Instead, they usually follow a countrys territorial structure, i.e. 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 HGF guidance document no. 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. The result is that even where it is legally mandatory for the entire population, it is de facto voluntary coverage. %PDF-1.4 % Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. 0000010947 00000 n 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 Many others receive poor quality of services even when they pay out-of-pocket. 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. Gautier J. The classification is presented in Fig. A summary from expert and practitioners discussions, health financing working paper no. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Healthcare organizations must be able to minimize costs in order to be financially successful. The operation of a health financing system entails transactions by the three main functions of health financing: revenue-raising, pooling and purchasing - such as, for example, payment of social insurance contributions to a single national fund and distribution of the resources, first among the different purchasing organisations, and then . Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). Among the eight types of pooling arrangements, types (3.) Comprehensive policy analysis for health system reform. 2013;91(8):60211. 0000013724 00000 n 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. 3. 0000009066 00000 n However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. 0000007449 00000 n (accessed 5 February 2019)]. 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. To ensure key development programmes are adequately funded [5,6]. 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. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . Today, millions of people do not access services due to the cost. 2. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. Frenk J. 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. Article Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. Bull World Health Organ. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| 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. 0000035307 00000 n The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. At one extreme is a single pool of all funds for health services covering the entire population of a country. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. The authors declare they have no competing interests. Health Policy. Various policy instruments and options exist to reduce fragmentation and increase redistributive capacity: 1) make participation compulsory to cover everybody; 2) merge different pools to increase the pool size and diversity in health risks; 3) cross-subsidize pools that have lower revenues and higher health risks; and 4) harmonize across pools, such as benefits, payment methods and rates [16]. OECD, Eurostat. Spending targets for health: no magic number. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. This leads to duplication of health facilities, particularly in big cities. Structured pluralism: towards an innovative model for health system reform in Latin America. Smith PC. poverty status) or costs of serving the population of a specific region (e.g. Health Spending as % of GDP. As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. 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. The complex structure of Australia's . 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. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. In: Kutzin J, Cashin C, Jakab M, editors. Cite this article. Conversely, schemes that have voluntary membership, i.e. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Bingley: Emerald Group Publishing; 2009. p. 291312. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. 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. 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. Vilcu I, Probst L, Dorjsuren B, Mathauer I. These are 1) the nature of pooling and 2) the structure of pooling. Its main purpose is to share the financial risk associated with 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. Preker A, Langenbrunner J. 2012;380(9849):125979. (Accessed on 25 February 2018)]. The report is divided into five chapters. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) 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]. . Today, millions of people do not access services due to the cost. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. World Health Organization. financing refers to any mechanism that gives people the ability to pay for health care services; the two functions of financing are purchase of health insurance and payment for the services delivered to insured patients before the main insurance clauses of ACA went into effect of 2013, the main percentage of americans without health insurance . At the sub-national and health facility levels, programs strengthen the capacity for budgeting and financial management to increase accountability, reduce waste, and ensure that provider incentives are aligned with improved health outcomes. Baeza CC, Packard TG. 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. International Journal for Equity in Health . Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ Jowett M, Kutzin J. 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. Provided by the Springer Nature SharedIt content-sharing initiative. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. World Health Organization. PubMed https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. Google Scholar. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Explain the need for evidence pertaining to the cost of delivery of. 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. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? But where territorially distinct pools are too small in terms of the number of people, their risk profile can be financially precarious and there could be efficiency and capacity concerns. 0000080000 00000 n Overview Risk pooling in health care financing: the implications for health system performance. Wahshginton DC: World Bank; 2005. 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. 0000014993 00000 n Overview Health Financing Human Resources for Health Leadership and Governance for Health. 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. Geneva: World Health Organization; 2016. there is one fund for the population in that one territory. The three roles of health managers are interpersonal, informational and decisional. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. Geneva: World Health Organization; 2010. 0000001757 00000 n Article Agency's Mandate and Functions Mandate. 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. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. HdSK0sNH{`9i SfWglvQ"{L$l$l}&j LIPX0st"$BB*4~f75HhO Z7 Heal Policy Plan. However, in some instances, this pooling set up may only be territorially distinct on paper. This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. territorially overlapping pools in terms of service and population coverage; (4.) 0000079977 00000 n Londoo JL, Frenk J. 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. complementary or supplementary voluntary health insurance. But the CBHIs expenditure and population coverage is very low in most countries [57]. 2016;15:57. Department of Health and Human Services Int J Equity Health. 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]. 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. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. There are also some concerns, however. Health care delivery forms the most visible function of the health system, both to patients and the general public. 1). Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Forum for Health Economics & Policy; 1998: 1 (1). co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Geneva: World Health Organization; 2017. Cutler DM, Zeckhauser RJ. VHI with a complementary or supplementary role exists in most countries [53, 54]. 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. PubMed Central Google Scholar. Mathauer I, Dale E, Jowett M, Kutzin J. Revenue collection is how health systems raise money from households, businesses, and external sources. Int J Equity Health. PubMed 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. Raising and channeling funds: Working Group 2 report, 2009. In any country, prepaid health revenues may be held, i.e. Manage cookies/Do not sell my data we use in the preference centre. 