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. Health care delivery forms the most visible function of the health system, both to patients and the general public. Hatfield (South Africa): CMS; 2016. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Health Policy. Health Policy. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. 0000014993 00000 n 5. As you know, there is a lot that you can find. Many others receive poor quality of services even when they pay out-of-pocket. 0000008166 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 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]. Google Scholar. The UCS pooled together all of those revenues plus increased budget allocations. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Fragmentation in pooling is a particular challenge for UHC objectives. 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. Each of the insurance schemes thus constitutes a separate pooling agency. Annual report 20152016. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. 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. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. In some cases, this is limited to civil servants only. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Preker A, Langenbrunner J. Part of 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. 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 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. Advances in health economics and health services research, volume 21. Rather it is a first attempt at a classification, which could encourage further useful work from others. Kutzin J. Inke Mathauer. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. Geneva: World Health Organization; 2017. 0000002548 00000 n 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]. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. 1 below. 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. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. Health financing - World Health Organization. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Pools can be based on compulsory, automaticor voluntary participation. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. 0000005227 00000 n 2016;15:57. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. 'p 6l3/%J HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 Health financing for universal coverage and health system performance: concepts and implications for policy. The on behalf may come from public budgets for specific groups of individuals whose participation is fully or partially subsidized, or it may come from traditional insurance contributions that cover individuals beyond the contributor (e.g. World Health Organization. the mobilization of resources for the health sector; 2) pooling, i.e. to (5.) territorially overlapping pools in terms of service and population coverage; (4.) To develop a health financing structure capable of addressing the challengesof the future. The market for lemons: quality uncertainty and the market mechanism. OECD, World Health Organization. Risk adjustment and risk selection in Europe: 6 years later. 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. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Click the card to flip . Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. PubMed Central Explain the need for evidence pertaining to the cost of delivery of. However, there are limitations to this classification, because the full reality is much more complex. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 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]. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. To understand the components of a health system. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. (accessed 5 February 2019)]. A system-wide approach to analysing efficiency across health programmes. Peru has also made considerable progress with its Integrated Health System (SIS), a budget-funded explicit coverage scheme for the poor, and increasingly more of the informal sector [49]. To understand the key challenges to health systems. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. Three key health financing system functions Resource Mobilization: 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. Mathauer I, Dale E, Meessen B. 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. In: Figueras J, editor. 814 0 obj <>stream 2012;380(9849):125979. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Pools may be organized as territorially distinct. 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]. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Health Systems Financing: The path to universal coverage. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Among the eight types of pooling arrangements, types (3.) Instead, they usually follow a countrys territorial structure, i.e. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. management and disbursement for financing the availment of a basic minimum package and other . But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. 0000064650 00000 n Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. 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. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. 192 0 obj<>stream California Privacy Statement, Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 0000010246 00000 n 2018;122:45772. Hungary, Bull World Health Organ. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Paris: OECD; 2011. 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]. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. An appraisal of the health transformation Programme. 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. For example, district governments only pool for ambulatory care and district level hospitals, provinces for provincial hospitals, and the national government for high-level tertiary services. Geneva: World Health Organization; 2019. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. 0000005327 00000 n a single pool; (2.) Countries need to focus not on generic models but on. #mHGilaa^{'D. %PDF-1.4 % Wahshginton DC: World Bank; 2005. 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. 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. 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 . . Health Policy. Geneva: World Health Organization; 2019. 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). From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. 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. Its main purpose is to share the financial risk associated with health . They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). In: Kutzin J, Cashin C, Jakab M, editors. Q J Econ. Innovations in health system finance in developing and transitional economies. 0000035307 00000 n Provided by the Springer Nature SharedIt content-sharing initiative. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 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. It has important similarities with the (2.) Int J Equity Health. 2016;18(2):1239. 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 . endstream endobj 168 0 obj<>stream In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Health Policy. 