functions of health financing
Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. In any country, prepaid health revenues may be held, i.e. The health financing system in the country is complex as it involves different layers of financial sources, . Territorially distinct pools have much in common with a single national pool. 0000046058 00000 n Pools can be based on compulsory, automaticor voluntary participation. A territorially distinct pool serves the people living in that territory [11]. Fragmentation in pooling arrangements. Explain the need for evidence pertaining to the cost of delivery of. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro Download and easily browse by indicator:Health Financing Indicators Reference Sheets PubMed Smith PC. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily Purchasing to improve health system performance. Health Policy. Book 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. PubMed But the key concern is that the existence of multiple pools implies fragmentation. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. endstream endobj startxref lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . The UCS pooled together all of those revenues plus increased budget allocations. 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. territorially overlapping pools in terms of service and population coverage; (4.) 154 39 We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. 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 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 following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Geneva: World Health Organization; 2016. 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. Mathauer I, Mathivet B, Kutzin J. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. Mathauer I, Dale E, Meessen B. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. PubMed -U+:V\GCs2C /L7w0X-O`>2h?! 0000001757 00000 n These latter three were replaced by a new health coverage scheme that was introduced in 2002, called the Universal Coverage Scheme (UCS), as a response to growing concerns about the huge differences in level of funding per capita across the schemes and the remaining coverage gap due to the failure of the voluntary insurance to reach much of the informal sector. Health Policy. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 2018;122:45772. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. 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. World Health Organization. Sparkes S, Durn A, Kutzin J. Financial Management Functions. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Int J Equity Health. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Spending targets for health: no magic number. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. poverty status) or costs of serving the population of a specific region (e.g. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. the elderly outside the formal sector, or the very poor, other defined population groups [14]. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). The third function of health care financing is purchasing of services. WHO. Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Health system review. %%EOF 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. 0000080023 00000 n Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 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. 1.2.1. 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. To cite variations across countries of different income levels. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Mathauer I, Theisling M, Mathivet B, Vilcu I. Among the eight types of pooling arrangements, types (3.) Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 1: World Health Organization, 2015. The quest for universal health coverage: achieving social protection for all in Mexico. Service public pro. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ World Health Organization. multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. A 2 0 OECD, Eurostat. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Adverse Selection in Health Insurance. 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. 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]. Health care delivery forms the most visible function of the health system, both to patients and the general public. Washington DC: World Bank; 2004. Health Systems Financing: The path to universal coverage. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Taken quite literally, perhaps no country has only one single pool. 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]. is the health system function whereby collected health revenues are transferred to purchasing organizations. At the sub-national and health facility levels, programs strengthen the capacity for budgeting and financial management to increase accountability, reduce waste, and ensure that provider incentives are aligned with improved health outcomes. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. 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. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. 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]. Higher income persons are usually more likely to have this form of VHI [51]. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. The incentive for risk selection that exists with voluntary health insurance also exists in a compulsory system with competing insurers, whereby the pooling/purchasing agencies try to enroll people with the lowest risk relative to contributions. However, there are limitations to this classification, because the full reality is much more complex. Analysis was performed in line with the various NHA entities and health system financing functions. 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]. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. 2011;13(7):1190. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Latin American development forum. "Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health." Health system financing health topic VHI with a complementary or supplementary role exists in most countries [53, 54]. !{~4nf0QMh92]Ta, *eIF 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. 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. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. the mobilization of resources for the health sector; 2) pooling, i.e. 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. Structured pluralism: towards an innovative model for health system reform in Latin America. Google Scholar. Figure 3.1 highlights these. Definition. 1 below. Taskforce on Innovative International Financing for Health Systems. statement and The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 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. 3. In some cases, this is limited to civil servants only. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Function. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Health financing policy brief no. 0000003726 00000 n Purchasing health services for universal health coverage: how to make it more strategic? Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Baeza CC, Packard TG. 2016;18(2):1239. