Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 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. N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! hmo6 All people have in principle access to the same benefits. By using this website, you agree to our National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. 0000014440 00000 n A critical requirement of this pooling arrangement is thus the riskadjustment of the revenues that go to each insurer as a means to limit segmentation of the population into different pools based on their health risks and to address inequities in resources available across different pools [38]. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. Risk pooling in health care financing: the implications for health system performance. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. trailer The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. Smith PC. Smith P. The role of markets and competition. Among the eight types of pooling arrangements, types (3.) Territorially distinct pools have much in common with a single national pool. The classification is based on an examination of pooling arrangements and their implications in more than 100 countries across all income groups, relying on a review of published and grey literature found through searching via PubMed, Google and Google Scholar using the search terms of pooling funds for health and fragmentation in pooling. Capacity strengthening of the MSP will also be an important component of this program. Washington DC: World Bank; 2006. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. 2014;16(1). pooled, in one or several pools. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. Many others receive poor quality of services even when they pay out-of-pocket. The company has multiple offices in the U.S. and program offices in more than 40 countries. U;c!=(i\s Adverse Selection in Health Insurance. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. https://doi.org/10.1093/heapol/czt054. 2019;97:33548. 0000002224 00000 n Geneva: World Health Organization; 2017. 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. 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. An appraisal of the health transformation Programme. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. 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. 0000010246 00000 n Bingley: Emerald Group Publishing; 2009. p. 291312. It serves multiple purposes, e.g. Revenue collection is how health systems raise money from households, businesses, and external sources. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. To ensure key development programmes are adequately funded [5,6]. Health Policy. Annual report 20152016. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. 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. Geneva: World Health Organization; 2010. World Health Report 2010 Technical Brief Series - Technical Brief No. The Health Financing Specialist will be based in the Abt office in Antananarivo. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. . 1997;41:136. Google Scholar. Innovations in Health System Finance in Developing and Transitional Economies. Then, within each health financing function, key performance issues and associated measurable indicators are developed. When people have access to publicly financed coverage schemes, this VHI is duplicating. 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. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. International Journal for Equity in Health Raising revenues for health in support of UHC: strategic issues for policy makers, health financing policy brief no. Busse R, Blmel M. Germany. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Akerlof GA. 2016;15:67. different pools for different socio-economic groups with population segmentation; (5.) to (5.) In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. 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. Mathauer I, Theisling M, Mathivet B, Vilcu I. 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. European Observatory on Health Systems and Policies; 2014. Wahshginton DC: World Bank; 2005. This was supplemented with information gathered from our professional work on health financing in countries around the world. 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 core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. 3. 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]. The Canada health transfer: changes to provincial allocations. 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. Taken quite literally, perhaps no country has only one single pool. management and disbursement for financing the availment of a basic minimum package and other . 'p 6l3/%J This is commonly referred to as a competitive social health insurance arrangement. 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. Mathauer I, Dkhimi F. 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