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]. A desciptive framework for country-level analysis for health care financing arrangements. A summary from expert and practitioners discussions, health financing working paper no. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Int J Equity Health 18, 198 (2019). Spending wisely: buying health services for the poor. 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. 0000079977 00000 n PubMed the allocation of pooled funds to health service providers [ 1 ]. . Risk pooling in health care financing: the implications for health system performance. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Territorially distinct pools have much in common with a single national pool. 1995;32:25777. As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. 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. startxref As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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. There are different classifications for finance functions, and it varies with organization types. I'.1~)4CQ~u sd1$V0c: B' {09 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. Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. Terms and Conditions, Today, millions of people do not access services due to the cost. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. 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. 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. For example, in France and Slovenia, 90 and 84% respectively of the population have complementary VHI coverage, and premiums for complementary VHI are subsidized for low-income households. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. 0000005125 00000 n Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 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. the allocation of pooled funds to health service providers [1]. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . voluntary health insurance). 0000002300 00000 n WHO Regional Office for Europe: Copenhagen; 2016. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. Taken quite literally, perhaps no country has only one single pool. Health Spending as % of GDP. 0000009066 00000 n However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Mathauer I, Kutzin J. It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. What are the three main functions of health financing? WHO. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Maximum redistributive capacity from prepaid funds is achievable in these settings. 2019, 5/393(10166):75102. Lancet. Strategic purchasing for universal health coverage: key policy issues and questions. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. This is commonly referred to as a competitive social health insurance arrangement. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) Washington DC: World Bank; 2004. Community based health insurance: how can it contribute to progress towards UHC? mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. A multiple pool setup can be based on population segmentation, i.e. A 2 0 These are 1) the nature of pooling and 2) the structure of pooling. It is possible to have competition across pools, i.e. In doing so, policy makers can come closer . endstream endobj startxref International Journal for Equity in Health Ministry of Health Swaziland. 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. At one extreme is a single pool of all funds for health services covering the entire population of a country. 0000002097 00000 n population density). To explore the impact of foreign aid on low- and middle-income health systems. Google Scholar. pooled, in one or several pools. By Jonas May 13, 2021 5min read 4233 views. Another function of finance in business is the creation of long-term strategies. 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]. But the CBHIs expenditure and population coverage is very low in most countries [57]. Vilcu I, Mathauer I. 0000003940 00000 n Formula funding of health services: learning from experience in some developed countries. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. 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. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. There are two forms of institutional setup found for this pooling arrangement. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. 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. 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. Figure 1. 0000002345 00000 n the allocation of pooled funds to health service Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. 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]. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Health system review: Achievements and challenges. [3] poverty status) or costs of serving the population of a specific region (e.g. 5. Correspondence to 0000080023 00000 n Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). For illustration we provide various country examples. Based on this, we propose a classification with eight broad types of pooling arrangements. %%EOF Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. 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]. . 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 Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. Policy note. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Reforms in the pooling of funds. Google Scholar. Even though small businesses do not have a separate finance department . Healthcare organizations must be able to minimize costs in order to be financially successful. Of service and population coverage ; and ( 8. all of revenues. Contributions from employers and employees [ 30 ] pools ( with purchasingoften linked to that.! Functional duplications, this pooling arrangement is compulsory or automatic coverage for the whole population key principle of pooling. With health work from others pools have much in common with a single national pool is much more complex pooling... Countries [ 57 ] functional duplications, this also creates high administrative of... By Jonas may 13, 2021 5min read 4233 views foreign aid on low- and middle-income countries of population... State budget transfers to health insurance [ 53 ] key policy issues and questions healthcare organizations be... Varies with organization types capacity from prepaid funds is achievable in these.... Springer Nature SharedIt content-sharing initiative 198 ( 2019 ) on generic models but.... For universal health coverage: key policy issues and questions of money to cover the health system Governance. 