functions of health financingfunctions of health financing

the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Risk pooling in health care financing: the implications for health system performance. The UCS pooled together all of those revenues plus increased budget allocations. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. 0000008166 00000 n Strategic purchasing for universal health coverage: key policy issues and questions. Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. Sometimes, these arrangements include a purchaser-provider split. 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. 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. 5. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Rather it is a first attempt at a classification, which could encourage further useful work from others. 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 Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Territorially distinct pools have much in common with a single national pool. taxes, user fees, private health insurance), business (e . However, there are limitations to this classification, because the full reality is much more complex. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. . 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. JK contributed to the interpretation of evidence and the manuscript drafting. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. To cite variations across countries of different income levels. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Taken quite literally, perhaps no country has only one single pool. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. 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]. Ministry of Health Swaziland. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 0000010947 00000 n 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. . https://doi.org/10.1093/heapol/czt054. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. 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. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. 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. Vilcu I, Mathauer I. Discussion paper. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. WHO. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. It also describes Ghana's health financing system. 0000006764 00000 n 2016;15:7. Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. World Health Report. 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. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. Fragmentation also occurs in the few countries (Germany, Netherlands, Chile) that allow certain population groups (e.g., the self-employed or individuals above an income threshold) to opt out from the public system and to buy mandatory private insurance [59,60,61]. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. Health Care Syst Transit. 8. This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. 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. Health Policy. OECD, Eurostat. In some cases, this is limited to civil servants only. 0000035307 00000 n 2001;56(3):171204. a single pool; (2.) What are the three main functions of health financing? The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. 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. Reforms in the pooling of funds. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Geneva: World Health Organization; 2008. 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. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. By Jonas May 13, 2021 5min read 4233 views. It has important similarities with the (2.) Int J Equity Health. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. 0000074834 00000 n 2013;91(8):60211. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Finally, we are grateful for valuable comments from two anonymous peer reviewers. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. 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 . An appraisal of the health transformation Programme. WHO Regional Office for Europe: Copenhagen; 2016. 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. Pettigrew LM, Mathauer I. hb```c, comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. the mobilization of resources for the health sector; 2) pooling, i.e. 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. there must be a specific contribution made by or on behalf of the covered person. Pooling arrangements influence not only risk pooling (and via this pathway, financial protection and equity in service use), but also the intermediate UHC objectives of efficiency and equity in the distribution of a health systems resources. 0000014440 00000 n This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. PS is a health systems adviser working in the WHO Country Office of Tunisia. By using this website, you agree to our 0000079931 00000 n Thailand Health Systems in Transition. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Beyond survival protecting households from health shocks in Latin America. Many others receive poor quality of services even when they pay out-of-pocket. For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. basic functions, together with the basic health system objectives they aredesigned to achieve. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . 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. Instead, they usually follow a countrys territorial structure, i.e. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. 2019;97:33548. 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. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. `733.aa``:S)C{CXhyB"&B)cc wlVJ36sJ120F0-`jjp`aXir23P'd Health Policy. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Library of Parliamentarians: Ottawa; 2011. VHI with a complementary or supplementary role exists in most countries [53, 54]. Smith PC, Witter SN. We also like to thank Lisa Seidelmann, Carlo Schmid Fellow and volunteer with the Department of Health Systems Governance and Financing at the time of producing this draft for her research assistance. Annual report 20152016. Washington DC: World Bank; 2006. Geneva: World Health Organization; 2017. Fragmentation in pooling can also contribute to inefficiency in the health system, as it typically implies a duplication (or multiplication) in the number of agencies required to manage the pools (and, usually, purchasing as well) [19]. 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. Baeza CC, Packard TG. Purchasing refers to the allocation of pooled funds to healthcare providers for the delivery of health services on behalf of certain groups or the entire population. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. As such, automatic entitlement is typically solely funded from general budget revenues. 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. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Health financing policy brief no. Google Scholar. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. 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. The on behalf may come from public budgets for specific groups of individuals whose participation is fully or partially subsidized, or it may come from traditional insurance contributions that cover individuals beyond the contributor (e.g. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. 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. 154 39 Even though small businesses do not have a separate finance department . To ensure key development programmes are adequately funded [5,6]. trailer 0000002548 00000 n there is no explicit purchaser-provider split. 0000003726 00000 n Health (Just Now) WebHealth financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Many others receive poor quality of services even when they pay out-of-pocket. 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. Collectively, they work to meet the physical and mental health care needs of Australians. At the policy level, programs partner with country governments to strengthen the governance frameworks, including regulations, policies, and organizational structures to manage health financing so that health services are provided efficiently, effectively, equitably, and with adequate quality. 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. Health financing is a key function of the health care system, and is a complex issue. 0000002191 00000 n 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. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Risk adjustment and risk selection in Europe: 6 years later. 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