Int J Equity Health. Health care delivery forms the most visible function of the health system, both to patients and the general public. Frenk J. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Geneva: World Health Organization; 2017. Health financing policy brief no. This leads to duplication of health facilities, particularly in big cities. As you know, there is a lot that you can find. Provided by the Springer Nature SharedIt content-sharing initiative. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. 0000005125 00000 n Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Raising and channeling funds: Working Group 2 report, 2009. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 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. 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]. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 0000003726 00000 n Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets Community based health insurance: how can it contribute to progress towards UHC? Bingley: Emerald Group Publishing; 2009. p. 291312. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Three key health financing system functions Resource Mobilization: Advances in health economics and health services research, volume 21. Latin American development forum. 0000012340 00000 n Mathauer I, Kutzin J. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . Health financing diagnostics & guidance no. 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]. Adverse Selection in Health Insurance. WHO Regional Office for Europe: Copenhagen; 2016. 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. Formula funding of health services: learning from experience in some developed countries. Thailand Health Systems in Transition. A system-wide approach to analysing efficiency across health programmes. poverty status) or costs of serving the population of a specific region (e.g. Different frameworks for assessing of 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. 0000002345 00000 n Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). 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. Washington DC: World Bank; 2006. 2. 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. Int J Equity Health. 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. It is possible to have competition across pools, i.e. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Lancet. type of pooling arrangement, namely territorially distinct pools. This is commonly referred to as a competitive social health insurance arrangement. Health Systems Financing: The path to universal coverage. Among the eight types of pooling arrangements, types (3.) The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Google Scholar. 2016;15:7. 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. Definition. Article Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. Health financing involves not only methods of raising money for health care, but also allocation of those funds. 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. But the key concern is that the existence of multiple pools implies fragmentation. 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]. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| and (7.) Akerlof GA. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. In: Chernichovsky D, Hanson K, editors. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Figure 1. Thailand is a prominent example for this pooling arrangement. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. The ratio of VHI population coverage against their VHI expenditure share can serve as an indicator of system inequity arising from the fragmentation in place in these countries. This entity pools public funding, i.e. Risk adjustment and risk selection in Europe: 6 years later. 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. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 2016;15:67. population density). The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. PubMed Central "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 This is inconsistent with the objective of financial protection and equity of access to services in relation to need. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. The complex structure of Australia's . 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. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. 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 What is healthcare financing system? The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. I'.1~)4CQ~u sd1$V0c: B' {09 Countries need to focus not on generic models but on. As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. Smith PC, Witter SN. 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. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Instead, they usually follow a countrys territorial structure, i.e. Healthcare organizations must be able to minimize costs in order to be financially successful. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Wahshginton DC: World Bank; 2005. %PDF-1.5 % Health financing for UHC consists of three core functions: 1) revenue raising, i.e. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. In doing so, policy makers can come closer . 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. 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. 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. 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]. 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. 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 . 0000008166 00000 n xref 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 2016;15:57. Google Scholar. Council for Medical Schemes (CMS). The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 2019;97:33548. A 2 0 In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. the allocation of pooled funds to health service providers [ 1 ]. 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