In: Figueras J, editor. Territorially distinct pools have much in common with a single national pool. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. 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. 0000035307 00000 n Health Financing in Ghana. A multiple pool setup can be based on population segmentation, i.e. All people have in principle access to the same benefits. Each of the insurance schemes thus constitutes a separate pooling agency. 0000005327 00000 n Capacity strengthening of the MSP will also be an important component of this program. Forum for Health Economics & Policy; 1998: 1 (1). Gautier J. This is due to two related reasons. 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. Many others receive poor quality of services even when they pay out-of-pocket. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Formula funding of health services: learning from experience in some developed countries. 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. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Pettigrew LM, Mathauer I. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. Bull World Health Organ. 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]. Paris: OECD; 2011. Advances in health economics and health services research, volume 21. 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. To ensure key development programmes are adequately funded [5,6]. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. 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. 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. Health Policy. Hungary, Bull World Health Organ. For illustration we provide various country examples. 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). Busse R, Blmel M. Germany. %%EOF Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. . Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. Pooling arrangements set the potential for redistributive health spending. different pools for different socio-economic groups with population segmentation; (5.) It has important similarities with the (2.) 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). Article Soors W, Devadasan N, Durairaj V, Criel B. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. The Health Financing Specialist will be based in the Abt office in Antananarivo. Inke Mathauer. This is the so-called death spiral of voluntary health insurance [24]. 0000080023 00000 n Int J Equity Health. 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. Even in countries with highly centralized pooling, there are usually several pools of funds that are used to pay for some health services, for example occupational health programs, supply-side funding for other government services such as those delivered through vertical programs or voluntary health insurance [1]. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. In particular, the aim in both is to match the level of per capita funding of each pool with the relative health risk of the population affiliated to each pool. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. 0000001757 00000 n WHO Regional Office for Europe: Copenhagen; 2016. These are 1) the nature of pooling and 2) the structure of pooling. Wahshginton DC: World Bank; 2005. These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. kem ZG, akar M. What have health care reforms achieved in Turkey? 0000014993 00000 n Management has five main functions: planning, organising, leading, coordinating and control. Health financing for universal coverage and health system performance: concepts and implications for policy. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 787 0 obj <> endobj &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Article 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. 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]. What are the functions of health financing mechanisms? The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. World Health Organization. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. There are different classifications for finance functions, and it varies with organization types. type of pooling arrangement, namely territorially distinct pools. 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. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Taken quite literally, perhaps no country has only one single pool. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Health financing policy brief no. [3] Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. The function of pooling and the ways that countries organize this is critical for countries progress towards universal health coverage, but its potential as a policy instrument has not received much attention. Smith PC. 2019;97:33548. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. Bingley: Emerald Group Publishing; 2009. p. 291312. Strategic purchasing for universal health coverage: key policy issues and questions. 6. Google Scholar. Geneva: World Health Organization; 2016. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. 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. Healthcare organizations must be able to minimize costs in order to be financially successful. 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. Self-paced (approximately 6 hours of course time) Click to enter this course 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. 8. 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. This is commonly referred to as a competitive social health insurance arrangement. Baeza CC, Packard TG. %PDF-1.5 % the allocation of pooled funds to health service providers [1]. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. 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. 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. 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. Hatfield (South Africa): CMS; 2016. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. There are also some concerns, however. Implementing health financing reform: lessons from countries in transition. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. Insurers with individual choice of insurer and compulsory participation data processing for Geriatric services... Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius are., coordinating and control some of the initially insured population groups civil servants another! 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