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. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. 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. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Implementing health financing reform: lessons from countries in transition. Health Financing. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. 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. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Health financing involves not only methods of raising money for health care, but also allocation of those funds. 0000046058 00000 n
0000014440 00000 n
Int J Equity Health. Structured pluralism: towards an innovative model for health system reform in Latin America. Health Policy. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Figure 1. 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. 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. Download and easily browse by indicator:Health Financing Indicators Reference Sheets 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). Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The UCS pooled together all of those revenues plus increased budget allocations. This has an adverse impact on equity in resources across pools. CAS Londoo JL, Frenk J. 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. A conclusion and lessons are presentedat the end. 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. Latin American development forum. 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. We propose eight broad types of pooling arrangements: (1.) population density). Programs build local capacity to track public and private health spending. 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. type of pooling arrangement, namely territorially distinct pools. Article Book 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]. Analysis was performed in line with the various NHA entities and health system financing functions. 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. it is the function of a 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. 0000079954 00000 n
2018;122:45772. 0000001864 00000 n
First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. Lancet. Health Policy. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 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. Innovations in Health System Finance in Developing and Transitional Economies. 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. kem ZG, akar M. What have health care reforms achieved in Turkey? Google Scholar. 0000012340 00000 n
When people have access to publicly financed coverage schemes, this VHI is duplicating. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. 0000008166 00000 n
Figure 1. Health Systems in Transition. 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]. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Policy note. Google Scholar. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. 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. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. People who have higher risks are just as covered as people who have lower risks. Department of Health and Human Services Its main purpose is to share the financial risk associated with health . the elderly outside the formal sector, or the very poor, other defined population groups [14]. -U+:V\GCs2C /L7w0X-O`>2h?! Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Innovations in health system finance in developing and transitional economies. 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. Gautier J. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Bingley: Emerald Group Publishing; 2009. p. 291312. 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. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. The three roles of health managers are interpersonal, informational and decisional. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). Higher income persons are usually more likely to have this form of VHI [51]. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. A system of health accounts. International Journal for Equity in Health Washington DC: World Bank; 2004. There are different classifications for finance functions, and it varies with organization types. 0000074834 00000 n
PubMed Geneva: World Health Organization; 2017. 154 0 obj <>
endobj
OECD reviews of health systems: Switzerland 2011. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. SMG 1117A.641 . Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 192 0 obj<>stream
. Today, millions of people do not access services due to the cost. Fragmentation in pooling is a particular challenge for UHC objectives. Geneva: World Health Organization; 2010. World Health Report. Health Systems Financing: The path to universal coverage. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. Implementing health financing reform: lessons from countries in transition. The complex structure of Australia's . However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. To cite variations across countries of different income levels. 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]. management and disbursement for financing the availment of a basic minimum package and other . There are also some concerns, however. 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. hb```c, 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. Article Int J Equity Health 18, 198 (2019). 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. 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. territorially overlapping pools in terms of service and population coverage; (4.) 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. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. 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. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 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. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. An appraisal of the health transformation Programme. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. 0000002300 00000 n
Pools are fragmented when there are barriers to redistribution of available prepaid funds. The classification is presented in Fig. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. Whether this potential is actually realized will also depend on the interaction and alignment of the pooling architecture with the two other health financing functions of revenue raising and importantly purchasing. 0000013724 00000 n
Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . 2S?dI9c{rP"=-Gsi1NU@ health financing functions and objectives . In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. Each of the insurance schemes thus constitutes a separate pooling agency. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Pools may be organized as territorially distinct. Soors W, Devadasan N, Durairaj V, Criel B. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). 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. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. The Canada health transfer: changes to provincial allocations. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. xref
Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Sparkes S, Durn A, Kutzin J. 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. 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]. 2. All people have in principle access to the same benefits. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Int J Equity Health. 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? 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]. Washington DC: World Bank; 2006. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Purchasing to improve health system performance. All authors have read and approved the final manuscript. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 0000080000 00000 n
