Decentralized countries often have pools organized by government administrative levels. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . 0000002300 00000 n 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. 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. The company has multiple offices in the U.S. and program offices in more than 40 countries. World Health Organization. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. 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. Bingley: Emerald Group Publishing; 2009. p. 291312. The classification is presented in Fig. Pettigrew LM, Mathauer I. Higher income persons are usually more likely to have this form of VHI [51]. 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. Implementing health financing reform: lessons from countries in transition. Book voluntary health insurance). In: Kutzin J, Cashin C, Jakab M, editors. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about However, there are limitations to this classification, because the full reality is much more complex. Kutzin J. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. 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. PubMed Pooling arrangements set the potential for redistributive health spending. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Innovations in Health System Finance in Developing and Transitional Economies. This is the so-called death spiral of voluntary health insurance [24]. Formula funding of health services: learning from experience in some developed countries. 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. At one extreme is a single pool of all funds for health services covering the entire population of a country. 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]. Each of the insurance schemes thus constitutes a separate pooling agency. 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. Council for Medical Schemes (CMS). As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. In: Kutzin J, Cashin C, Jakab M, editors. Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Health financing policy brief no. 0000012340 00000 n Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. 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. There are two forms of institutional setup found for this pooling arrangement. Definition. 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 Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). poverty status) or costs of serving the population of a specific region (e.g. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. 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. These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. Thailand Health Systems in Transition. Int J Equity Health. 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. Reforms in the pooling of funds. kem ZG, akar M. What have health care reforms achieved in Turkey? to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. Thailand is a prominent example for this pooling arrangement. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. population density). 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]. 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]. "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). Pools may be organized as territorially distinct. Google Scholar. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 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. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. 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. Google Scholar. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. 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. WHO Regional Office for Europe: Copenhagen; 2016. 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]. A desciptive framework for country-level analysis for health care financing arrangements. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. endstream endobj startxref Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. WHO Regional Office for Europe: Copenhagen; 2016. Australia's health system is a complex mix of service providers and other health professionals from a range of organisations - from Australian and state and territory governments and the non-government sector. But it has important implications and impacts on the other pooling arrangements, which is why it is discussed here as a separate type of pooling arrangement. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. To develop a health financing structure capable of addressing the challengesof the future. World Health Organization. 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