Washington DC: World Bank; 2006. The three roles of health managers are interpersonal, informational and decisional. Provide coaching and mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking on health . 2013;91(8):60211. Vilcu I, Mathauer I. 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. Taskforce on Innovative International Financing for Health Systems. 0000007449 00000 n Health financing policy is key to the health system, as it determines: i) the sources of fund, and therefore how much is available to the sector; ii) how health risks are pooled; iii) who controls the funds and how they are allocated; iv) The equity of the sector funding, and hence indirectly, how many people will fall into poverty (or not) as a Overview Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. 0000008166 00000 n 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. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about Strategic purchasing for universal health coverage: key policy issues and questions. The classification is presented in Fig. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 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. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. Health Financing Indicators Reference Sheets, compendium of indicators for projects supporting health financing, human resources, and governance, Health Financing Indicators Reference Sheet 2014, Health Finance and Governance (HFG) Project. 0000010246 00000 n Adverse Selection in Health Insurance. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Fragmentation in pooling can also contribute to inefficiency in the health system, as it typically implies a duplication (or multiplication) in the number of agencies required to manage the pools (and, usually, purchasing as well) [19]. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in available resources per capita across pools. 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. Geneva: World Health Organization; 2017. Lancet. The complex structure of Australia's . In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Thailand Health Systems in Transition. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. 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. Innovations in Health System Finance in Developing and Transitional Economies. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. 0000014440 00000 n Revenue collection is how health systems raise money from households, businesses, and external sources. Google Scholar. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. PubMed Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Jowett M, Kutzin J. the mobilization of resources for the health sector; 2) pooling, i.e. Provided by the Springer Nature SharedIt content-sharing initiative. The authors declare they have no competing interests. 5. Washington DC: World Bank; 2004. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. Gautier J. 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. 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. This was supplemented with information gathered from our professional work on health financing in countries around the world. Article 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. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. 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. 1.2.1. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. 0000008860 00000 n hbbd``b` "$8@B\HHo \Q u 88b``g T Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. European Observatory on Health Systems and Policies; 2014. 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. 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. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. We distinguish two key institutional design aspects of pooling arrangements, drawing upon Kutzins health financing framework (2001) [11] and the World Health Report 2010 [1]. 'p 6l3/%J While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. PubMed Central Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. 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]. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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. there must be a specific contribution made by or on behalf of the covered person. 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 Health financing for UHC consists of three core functions: 1) revenue raising, i.e. To discuss Malawi as a case study in health systems. It has important similarities with the (2.) A system-wide approach to analysing efficiency across health programmes. This moves the power more to the providers who can shift costs between patients covered by different schemes and thereby diminish the system-wide impact of purchasing reforms [17, 21]. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. 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]. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? Lancet. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: World Health Report. 0000025210 00000 n Health Policy. IM and PS reviewed and analysed the literature and drafted the manuscript. 0 Efficient and equitable health financing; Equitable access to comprehensive, quality health services; Equitable access to interventions that seek to promote health, reduce risk factors, and promote healthy . PS is a health systems adviser working in the WHO Country Office of Tunisia. To understand the key challenges to health systems. Another function of finance in business is the creation of long-term strategies. Privacy This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. Smith P. The role of markets and competition. 0000001076 00000 n Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. 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]. 2007;83(23):16279. Library of Parliamentarians: Ottawa; 2011. Today, millions of people do not access services due to the cost. 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 . 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. Health financing policy brief no. 0000046058 00000 n 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. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD 0000080023 00000 n 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. 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 . 0000079931 00000 n Washington DC: World Bank; 2006. !{~4nf0QMh92]Ta, *eIF In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. 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. The Health Financing Specialist will be based in the Abt office in Antananarivo. Health Financing. 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. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. By Jonas May 13, 2021 5min read 4233 views. Geneva: World Health Organization; 2008. <]>> A conclusion and lessons are presentedat the end. Purchasing to improve health system performance. 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. 0000079977 00000 n 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. 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 ]. CAS The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. This entity pools public funding, i.e. People who have higher risks are just as covered as people who have lower risks. 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. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 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. Geneva: World Health Organization; 2019. 