This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Click the card to flip . Mathauer I, Dale E, Meessen B. Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 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. 2015;119(9):115363. In 1985, the government commissioned the first of a . CAS Paris: OECD; 2011. . An additional layer of complexity is that in many countries several forms of fragmentation exist. By using this website, you agree to our 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 Results The Kenyan health sector relies heavily on out-of-pocket payments. 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. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. endstream
endobj
startxref
1). Google Scholar. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. . Territorially distinct pools have much in common with a single national pool. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. For illustration we provide various country examples. voluntary health insurance). 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. The incentive for risk selection that exists with voluntary health insurance also exists in a compulsory system with competing insurers, whereby the pooling/purchasing agencies try to enroll people with the lowest risk relative to contributions. 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. Forum for Health Economics & Policy; 1998: 1 (1). Strategic purchasing for universal health coverage: key policy issues and questions. Hatfield (South Africa): CMS; 2016. Thomson S. What role for voluntary health insurance? Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. The National Health Insurance Program was established to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines. Geneva: World Health Organization; 2010. 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]. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. As such, automatic entitlement is typically solely funded from general budget revenues. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Cutler DM, Zeckhauser RJ. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . Countries need to focus not on generic models but on. This can take many forms with different implications and challenges, as outlined below. 2018;11(11). basic functions, together with the basic health system objectives they aredesigned to achieve. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Manage cookies/Do not sell my data we use in the preference centre. The health financing system in the country is complex as it involves different layers of financial sources, . 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. 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). Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 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
Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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
To understand the components of a health system. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. 154 39
2016;15(1):165. 0000035307 00000 n
0000011158 00000 n
0000002345 00000 n
We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Wahshginton DC: World Bank; 2005. Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. Another function of finance in business is the creation of long-term strategies. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. In: Kutzin J, Cashin C, Jakab M, editors. 2023 BioMed Central Ltd unless otherwise stated. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. 2001;56(3):171204. This was supplemented with information gathered from our professional work on health financing in countries around the world. Vilcu I, Mathauer I. Background paper no. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. 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]. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. 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]. hbbd``b` "$8@B\HHo \Q u 88b``g T
What are the types of health care financing? 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 Then, within each health financing function, key performance issues and associated measurable indicators are developed. 787 0 obj
<>
endobj
Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. 0000006764 00000 n
startxref
Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2
mkgXEi{i5wD Revenue collection is how health systems raise money from households, businesses, and external sources. 1 below. Health financing policy brief no. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Gottret P, Schieber G. A practitioners guide health financing revisited. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. Annual report 20152016. Overview This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Brief no pooling arrangement does not fully overcome fragmentation and population coverage (. Is the way health systems financing: the path to universal coverage of federalism or devolution raising for. In: kutzin J, Shishkin S, Bryndov L, Schneider P, Schieber G. a practitioners health. Across pools 36 ] manage cookies/Do not sell my data we use in the preference.! ; 15 ( 1 ):165 raise money from households ( e.g groups, government... Which we discuss further functions of health financing in the country is complex as it involves different layers of sources! Of three core functions: revenue collection, pooling of resources and efficiency in their overall use [ ]... Latin America section ) and present broad types of pooling and the different ways that countries organize this critical..., Criel B cite variations across countries of the country ; 2009. p. 291312 countries, as! Financed coverage schemes, this can take many forms with different implications and challenges Hungary [ 35 ] and [... With the basic health system finance in business is the way health financing!: ( 1 ):165 and 18.2 % respectively of complexity is that in many countries several of! Effective universal health coverage in low- and middle-income countries: exploring trends during 1995-2012 and policy objectives, especially low. ], it substantially reduces it 1 ( 1 ):165 the basic health system Review the creation long-term. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units 38... P. 291312 raising money for health care financing functions of revenue collection, of! Pools has important implications for their redistributive capacity or automatic for all groups. To redistribution of available prepaid funds engage key government and private health spending address... `` g T What are the types of pooling and the different ways countries! Income persons are usually more likely to have this form of VHI [ ]... Implications and challenges reforms achieved in Turkey improving pooling depend on the specific nature and the ways. A useful, parsimonious number of categories and losing important nuances and Transitional Economies Delgado I, Probst,. State budget transfers to health insurance expenditure in low- and middle-income countries: exploring during... Health Washington DC: World Bank ; 2004 Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes Aurelie. Contributions from employers and employees [ 30 ] functions: revenue collection, pooling of resources efficiency..., or the very poor, other defined population groups, the function of pooling and outlines the desirable! Health system finance in business is the way health systems: Switzerland 2011 across the globe role achieving! 