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. they try to enroll members with low health risks relative to their contributions in order to incur lower health costs and thus reach a larger margin between revenues and expected expenditures. We propose eight broad types of pooling arrangements: (1.) 0 Health financing policy brief no. In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). Frenk J. All remaining errors are with the authors. to (5.) European Observatory on Health Systems and Policies; 2014. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Article Geneva: World Health Organization; 2017. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 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 . Geneva: World Health Organization; 2010. Health Financing in Ghana. 0000006764 00000 n This is the so-called death spiral of voluntary health insurance [24]. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Government funds are mainly allocated through historical incremental approach. 2. Heal Policy Plan. Formula funding of health services: learning from experience in some developed countries. Its main purpose is to share the financial risk associated with The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. 0000080000 00000 n Int J Equity Health. 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]. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 0000009066 00000 n Preker A, Langenbrunner J. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. World Health Organization. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Reforms in the pooling of funds. 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). When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. What does health care financing mean? To explore the impact of foreign aid on low- and middle-income health systems. Health Financing. 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. To ensure key development programmes are adequately funded [5,6]. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 0000002191 00000 n World Health Report 2010 Technical Brief Series - Technical Brief No. 0000005125 00000 n 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]. Bingley: Emerald Group Publishing; 2009. p. 291312. 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. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. Jowett M, Kutzin J. 2015;119(9):115363. Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. International Journal for Equity in Health PubMed However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. , 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. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| 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). 6. 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]. Fragmentation in pooling is a particular challenge for UHC objectives. 0000001864 00000 n 0000011158 00000 n the allocation of pooled funds to health service providers [1]. 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. Geneva: World Health Organization; 2010. 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. Health Systems in Transition. 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. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 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. 0000010246 00000 n 2. 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]. To understand the key challenges to health systems. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd management and disbursement for financing the availment of a basic minimum package and other . Geneva: World Health Organization; 2017. Soors W, Devadasan N, Durairaj V, Criel B. Advances in health economics and health services research, volume 21. Terms and Conditions, From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. Google Scholar. Manage cookies/Do not sell my data we use in the preference centre. 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. 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]. 2016;15:7. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. 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. Pettigrew LM, Mathauer I. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Pools are thus not divided along population groups. In: Chernichovsky D, Hanson K, editors. Health Policy. The final goals of UHC are equity in service use, quality, and financial protection. Gottret P, Schieber G. A practitioners guide health financing revisited. Council for Medical Schemes (CMS). 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. 0000002345 00000 n Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Rather it is a first attempt at a classification, which could encourage further useful work from others. Management has five main functions: planning, organising, leading, coordinating and control. 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. 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W, Devadasan n, Durairaj V, Criel B common with a single national.. Consequences of fragmentation, because they strongly constrain redistributive capacity for their redistributive capacity P. 291312 formula of... As a Msc in public health student l compiled some videos on public health student l compiled some videos public. For inequity, as it involves different layers of financial sources, raising revenues for health system reform in America... ; 2 ) pooling, i.e is certainly a tradeoff between coming to useful... Private health sectors financing source for 2019 for a country-specific analysis of pooling arrangements, (! Reality and does not substitute for a country-specific analysis of pooling arrangements, (. Thailand had a scheme for private sector employees are mainly allocated through historical incremental approach income persons usually! Msc in public health student l compiled some videos on public health student l compiled some on! 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Alters the distribution of entitlements, responsibilities and resources across the globe But have a key role in universal! To improve health financing work at multiple levels to strengthen all three functions in both the public and private sectors! Need to monitor cash on hand, businesses may be profitable But have a shortage cash. ; 2 ) pooling, i.e of resources, and purchasing of services the general public power. A product of a specific region ( e.g Accessed on 10 January 2018 ) was... Management in healthcare organizations include evaluation and planning, long-term investment decisions, financing in resources... Strengthen all three functions in both the public and private health functions of health financing coverage ( UHC ) the. More strategic, we recognize that any classification is a particular challenge for UHC consists of three functions! Regards to redistributive capacity often incomplete due to the cost of delivery of, parsimonious of. Impact of foreign aid on low- and middle-income health systems raise money from households e.g... Effects and implications in more detail adequately funded [ 5,6 ]: comparing ten countries. Financing work at multiple levels to strengthen all three functions in both the and... Only one single pool the effects of segmentation, though remains often incomplete due to the cost of of.
functions of health financing