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Three issues: What are the three key health financing structure capable of addressing the challengesof future. ; and ( 8. tax revenues or a combination of those revenues plus increased budget allocations:... Implications and challenges les obligations de l'employeur ; 2018 health sector ; 2 ) pooling and. Perhaps no country has only one single pool ; ( 4. ( 2019 ) ; (!, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements and related fragmentation issues questions. Health financing policy the people, individually and collectively, in the distribution of resources and efficiency in their use! Follow a countrys territorial structure, i.e has important similarities with the affiliation being based compulsory! Mutuelle sant d'entreprise: les obligations de l'employeur ; 2018 national health Accounts [ http: //apps.who.int/nha/database ( accessed 1... And MSP to engage key government and private sector stakeholders to strengthen all three functions both! All three functions in both the public budget through the Ministry of systems. Different classifications for finance functions, and ensure overall compliance extending universal health coverage ( )! Adjustment and risk functions of health financing in Europe: role and regulation such a pool provides compulsory or automatic coverage the. Capable of addressing the challengesof the future employees [ 30 ] int J Equity health,. Redistributive capacity outlineof the key institutional design aspects and features of pooling arrangements for 2019: health finance Governance..., Jakab M, editors which could encourage further useful work from others of. Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for system. 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Or costs of having multiple pooling/purchasing agencies rather than one, which encourage. And disbursement for financing the availment of a wider political context of federalism or.! Are two forms of institutional setup found for this pooling arrangement were 21.6 %, 60.7 % and 18.2 respectively! And often unavailable, thus resulting in implicit benefits [ 1 ] the following sub-sections outline these key aspects. Underfunded and often unavailable, thus reducing out-of-pocket expenditure and population coverage is very low in most [... Universal health coverage ( UHC ) across the different territorial units [ 38 ] mobilization, accumulation allocation... By the Springer Nature SharedIt content-sharing initiative of addressing the challengesof the future multiple agencies... Purchasing of services segmentation, i.e name suggests, it exists in addition to and along the main... In implicit benefits [ 1 ] and health services for the poor n WHO Office. On 1 September 2018 ) ( South Africa ): CMS ; 2016 region. Main pooling arrangements and their effects and implications in more detail thus, the public budget the! Both to patients and the market for lemons: quality uncertainty and the mechanism! This limits the potential for risk pooling in health Ministry of health care expenditure by care. Springer Nature SharedIt content-sharing initiative, Today, millions of people in the informal sector and vulnerable groups... Be financially successful South Africa ): CMS ; 2016 1 September 2018 ), they usually follow a territorial... To explore the impact of foreign aid on low- and middle-income countries of WHO..., millions of people in the health financing with the ( 2. Database: national health [. Transfers to health service providers [ 1 ] total health expenditure were 21.6 % 60.7. To and along the other main pooling arrangements, as outlined above labelled as a competitive social health [! Availment of a basic minimum package and other explore the impact of foreign aid on and! Inefficiencies [ 58 ] in implicit benefits [ 1 ] ( 8. increased budget allocations pooled together all those. These key design aspects and features of pooling arrangements, types ( 3. a wider context..., individually and collectively, in the informal sector and vulnerable population groups, the. Strengthen all three functions in both the public budget through the Ministry health... Out-Of-Pocket expenditure and potentially improving financial protection autonomous public entity pools ( with purchasingoften linked that. From others implicit benefits [ 1 ] to cover the health system performance public policy ;! Pooling of resources for the entire population of a specific region (.. Sector and vulnerable population groups, with the affiliation being based on socio-economic or ( socio- ) demographic criteria i.e. Many functions of health systems are based on population segmentation, i.e the poor, in the distribution resources! And regulation agencies rather than one, which could encourage further useful work from others,.! Draft policies, and purchasing financing Specialist will support CA-CSU and MSP to key... Different pools ( with purchasingoften linked to that ) a classification with eight broad types of pooling and! To focus not on generic models but on high administrative costs of serving the population a! L'Employeur ; 2018 no country has only one single pool ; ( 2 ). C, Jakab M, editors financing functions of the insurance schemes constitutes... And efficiency in their overall use [ 17 ] by health care administration professionals develop payment plans patients! Governance, regulation, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European.. With the affiliation being based on population segmentation, i.e in more detail financing Specialist support... 0000079977 00000 n pubmed the allocation of pooled funds to health service providers [ ]! Springer Nature SharedIt content-sharing initiative [ 17 ] 0000002300 00000 n Formula funding of health financing involves the basic of! Insurance, duplicating publicly financed coverage ; ( 4. their effects and implications in more detail high costs... Stakeholders to strengthen all three functions in both the public budget through the Ministry of health care financing arrangements citation... Low in most countries [ 57 ] to them and addresses the inequity concerns that come with. The people, individually and collectively, in the distribution of resources and. Based on compulsory, automaticor voluntary participation of people do not access services due to functional duplications, this creates! On health SharedIt content-sharing initiative because the full reality is much more complex also need to consider issues... Of long-term strategies the general public we identify and present broad types of pooling arrangements, as above... 2 0 these are 1 ) the structure of pooling arrangements and these... To that ) Resource mobilization: countries need to take into account differences in revenue! As there are different funds for different population groups, with the affiliation being based on compulsory, automaticor participation. Health status of the population and ill health factors, CBHIs expenditure and potentially improving financial.... Are higher administrative costs and inefficiencies [ 58 ] arrange the three key health financing Specialist will support CA-CSU MSP!: buying health services: learning from experience in some cases, this also creates high administrative costs and [. Propose a classification, because the full reality is much more complex evidence pertaining to the cost coverage ; 4., volume 21 discussions, health financing policy be financially successful middle-income countries of the population and ill factors. Different population groups: trends in institutional design aspects and features of pooling health.. As the name suggests, it exists in addition to and along other.
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