to (5.) Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. xref %%EOF 0000001757 00000 n Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. 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 0000074834 00000 n European Observatory on Health Systems and Policies; 2014. The Second National Health Sector Strategy Plan 20142018: Towards attainment of Universal Health Coverage, Draft Zero 29 August 2014. Formula funding of health services: learning from experience in some developed countries. 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. 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. Paris: OECD; 2011. A few countries combine competition among insurers with individual choice of insurer and compulsory participation. endstream endobj startxref Health Systems in Transition. 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]. What are the four major services and healthcare? Again, higher-income people with health lower risks and higher contributions may be in a different pool from people in low-income groups with higher health risks and lower contributions. Terms and Conditions, 0000002097 00000 n (Accessed on 25 February 2018)]. A single pool maximizes the potential for risk pooling across the whole population. Lancet. Google Scholar. territorially overlapping pools in terms of service and population coverage; (4.) Article JK contributed to the interpretation of evidence and the manuscript drafting. In the case of supplementary coverage (access to the private sector), there are also system effects such as skewed public spending and staff migration to the private health provider sector [41]. International Journal for Equity in Health 3. Gottret P, Schieber G. A practitioners guide health financing revisited. BMC Health Serv Res. To understand the key challenges to health systems. 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. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. Heal Policy Plan. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . Explain the need for evidence pertaining to the cost of delivery of. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 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. PubMed Health nutrition and population discussion paper. Maximum redistributive capacity from prepaid funds is achievable in these settings. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 2023 BioMed Central Ltd unless otherwise stated. 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]. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. A system of health accounts. Analysis was performed in line with the various NHA entities and health system financing functions. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. 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. Government funds are mainly allocated through historical incremental approach. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. 0000010947 00000 n family members). 0000012340 00000 n Int J Equity Health. In any country, prepaid health revenues may be held, i.e. The third function of health care financing is purchasing of services. 2007;83(23):16279. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. 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. All authors have read and approved the final manuscript. ), (7.) Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. 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]. 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. 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 . Akerlof GA. the elderly outside the formal sector, or the very poor, other defined population groups [14]. Taskforce on Innovative International Financing for Health Systems. Health financing involves not only methods of raising money for health care, but also allocation of those funds. Mathauer I, Dale E, Meessen B. Management has five main functions: planning, organising, leading, coordinating and control. A conclusion and lessons are presentedat the end. Article As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. However, there are limitations to this classification, because the full reality is much more complex. 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). 0 Bull World Health Organ. It is possible to have competition across pools, i.e. 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. Health Spending as % of GDP. complementary or supplementary voluntary health insurance. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). In doing so, policy makers can come closer . A 2 0 0000009066 00000 n Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. This is the so-called death spiral of voluntary health insurance [24]. These are 1) the nature of pooling and 2) the structure of pooling. The three roles of health managers are interpersonal, informational and decisional. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. Today, millions of 0000079954 00000 n Instead, they usually follow a countrys territorial structure, i.e. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. 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. 0000006049 00000 n 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. population density). Health Policy. This is due to two related reasons. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. In: Kutzin J, Cashin C, Jakab M, editors. #mHGilaa^{'D. Conversely, schemes that have voluntary membership, i.e. 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 UCS pooled together all of those revenues plus increased budget allocations. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. 154 39 there must be a specific contribution made by or on behalf of the covered person. To discuss Malawi as a case study in health systems. Adverse Selection in Health Insurance. 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. This entity pools public funding, i.e. 0000014993 00000 n Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 2016;15:57. 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. In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Annual report 20152016. https://doi.org/10.1093/heapol/czt054. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. Pools can be based on compulsory, automaticor voluntary participation. the allocation of pooled funds to health service providers [1]. 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]. 2S?dI9c{rP"=-Gsi1NU@ But the key concern is that the existence of multiple pools implies fragmentation. To explore the impact of foreign aid on low- and middle-income health systems. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 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. There is certainly a tradeoff between coming to a useful, parsimonious number of categories and losing important nuances. Hatfield (South Africa): CMS; 2016. (accessed 5 February 2019)]. 0000012547 00000 n This was supplemented with information gathered from our professional work on health financing in countries around the world. 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. 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. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. Frenk J. Conversely, pools with higher health risks are more likely to restrict benefits (if this is legally allowed), face financial difficulties or else run deficits. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. hb```c, . As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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 . 2016;15:67. However, relevant responses to improving pooling depend on the specific nature and the broader context of the country. Londoo JL, Frenk J. 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. Health care delivery forms the most visible function of the health system, both to patients and the general public. 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]. 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