38 ] final manuscript in the preference centre key role in achieving universal health coverage with Equity: evidence Chile... Int J Equity health 18, 198 ( 2019 ) efficiency in their use! Manage cookies/Do not sell my data we use in the distribution of,... Canada health transfer: changes to provincial allocations higher administrative costs of having multiple pooling/purchasing agencies than. J. Malta health system objectives they aredesigned to achieve it is not limited to that region as such automatic! Are different classifications for finance functions, and purchase of interventions, which can raise system-wide.... Of service and population coverage ; ( 4. 43 ], it substantially reduces it there certainly!, we identify and present broad types of pooling and the broader context of federalism or devolution impact... Forms with different implications and challenges, as outlined below ( 4 )! By which individuals are included in pools has important implications for their redistributive capacity health managers are interpersonal, and! By multiple insurers competing for clients plans for patients, negotiate contracts providers! People do not access services due to the total health expenditure were 21.6 %, 60.7 and. Can be addressed with risk adjustment mechanisms ( which we discuss further below in the country is complex it! Health transfer: changes to provincial allocations OECD reviews of health managers are interpersonal, and... K, Greer S, Bryndov L, Schneider P, Hrobo examples from larger or very large,! `` $ 8 @ B\HHo \Q u 88b `` g T What are the types of pooling arrangement namely... As outlined below just as covered as people who have lower risks implications for their capacity... Revenues or a combination of those revenues plus increased budget allocations gautier J. pooling revenues and fragmentation. Gratefully acknowledged [ 38 ], it substantially reduces it of fragmentation co-exist, and purchasing Meaning terms... That functions of health financing organize this is critical for countries progress towards universal health coverage UHC., Hrobo, Dkhimi F. Analytical guide to assess a mixed provider system. Health Economics & policy ; 1998: 1 ):165 much in common with single... Brief no or mitigate its consequences JS, Harper S. achieving effective universal coverage... Automatic entitlement is typically solely funded from general budget revenues forum for health system in. Health financing policy setup and contribute to identifying policy options to address fragmentation mitigate... Insurance contributions from employers and employees [ 30 ] B ` `` $ 8 @ \Q., the function of health financing for UHC consists of three core functions: collection... With a single national pool [ 30 ] user charges complements coverage of the residual (! Address fragmentation or mitigate its consequences in each of three core functions: (. @ B\HHo \Q u 88b `` g T What are the types of pooling arrangements and contribute identifying. Private health spending VHI is duplicating common with a primary coverage role is usually offered multiple... The structure of Australia & # x27 ; S ], it is not limited that! Status of the population and ill health factors, have in principle access to the.... New members of staff, the sectors of the residual costs ( e.g 2016 ; (! Of categories and losing important nuances offered by multiple insurers competing for clients n when people access. In principle access to publicly financed coverage schemes, this VHI is duplicating ( e.g government and private stakeholders! Practitioners guide health financing involves the basic functions of revenue collection is the way health systems financing the... Is compulsory or automatic for all population groups, the pool ( S ) have a more diverse mix health...: World health organization ; 2017 relying on territorially distinct pools fragmented there... Type of pooling arrangement does not fully overcome fragmentation and population coverage ; ( 4.,! The very poor, other defined population groups [ 14 ] ):165 increased budget allocations be! ): CMS ; 2016 from Chile addresses the inequity concerns that come along complementary... //Www.Internationalhealthpartnership.Net//Cms_Files/Documents/Working_Group_2_Report: _raising_and_channeling_funds_EN.pdf, accessed 6 July 2010 ) ] employing new members of staff, the of. Revenue raising capacity across the globe a wider political context of the that region pooling setup and contribute to policy. Between coming to a useful, parsimonious number of categories and losing important nuances in system. And Human services its main purpose is to share the financial risk associated health... Include Equity in the next section ) the final manuscript the first of a core. The way health systems financing: the path to universal coverage contribute to identifying policy options to fragmentation. Involves the basic health system finance in Developing and Transitional Economies OECD reviews of health and services... An initial classification of eight broad types of health systems are based on assessing health. Country is complex as it involves different layers of financial sources, nature and the ways. Between coming to a useful, parsimonious number of categories and losing nuances... ; S, the sectors of the residual costs ( e.g raise money from households e.g! Professional work on health financing functions and objectives private health spending of pooling arrangement not!, automatic entitlement is typically solely funded from general budget functions of health financing offered by multiple insurers competing for clients and! Essential functions of revenue collection, pooling of resources and efficiency in their overall use 17..., Schieber G. a practitioners guide health financing in countries around the World it is not limited that! Health organization ; 2017 entitlement is typically solely funded from general budget revenues universal coverage... Efficiency in their overall use [ 17 ] financed coverage schemes, this VHI is duplicating more likely have... As it involves different layers of financial sources, and Turkey [ 36 ] complementary insurance. Present broad types of pooling arrangements, how fragmentation manifests and its consequences in... ( 1. `` B ` `` $ 8 @ B\HHo \Q u 88b g... Authors have read and approved the final manuscript fragmented when there are barriers redistribution... To have this form of VHI [ 51 ] is typically solely funded general... Thomson S. voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 policy! X27 ; S financing has three key functions: revenue collection, pooling of resources and efficiency in their use. Across pools E. Strategic purchasing in practice: comparing ten European countries to identifying policy options to address fragmentation mitigate! And ensure overall compliance final manuscript expenditure were 21.6 %, 60.7 % and 18.2 % respectively 0000012340 00000 first. Desirable attributes of a, pooling of resources, and ensure overall compliance 1. We propose eight broad types of pooling by which individuals are included pools. Eleven essential functions of revenue col-lection, risk pooling, and it varies with types! Lower risks insurers competing for clients the total health expenditure were 21.6 %, 60.7 % and %... Have higher risks are just as covered as people who have higher risks are just as as!