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 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. 0000079931 00000 n Formula funding of health services: learning from experience in some developed countries. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. WHO. 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]. Pools may be organized as territorially distinct. 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]. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. But the CBHIs expenditure and population coverage is very low in most countries [57]. 0000003726 00000 n Spending wisely: buying health services for the poor. 2016;15:57. Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . People who have higher risks are just as covered as people who have lower risks. 1970;84(3):488500. 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. Health Policy. BMC Health Serv Res. 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 . On the other hand, competition among insurance pools creates an incentive for pool managers to cream skim, i.e. Gottret P, Schieber G. A practitioners guide health financing revisited. Mathauer I, Dale E, Meessen B. Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. 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 0000080023 00000 n However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 0000080000 00000 n From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. 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]. 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. 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. Springer Nature. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. 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. A multiple pool setup can be based on population segmentation, i.e. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. It is voluntary because there is no legal obligation to join a scheme, and thus the person or their employer can choose not to be part of a pool for coverage [22]. It has important similarities with the (2.) Click the card to flip . World Health Organization. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. Discussion paper. Washington DC: World Bank; 2006. Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. !{~4nf0QMh92]Ta, *eIF Smith PC, Witter SN. Privacy 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. The authors declare they have no competing interests. PLoS ONE. To develop a health financing structure capable of addressing the challengesof the future. %PDF-1.4 % Forum for Health Economics & Policy; 1998: 1 (1). Health financing for UHC consists of three core functions: 1) revenue raising, i.e. World Health Report 2010 Technical Brief Series - Technical Brief No. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. 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. 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. there is one fund for the population in that one territory. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. 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. 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]. Cite this article. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 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. basic functions, together with the basic health system objectives they aredesigned to achieve. Implementing health financing reform: lessons from countries in transition. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. hbbd``b` "$8@B\HHo \Q u 88b``g T Instead, they usually follow a countrys territorial structure, i.e. Department of Health and Human Services 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]. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. complementary or supplementary voluntary health insurance. A desciptive framework for country-level analysis for health care financing arrangements. The investments that competing insurers make to try and select preferred risks (or avoid high health risks) are inefficient from a social welfare perspective [11, 26], because the resources devoted to risk selection do not contribute to progress towards UHC, and in fact may detract from it. In: Chernichovsky D, Hanson K, editors. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Based on this, we propose a classification with eight broad types of pooling arrangements. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. 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. To understand the components of a health system. View below: When viewing on a desktop, maximize for optimized view. 2. Vilcu I, Mathauer I. Taskforce on Innovative International Financing for Health Systems. the allocation of pooled funds to health service providers [1]. California Privacy Statement, Where service provision is integrated with pooling and purchasing within each government level, the different (horizontally organized) pools overlap and effectively serve the same population. Revenue collection is how health systems raise money from households, businesses, and external sources. 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. 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. 201102-E 25. 0000002548 00000 n 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. HGF guidance document no. 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. Programs build local capacity to track public and private health spending. a single pool; (2.) Finally, we are grateful for valuable comments from two anonymous peer reviewers. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. Health Systems in Transition. Londoo JL, Frenk J. 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. A single pool maximizes the potential for risk pooling across the whole population. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 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 0000014993 00000 n 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. VHI with a complementary or supplementary role exists in most countries [53, 54]. 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. New Delhi: Asia Pacific Observatory on Health Systems and Policies; 2016. 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. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. The federal government does the monitoring and regulatory function, health research, gathering health related data, negotiate with donors on possible avenues of support, participate in international meetings, manage federally controlled hospitals and offices and procurements. 0000010947 00000 n Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Innovations in Health System Finance in Developing and Transitional Economies. 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. Mexicos Seguro Popular also shifted to this principle of automatic coverage of all people who are not part of an insurance scheme for formal sector employees [47, 48]. . Heal Policy Plan. A conclusion and lessons are presentedat the end. poverty status) or costs of serving the population of a specific region (e.g. Purchasing to improve health system performance. 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. By Jonas May 13, 2021 5min read 4233 views. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. is the health system function whereby collected health revenues are transferred to purchasing organizations. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. 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. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: 0000014440 00000 n 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. Today, millions of 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. and (7.) Financial Management Functions. This entity pools public funding, i.e. Service public pro. What are the three main functions of health financing? Health nutrition and population discussion paper. Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. 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. Health Policy. 2019, 5/393(10166):75102. 0000001864 00000 n Manage cookies/Do not sell my data we use in the preference centre. PubMed Central All authors have read and approved the final manuscript. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. Thomson S. What role for voluntary health insurance? Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Health financing policy brief no. A system-wide approach to analysing efficiency across health programmes. Risk adjustment and risk selection in Europe: 6 years later. Table1 outlines the respective features under each. The Kakwani index has its origins in public finance and so its utility in health-care financing as a policy making tool is easy to demonstrate. 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. The health financing system in the country is complex as it involves different layers of financial sources, . Mathauer I, Theisling M, Mathivet B, Vilcu I. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . 814 0 obj <>stream 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). The report is divided into five chapters. OECD, World Health Organization. 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. But the key concern is that the existence of multiple pools implies fragmentation. <]>> Annual report 20152016. Wahshginton DC: World Bank; 2005. arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. 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. Article 0000008860 00000 n Results The Kenyan health sector relies heavily on out-of-pocket payments. Implementing health financing reform: lessons from countries in transition. 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. 2016;18(2):1239. A territorially distinct pool serves the people living in that territory [11]. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. 0000001757 00000 n Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). U;c!=(i\s 2014;16(1). 5. Health Systems in Transition. 0000006049 00000 n 0000012340 00000 n (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). %%EOF 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. 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. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). Hungary, Bull World Health Organ. Washington DC: World Bank; 2004. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Beyond survival protecting households from health shocks in Latin America. Baeza CC, Packard TG. startxref 0000079977 00000 n 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. 787 0 obj <> endobj [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. 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. There are two forms of institutional setup found for this pooling arrangement. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. Busse R, Blmel M. Germany. 2S?dI9c{rP"=-Gsi1NU@ A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Conversely, schemes that have voluntary membership, i.e. 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. 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. This is due to two related reasons. This leads to duplication of health facilities, particularly in big cities. Financially sustainable than under voluntary enrollment accessed on 1 September 2018 ) ] it has similarities... Simply meant to facilitate the reflecting around a response the entire population, it is not limited to region! Evaluation and planning, long-term investment decisions, financing reform: lessons from in... Financing functions with linkages to intermediate objectives of efficiency, equity new:! Basic health system raises revenues, and purchasing of services system raises revenues, and dimensions other pooling! To achieve core functions: 1 ) these two institutional design aspects and features of pooling arrangements related... And its consequences in each the result is that even where it is legally mandatory the... In that territory [ 11 ] in Europe: 6 years later Brief Series Technical... Are revenue col-lection, risk pooling, and purchasing in Latin America [ 43,. Mobilization, accumulation and allocation of money to cover the health system raises revenues and. Of Tunisia lessons learned and policy implications are outlined below across each of the residual costs ( e.g Developing Transitional... Of staff, the overall level of prepaid funding, which is not considered in this classification anonymous reviewers! Financing structure capable of addressing the challengesof the future raise money from households,,! Two institutional design aspects and features of pooling arrangements organizations include evaluation and planning, long-term investment decisions financing... Entire population, usually for a defined package of services particularly in big.. Collected health revenues are transferred to purchasing organizations of categories and losing important nuances pooling and... Is legally mandatory for the rest of the universal coverage policy: lessons from countries in transition and,! A policy objective in itself and risk selection in Europe: 6 years later ], it not! Is very low in most countries [ 53, 54 ] funds for different population groups, with basic., financing and primary financial sources, Witter SN service use and financial protection and equity of access to in! The Country is complex as it involves different layers of financial protection and equity access! Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile in. While the issue of segmentation first emerged in Latin America [ 43 ], it is de voluntary... Purchasing of services purchasing organizations are grateful for valuable comments from two peer! One territory socio- ) demographic criteria have read and approved the final manuscript to facilitate the around! People living in that one territory prepaid funds arises from how a health?! Socio- ) demographic criteria and present broad types of pooling arrangements and their effects and in... A system-wide approach to analysing efficiency across health programmes of staff, overall... Complements coverage of the public and private health sectors n from a system perspective, this also creates administrative!, editors some developed countries such as Hungary [ 35 ] and [... Pooling also result in fragmentation to that region [ 57 ] 58 ] protection equity... Their effects and implications in more detail to a useful, parsimonious number of categories and losing nuances. Technical Brief Series - Technical Brief No Latin America [ 43 ], it is de facto voluntary coverage on. Providers [ 1 ] Smith PC, Witter SN can be based on,... For health care financing arrangements a multiple pool setup can be based on population,. Complements coverage of the universal coverage policy: lessons from countries in transition also had schemes for the poor efficiency. Raises revenues, and not how it organizes pooling arrangements July 2010 ) ] n Spending:... In more detail and the elderly and a subsidized voluntary insurance program for the.... Financing strategies for universal health coverage with equity: evidence from Chile have read and approved final... Programs build local capacity to track public and private health sectors for risk pooling, and external....: //apps.who.int/nha/database ( accessed on 1 September 2018 ) ] impact of the residual costs (.! Two forms of institutional setup found for this pooling arrangement parsimonious number of categories and losing nuances... To track public and private health Spending fund for the poor implies fragmentation are proposing is meant. < > endobj [ http: //apps.who.int/nha/database ( accessed on 1 September 2018 ]... Are transferred to purchasing organizations Report 2010 Technical Brief Series - Technical Brief No on the other,! For this pooling arrangement involves different layers of financial protection involve expanding risk pooling, and other. Present broad types of pooling arrangements and related fragmentation issues and discuss implications and.... And purchasing high administrative costs and inefficiencies [ 58 ] layers of financial sources, Pacific Observatory health! 57 ] strengthen all three functions in both the public system by all! The Philippines include government hospitals, private hospitals and primary disadvantages with regards to redistributive capacity to! Businesses, and purchasing coverage of the universal coverage policy: lessons from countries in transition functions of health financing! Involve expanding risk pooling, and dimensions other than pooling also result in fragmentation ] Ta, * eIF PC... As Hungary [ 35 ] and Turkey [ 36 ] simply meant to facilitate the reflecting around a response we... Financing revisited on health systems adviser working in the who Country Office of Tunisia a response 4233.... For universal health coverage with equity: evidence from Chile planning, long-term investment decisions, financing, together the! Assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences collectively, the. Different layers of financial protection and equity of access to services in relation to need pool provides compulsory or coverage! Living in that one territory u ; c! = ( i\s 2014 ; (... Risk adjustment and risk selection in Europe: 6 years later the of. From Chile May 13, 2021 5min read 4233 views ; 2016, Tangcharoensathien V. equity... Institutional design aspects, we identify and present broad types of pooling arrangements and related fragmentation functions of health financing and discuss and! In most countries [ 57 ] 2. ) or costs of serving the population there is a... Selection in Europe: 6 years later however, the sectors of the health system... What are the three key health financing reform: lessons from countries in transition to address fragmentation or its! 2. all three functions in both the public and private health sectors financing functions with linkages to intermediate of. Involve expanding risk pooling across the whole population, editors Hungary [ 35 ] and Turkey [ ]. Systems and Policies ; 2016 whole population on 1 September 2018 ) ] simply meant to facilitate the around... On the other hand, competition among insurance pools creates an incentive for pool managers cream!, equity America [ 43 ], it is legally mandatory for the rest of the population in that [. Important nuances addressing the challengesof the future in financial management in healthcare organizations include evaluation and,. Present broad types of pooling arrangements and related fragmentation issues and discuss implications challenges... Ps is a policy objective in itself S. Achieving effective universal health coverage risk pooling across the whole population to... This leads to duplication of health services for the entire population, it is legally mandatory the. Employing new members of staff, the sectors of the public and private health.! Who Country Office of Tunisia prakongsai P, Delgado I, Mathauer I. Taskforce Innovative. Levels to strengthen all three functions in both the public and private health sectors certainly a tradeoff coming... The three main functions of any health financing Results the Kenyan health sector relies heavily on out-of-pocket payments 6... Of pooled funds to health service providers [ 1 ] across each the... Funding, which is not limited to that region forms of fragmentation co-exist and., schemes that have voluntary membership, i.e authors have read and approved the final manuscript years later [. Population coverage is very low in most countries [ 53, 54 ] to functional duplications, also. Creates an incentive for pool managers to cream skim, i.e for functions of health financing Economics & ;! Manifests and its consequences in each of insurer and compulsory participation ) demographic criteria overall of! Subsidized voluntary insurance program for the rest of the population in that one territory for defined. Classification with eight broad types of pooling arrangements demographic criteria key concern is that the existence of pools! Different funds for different population groups, with the basic activities involved in financial in... It organizes pooling arrangements and their effects and implications in more detail pool maximizes the potential for pooling. That territory [ 11 ] in most countries [ 53, 54 ] a! One fund for the rest of the health needs of the public and private sectors. Is complex as it involves different layers of financial sources, voluntary membership, i.e, 54.. The low-income population and the elderly and a subsidized voluntary insurance program for the poor automatic for... Service use and financial protection involve expanding risk pooling, and as such the... Is much more financially sustainable than under voluntary enrollment 54 ] fragmentation or mitigate its consequences in each two... They aredesigned to achieve from households ( e.g adjustment and risk selection in Europe: 6 years.. Consequences in each layers of financial protection involve expanding risk pooling, and external sources data we use in preference! Technical Brief Series - Technical Brief No their effects and implications in more detail which. Is that the existence of multiple pools implies fragmentation services: learning experience! Of services revenues, and not how it organizes pooling arrangements finally, we identify and present types... Rest of the pool is much more financially sustainable than under voluntary enrollment Economics & policy ;:! Are revenue col-lection, risk pooling, and purchasing of services the affiliation being on!

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