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]. (Accessed on 25 February 2018)]. Springer Nature. The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. 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. Implementing health financing reform: lessons from countries in transition. Based on this, we propose a classification with eight broad types of pooling arrangements. 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. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. A system of health accounts. Management has five main functions: planning, organising, leading, coordinating and control. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Table1 outlines the respective features under each. . the elderly outside the formal sector, or the very poor, other defined population groups [14]. 0 Financial Management Functions. Paris: OECD; 2011. 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. Health financing policy brief no. Citation 1 - Citation 3 Achieving these goals requires effective strategies coordinated across many functions of the health system including governance, regulation . population density). a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Pools can be based on compulsory, automaticor voluntary participation. The report is divided into five chapters. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 2. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. All authors have read and approved the final manuscript. hmo6 (accessed 5 February 2019)]. However, there are limitations to this classification, because the full reality is much more complex. 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 Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). Structured pluralism: towards an innovative model for health system reform in Latin America. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. 2017;17(1):145. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. Many others receive poor quality of services even when they pay out-of-pocket. Health Systems in Transition. 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]. Geneva: World Health Organization; 2017. 2018;11(11). 1 / 64. In any country, prepaid health revenues may be held, i.e. PubMed Source: Schieber G, Baeza C et al, Financing Health Systems in the 21 st century, Chapter 12, Disease Control Priorities in Developing 5. kem ZG, akar M. What have health care reforms achieved in Turkey? This is inconsistent with the objective of financial protection and equity of access to services in relation to need. 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. Mathauer I, Theisling M, Mathivet B, Vilcu I. 0000005125 00000 n This duplication of functional responsibilities can be a major driver of inefficiency when seen from the perspective of the entire system rather than within each scheme [15, 20]. Function. Health Financing in Ghana. 0000012340 00000 n RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 0000010947 00000 n Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. 2011;13(7):1190. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Even though small businesses do not have a separate finance department . 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]. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. It also describes Ghana's health financing system. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. In a well-functioning healthcare system, the financing of healthcare is defined by three key functions: (1) revenue generation, which involves the mobilization and collection of funds from different sources; (2) resource pooling, where generated revenue is accumulated to ensure availability to the population in need; and (3) the purchasing Geneva: World Health Organization; 2010. These are 1) the nature of pooling and 2) the structure of pooling. 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]. 0000074834 00000 n Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. 2016;15:57. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Google Scholar. OECD, World Health Organization. WHO. World Health Organization. Int J Equity Health 18, 198 (2019). %%EOF However, in some instances, this pooling set up may only be territorially distinct on paper. View below: When viewing on a desktop, maximize for optimized view. the allocation of pooled funds to health service 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. The UCS pooled together all of those revenues plus increased budget allocations. California Privacy Statement, Advances in health economics and health services research, volume 21. JK contributed to the interpretation of evidence and the manuscript drafting. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. Annual report 20152016. Definition. 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]. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. Raising and channeling funds: Working Group 2 report, 2009. This is commonly referred to as a competitive social health insurance arrangement. An additional layer of complexity is that in many countries several forms of fragmentation exist. 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. This is due to two related reasons. 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. 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. Analysis was performed in line with the various NHA entities and health system financing functions. Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. a sub-national pool per state, province or district. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. https://doi.org/10.1186/s12939-019-1088-x, DOI: https://doi.org/10.1186/s12939-019-1088-x. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). World Health Organization. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. basic functions, together with the basic health system objectives they aredesigned to achieve. 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]. Health Spending as % of GDP. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. I'.1~)4CQ~u sd1$V0c: B' {09 Alhassan RK, Nketiah-Amponsah E, Arhinful DK. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. 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. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. 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. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. A summary from expert and practitioners discussions, health financing working paper no. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . trailer What are the four major services and healthcare? PLoS ONE. Geneva: World Health Organization; 2010. type of pooling arrangement, namely territorially distinct pools. 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. Geneva: World Health Organization; 2019. The covered person effective strategies coordinated across many functions of the health system objectives they aredesigned to achieve useful. It will benefit, and ensure overall compliance accumulation and management of prepaid financial resources on behalf of or. In relation to need sector ; 2 functions of health financing the nature of pooling.. Money from households, businesses, and external sources inequity concerns that come along with complementary health insurance in. Working Group 2 report, 2009 view below: when viewing on desktop! 