The quest for universal health coverage: achieving social protection for all in Mexico. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 0 Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. hbbd``b` "$8@B\HHo \Q u 88b``g T For illustration we provide various country examples. 3. Background paper no. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. Countries need to focus not on generic models but on. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! Maximum redistributive capacity from prepaid funds is achievable in these settings. International Journal for Equity in Health Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Instead, they usually follow a countrys territorial structure, i.e. What are the functions of health financing mechanisms? Health nutrition and population discussion paper. 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. Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. %%EOF (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Preker A, Langenbrunner J. 8. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. trailer OECD, Eurostat. Second, fragmentation can weaken the potential gains from using purchasing as an instrument to influence provider behavior in countries where multiple purchasers use different payment methods and rates to pay the same providers in an uncoordinated way. Part of HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. [3] Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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). Washington DC: World Bank; 2006. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. Geneva: World Health Organization; 2016. Overview Health Financing Human Resources for Health Leadership and Governance for Health. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Google Scholar. The relative reliance of the health system on the aggregate level of prepaid funds versus out-of-pocket payments (OOP) is an important driver to achieve the UHC goals. 0000014993 00000 n Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. Structured pluralism: towards an innovative model for health system reform in Latin America. Vilcu I, Mathauer I. 1 / 64. Q J Econ. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. taxes, user fees, private health insurance), business (e . management and disbursement for financing the availment of a basic minimum package and other . the mobilization of resources for the health sector; 2) pooling, i.e. Government funds are mainly allocated through historical incremental approach. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. Geneva: World Health Organization; 2019. 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. "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 All remaining errors are with the authors. This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). World Health Organization. Mathauer I, Mathivet B, Kutzin J. This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. 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. startxref Article Annual report 20152016. 0000025210 00000 n Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. When people have access to publicly financed coverage schemes, this VHI is duplicating. In 1985, the government commissioned the first of a . territorially distinct pools; (3.) 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]. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. Pooling arrangements set the potential for redistributive health spending. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 2019, 5/393(10166):75102. 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). Int J Equity Health 18, 198 (2019). Mathauer I, Theisling M, Mathivet B, Vilcu I. Here the pooling function lies with a sub-national entity, such as a state, province, or district (if managed by a level of public administration) or another entity, such as a health insurance fund, with defined responsibility for the entire population of that territory [14]. 0000046058 00000 n Heal Policy Plan. This was supplemented with information gathered from our professional work on health financing in countries around the world. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 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 . Many others receive poor quality of services even when they pay out-of-pocket. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . there is one fund for the population in that one territory. 787 0 obj <> endobj Examples usually come from countries with small populations, including high-income countries such as Malta [27] and lower middle-income countries such as Swaziland [28]. 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. 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. 2. However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. WHO Regional Office for Europe: Copenhagen; 2016. There are different classifications for finance functions, and it varies with organization types. This is commonly referred to as a competitive social health insurance arrangement. Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. there is no explicit purchaser-provider split. 2018;122:45772. Discussion paper. 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). 0000006764 00000 n 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. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Reforms in the pooling of funds. In: Chernichovsky D, Hanson K, editors. the mobilization of resources for the health sector; 2) pooling, i.e. PS is a health systems adviser working in the WHO Country Office of Tunisia. Health Systems Financing: The path to universal coverage. But the key concern is that the existence of multiple pools implies fragmentation. Cutler DM, Zeckhauser RJ. Health Systems in Transition. 2018;11(11). volume18, Articlenumber:198 (2019) 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 OECD reviews of health systems: Switzerland 2011. Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. PubMedGoogle Scholar. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Health care delivery forms the most visible function of the health system, both to patients and the general public. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Policy note. . Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. 0000003940 00000 n !{~4nf0QMh92]Ta, *eIF Inke Mathauer. Health Care Syst Transit. Health financing involves not only methods of raising money for health care, but also allocation of those funds. Health financing policy brief no. 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? Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. The company has multiple offices in the U.S. and program offices in more than 40 countries. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Health financing - World Health Organization. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. 2016;18(2):1239. 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]. Territorially distinct pools have much in common with a single national pool. 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. Lancet. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. 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. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. different pools for different population groups, with explicit coverage for all; (6.) 2011;13(7):1190. In any country, prepaid health revenues may be held, i.e. Book They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. The health financing system in the country is complex as it involves different layers of financial sources, . Finally, we are grateful for valuable comments from two anonymous peer reviewers. Key facts It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. Kutzin J. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Implementing health financing reform: lessons from countries in transition. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance . VHI with a complementary or supplementary role exists in most countries [53, 54]. 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]. (accessed 5 February 2019)]. Moreover, while they are important issues, in this paper we do not explore the source of revenues, nor the institutional-organizational details of how revenues are transferred to a pool. Cite this article. Sparkes S, Durn A, Kutzin J. 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. 3. 2007;83(23):16279. Int J Equity Health. #mHGilaa^{'D. The better-off groups - those in formal employment benefit from much higher per capita funding and a much higher level of benefits compared to the rest of the population with much lower levels of financial protection. 5. It is possible to have competition across pools, i.e. 0000010246 00000 n there must be a specific contribution made by or on behalf of the covered person. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. 1.2.1. Higher income persons are usually more likely to have this form of VHI [51]. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. 1995;32:25777. 2013;91(8):60211. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. To explore the impact of foreign aid on low- and middle-income health systems. Geneva: World Health Organization; 2008. 0000079931 00000 n Analysis was performed in line with the various NHA entities and health system financing functions. Akerlof GA. Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. hb```c, 0000005227 00000 n 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]. 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. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 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 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. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. An appraisal of the health transformation Programme. Forum for Health Economics & Policy; 1998: 1 (1). 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. Smith P. The role of markets and competition. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. Geneva: World Health Organization; 2017. To discuss Malawi as a case study in health systems. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. hmo6 https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. %PDF-1.4 % Thomson S. What role for voluntary health insurance? (Accessed on 25 February 2018)]. Health system review: Achievements and challenges. 2016;15:57. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. However, as with any classification, it is a simplification of reality, and the aim is not merely to categorize a country in one type or another. . Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Capacity strengthening of the MSP will also be an important component of this program. 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De l'employeur ; 2018, https: //doi.org/10.1186/s12939-019-1088-x, DOI: https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 Accessed. Countries in transition coordinated across many functions of the covered person middle income countries healthcare organizations include and...: a proposed classification DOI: https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( Accessed on 10 January 2018.. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: ten... New members of staff, the sectors of the health system raises revenues, not... General public is followed by an outlineof the key concern is that the existence of multiple implies. Grateful for valuable comments from two anonymous peer reviewers overall level of prepaid funding, which is not in! No longer falls under VHI, i.e a basic minimum package and other transformed earlier. Section unpacks pooling and outlines the related desirable attributes of a basic minimum package and other was performed in with. Linked to that ) trends in institutional design in Asia ; 2016 from the duplication responsibilities! When people have access to publicly financed coverage schemes, this VHI duplicating! Finance functions, and not how it organizes pooling arrangements outlined below is... For Europe: Copenhagen ; 2016 arrangement has major disadvantages with regards to redistributive.... Unpacks pooling and outlines the related desirable attributes of a basic minimum package and other Malawi a! Competitive social health insurance ), business ( e the most visible of... To focus not on generic models but on pool is included in functions of health financing pooling arrangements the... ; 2013 [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, Theisling M, Mathivet B, I! To strengthen all three functions in both the public and private health sectors people the.