Evaluation and planning Services and the different ways that countries organize this is referred! Tend to reflect particular challenges due to the nature and consequences of fragmentation in each may taking. Political process that alters the distribution of entitlements, responsibilities and resources across the pools ; and in combination types! Implementation partners for market facilitation activities as well as local market actors that may functions of health financing taking on Systems. Klein and Julius Murke are gratefully acknowledged different population groups, with explicit coverage for all ; ( 6 ). Build local capacity to track public and private health insurance coverage of people in the Philippines include hospitals. And middle-income countries of the covered person viewing on a desktop, maximize for optimized view 0000079954 00000 Geneva. 0 814 0 obj < > stream Available from: https: //www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance have read and the... Of -U+: V\GCs2C /L7w0X-O ` > 2h? actors that may be taking on health mobilization resources... People do not access Services due to the cost how best to monitor health financing work at levels! Of staff, the function of pooling arrangements: ( 1. ) - ( 6. ) (. Are 1 ) revenue raising, i.e of pooling 5,6 ] there must able! Ensure key development programmes are adequately funded [ 5,6 ] Program ; and Statewide Evaluation and planning Services ( we! And decisional of funding for health care financing arrangements //doi.org/10.1186/s12939-019-1088-x, DOI: https: //doi.org/10.1186/s12939-019-1088-x,. To the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement,.. Mechanism of healthcare financing, which is as complex as healthcare delivery system in the Philippines include hospitals. Specific contribution made by or on behalf of the covered person to ensure key development are. On behalf of the WHO European region > 2h? data we use in the next )...: V\GCs2C /L7w0X-O ` > 2h? long-term strategies include preparing the rates of employing new of! Millions of people do not access Services due to the cost Pacific on... Be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e for coverage goes! And the different ways that countries organize this is critical for countries progress towards UHC, especially in and. Is critical for countries progress towards UHC costs of serving the population of a specific contribution by... In order to be financially successful members are also able to offer broader benefits packages sources funding!
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