Health Policy. 2007;83(23):16279. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. Pools can be based on compulsory, automaticor voluntary participation. 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. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! SMG 1117A.641 (02/09/2022) 1 . Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. 1 below. World Health Organization. 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. 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. Geneva: World Health Organization; 2017. 2S?dI9c{rP"=-Gsi1NU@ 1: World Health Organization, 2015. 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream 787 0 obj <> endobj 2015;119(9):115363. Therefore, maximizing the potential to redistribute from lower-need to higher-need individuals by de-linking contributions (of whatever form, such as taxes or insurance premiums) from their health risk is the central objective for pooling. Geneva: World Health Organization; 2019. Health financing diagnostics & guidance no. VHI with a complementary or supplementary role exists in most countries [53, 54]. different pools for different socio-economic groups with population segmentation; (5.) In: Kutzin J, Cashin C, Jakab M, editors. 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 . poverty status) or costs of serving the population of a specific region (e.g. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. International Journal for Equity in Health health financing functions and objectives . 0000079977 00000 n Akerlof GA. Service public pro. there is one fund for the population in that one territory. At one extreme is a single pool of all funds for health services covering the entire population of a country. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. IM and PS reviewed and analysed the literature and drafted the manuscript. volume18, Articlenumber:198 (2019) endstream endobj 168 0 obj<>stream Health financing is a key function of the health care system, and is a complex issue. A desciptive framework for country-level analysis for health care financing arrangements. Purchasing to improve health system performance. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. 154 39 The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. 0000013724 00000 n 0000080000 00000 n The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Community based health insurance: how can it contribute to progress towards UHC? the mobilization of resources for the health sector; 2) pooling, i.e. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Health financing: the basics FP Financing Roadmap. 0000002191 00000 n 0000002300 00000 n Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. 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. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. A system-wide approach to analysing efficiency across health programmes. As such, automatic entitlement is typically solely funded from general budget revenues. 2019;97:33548. Google Scholar. Ministry of Health Swaziland. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. 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]. Health Systems in Transition. Smith P. The role of markets and competition. 201102-E 25. territorially overlapping pools in terms of service and population coverage; (4.) Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. 2014;29:71731. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Health system review. 0000014440 00000 n The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Health Policy. 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. 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. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . What are the three main functions of health financing? K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Pooling arrangements set the potential for redistributive health spending. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. An appraisal of the health transformation Programme. 0000003940 00000 n 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. Beyond survival protecting households from health shocks in Latin America. 3. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. %%EOF Health Policy. ), (7.) Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 3. 1.2.1. PS is a health systems adviser working in the WHO Country Office of Tunisia. Reforms in the pooling of funds. I'.1~)4CQ~u sd1$V0c: B' {09 0000005227 00000 n Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Hungary, Bull World Health Organ. %PDF-1.4 % But the key concern is that the existence of multiple pools implies fragmentation. 0000025210 00000 n These are 1) the nature of pooling and 2) the structure of pooling. 2016;15:7. Health Systems Financing: The path to universal coverage. Health nutrition and population discussion paper. 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 . The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Overview Health Financing Human Resources for Health Leadership and Governance for Health. 814 0 obj <>stream Int J Equity Health. 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. 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). Article New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. This is commonly referred to as a competitive social health insurance arrangement. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Washington DC: World Bank; 2006. 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. Int J Equity Health. 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functions of health financing