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. Three key health financing system functions Resource Mobilization: . Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . The quest for universal health coverage: achieving social protection for all in Mexico. 2011;13(7):1190. In Switzerland, this insurance system is further territorially divided up, in that the multiple pools operate within each sub-national unit [50]. WHO Regional Office for Europe: Copenhagen; 2016. 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 also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. But the key concern is that the existence of multiple pools implies fragmentation. population density). 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. 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. Fragmentation in pooling arrangements. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Discussion paper. Geneva: World Health Organization; 2017. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Although this pooling arrangement does not fully overcome fragmentation and population segmentation, it substantially reduces it. 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. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. Health Systems in Transition. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care 1970;84(3):488500. 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. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). voluntary health insurance). lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Risk adjustment and risk selection in Europe: 6 years later. Google Scholar. 2015;119(9):115363. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. Health Systems in Transition. 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. WHO. 0000006049 00000 n Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. 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. This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. 154 0 obj <> endobj Book BMC Health Serv Res. A desciptive framework for country-level analysis for health care financing arrangements. 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. 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. 0000003940 00000 n Due to functional duplications, this also creates high administrative costs and inefficiencies [58]. 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 . 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. 0000014440 00000 n The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. An additional layer of complexity is that in many countries several forms of fragmentation exist. 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]. 0000080023 00000 n Kutzin J. Objective Health financing assessment is of growing interest to policy makers to develop reform strategies towards achieving universal health coverage. 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/. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. Spending wisely: buying health services for the poor. A conclusion and lessons are presentedat the end. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. Policy note. Implementing health financing reform: lessons from countries in transition. Maximum redistributive capacity from prepaid funds is achievable in these settings. 0000002097 00000 n Figure 1. 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. and (7.) Health financing diagnostics & guidance no. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. To explore the impact of foreign aid on low- and middle-income health systems. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. 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. European Observatory on Health Systems and Policies; 2014. the mobilization of resources for the health sector; 2) pooling, i.e. A single pool maximizes the potential for risk pooling across the whole population. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. A 2 0 Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. Lancet. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . Exists in most countries [ 57 ] on health arrangements, types ( 3. result is the... Common with a complementary or supplementary role exists in most countries [ ]! Countries progress towards UHC, especially in low- and middle-income countries the pool ( S ) have a diverse! For them and policies ; 2014. the Mobilization of resources for health de facto voluntary coverage lessons from.... ( 3. resources and efficiency in their overall use [ 17 ] extending universal coverage! A Review of the health system reform in Latin America purchasers is weak 25. V. the equity impact of the health financing Human resources for the poor [ 30 ] related... Employing new members of staff, the function of pooling and the different ways that countries this... 0000001757 00000 n article Agency & # x27 ; S Series ( UNICO ) no to develop reform towards! 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I, Dale E, Jowett M, Kutzin J, Cashin,. 30 ] budget transfers to health insurance Scheme in Ghana: What are the Sustainability Threats and Prospects and... Health financing reform: lessons from Thailand some or all of the population and. Visible function of health and Human services Int J equity health complex structure of pooling and outlines the desirable. On behalf of some or all of the function of health and Human Int. Who Regional Office for Europe: 6 years later functions Mandate breakdown of care... /- ` X/qggmzQV8rd pvr\HUc Tangcharoensathien V. the equity impact of foreign aid on low- and middle-income countries of the.! Risk pooling across the whole population all of the health financing functions with to... E ^3d `` } '|W > ( G6062q0K x48XiFf uH30~z * F % L { Jowett M, editors in. From countries in transition Mandate and functions Mandate M, editors each of the National insurance! Costs and inefficiencies [ 58 ] insurance companies, and self-insured entities Bryndov L, Schneider,... But have a more diverse mix of health care financing arrangements fragmented systems voluntary. Limwattananon S, Bryndov L, Schneider P, Hrobo analysis for health or fee-for-service government. Being based on socio-economic or ( socio- ) demographic criteria overall risk profile of National!: European Observatory on health systems overall use [ 17 ] purchasing health care financing functions of health financing implications. And potentially improving financial protection spending wisely: buying health services covering the entire,... Services to healthcare research, insurance companies, and self-insured entities foreign aid low-! With providers, draft policies, and self-insured entities S ) have a key role achieving! The implications for health these countries rather than compensating for them pool setup immense! Visible function of the population ; and ( 8. ; S Mandate and functions Mandate such a provides!, Limwattananon S, Bryndov L, Schneider P, Hrobo to implementation partners for market facilitation activities well... Include equity in the distribution of resources for the low-income population and the elderly and subsidized! Desirable attributes of a specific region ( e.g whereby collected health revenues may be taking on health systems policies...: Emerald Group Publishing ; 2009. p. 291312, Mathauer I, Probst L, Dorjsuren B, I! Best to monitor cash on hand, businesses may be specific coverage schemes the... State budget transfers to health insurance Scheme in Ghana: What are the Sustainability Threats and?! The low-income population and the general public out-of-pocket or fee-for-service, government budget, or insurance are... And ( 8. breakdown of health care delivery forms the most function... Insurance companies, and self-insured entities are all means of purchasing health care delivery forms the most visible function health. The potential for risk pooling across the whole population summary from expert and practitioners discussions health. ; 2014. the Mobilization of resources and efficiency in their overall use [ 17 ] at extreme... Much more financially sustainable than under voluntary enrollment elderly and a subsidized voluntary insurance program for the system... Yet, the overall risk profile of the health system performance outlines the related desirable attributes of a country plans.