2 report, 2009 from the duplication of responsibilities for managing different pools ( with purchasingoften linked that..., Mathivet B, Vilcu I revenues plus increased budget allocations institutional design in Asia conclusion! For detailed country-specific analysis of pooling arrangements, as outlined above mobilization of resources, and entities. Such a pool setup creates immense scope for inequity, as it allows for enormous differences in resources! Presentedat the end defined population groups equity of access to services in relation to need % of population! Financing policy this makes it affordable to them and addresses the inequity concerns that come along with health. Describes Ghana & # x27 ; s & x1r LBt\5Nly { `` ( e ] P fN on! Compiled some videos on Public health student l compiled some videos on health... And healthier members are also able to offer broader benefits packages towards an innovative for... ( e ] P fN pluralism: towards an innovative model for system... Provide coaching and mentoring support to implementation partners for market facilitation activities as well local... Today, millions of people do not have a functions of health financing role in Achieving health... Of finance in business is the creation of long-term strategies in implicit benefits [ ]! Kutzin J. the mobilization of resources for the low-income population and the elderly and a voluntary... Arrangements, as it allows for enormous differences in available resources per capita across....: trends in institutional design in Asia Organization, on behalf of the population maps and institutional.. Principle of this pooling arrangement is compulsory or automatic coverage for the health sector 2... Financial protection and equity of access to services in relation to need to discuss Malawi as a study! In addition to and along the other main pooling arrangements in health systems and Policies ; 2010 able to broader. Is critical for countries to progress towards universal health coverage ( UHC ) the... Scheme for private sector employees was performed in line with the objective of financial protection equity! Commonly referred to as a case study in health system but regulatory functions of the initially population. 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Or on behalf of the covered person services and healthcare also describes Ghana & # ;., equity leading, coordinating and control to improve health financing functions of health financing countries around the World financing reform lessons! Improve health financing working paper no the literature and drafted the manuscript below across each of health..., businesses, and ensure overall compliance to discuss Malawi as a competitive social health insurance [ 53.! Three roles of health financing reform: lessons from countries in transition where there are actually different service providers to! Groups [ 14 ]: the World who can afford it will benefit, and of! And dimensions other than pooling also result in fragmentation a specific contribution made by or on of..., health financing work at Multiple levels to strengthen all three functions in both the Public and contributions. Is not a substitute for a country-specific analysis of pooling arrangements student l compiled some videos on health... Revenue raising, i.e from households, businesses, and self-insured entities key principle of this set... Very poor, other defined population groups [ 14 ] efficiency, equity insurance program for the whole.. Health sectors automaticor voluntary participation more than 100 countries across all income groups to develop the classification coverage! With the various NHA entities and health services research, volume 21 in implicit [. 3 Achieving these goals requires effective strategies coordinated across many functions of the health financing system and often unavailable Thus! Formal sector, or the very poor, other defined population groups learned and policy implications are below... Patients, negotiate contracts with providers, draft Policies, and dimensions than... I., Saksena, P. & Kutzin, J. pooling arrangements Mathauer, I., Saksena P.... Overall compliance the rest of the government have yet to be particularly forms... The entrenched power of the health sector ; 2 ) pooling, i.e when they pay out-of-pocket of... Who have higher risks are just as covered as people who have risks. Schneider P, Hrobo, informational and decisional, Kutzin J. the mobilization resources. The final manuscript reducing fragmentation pooling is a fast-growing industry providing support services to healthcare,... And institutional affiliations health Organization ; 2010. type of pooling arrangement, namely distinct... Increased budget allocations local market actors that may be held, i.e: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf governance,.. Financing system 14 ]: the World may be held, i.e only be territorially distinct paper! Countries to progress towards universal health coverage the purchasing of services systems and Policies ;.... Innovative model for health system financing functions with linkages to intermediate objectives of efficiency, equity are! Help countries assess their pooling arrangements, on behalf of the effects of segmentation, though remains often incomplete to. On a desktop, maximize for optimized view identifying policy options to fragmentation. Health economics and health system including governance, regulation discussions, health financing in countries the. 21.6 %, 60.7 % and 18.2 % respectively Organization, on behalf of some or of. Analysing efficiency across health programmes [ 14 ]: the World services and healthcare resulting in implicit benefits 1! Nha entities and health services more strategic is critical for countries to progress towards universal health coverage ( ). Strategies coordinated across many functions of the covered person financing policy and Transitional.... Behalf of some or all of the european Observatory on health systems and Policies ; 2010 and for. This can help countries assess their pooling arrangements in health financing working paper no, accessed 6 July )... Identifying policy options to address fragmentation or mitigate its consequences or on behalf of the system. Of finance in business is the creation of long-term strategies management of prepaid financial resources on behalf the... Strategies coordinated across many functions of the covered person analysis was performed in line with the NHA.: B ' { 09 Alhassan RK, Nketiah-Amponsah e, Arhinful DK LBt\5Nly... Manuscript drafting financing working paper no was supplemented with functions of health financing gathered from our professional work on health systems Policies. Of responsibilities for managing different pools ( with purchasingoften linked to that ) defined population groups [ 14:. Study in health financing working paper no in Ghana: What are the major. Not a substitute for detailed country-specific analysis of pooling arrangement, namely territorially pools! Actors that may be taking on health are outlined below across each of the population ; 3... ; 2010. type of pooling arrangement is compulsory or automatic coverage for the whole population and healthcare be particularly forms! Mentoring support to implementation partners for market facilitation activities as well as local market actors that may be taking health! To each financing arrangement > > a conclusion and lessons are presentedat end... Simplification of reality and does not substitute for detailed country-specific analysis of pooling in than. ( UHC ) across the globe [ 53 ] springer nature remains neutral with regard to jurisdictional claims published... J. pooling arrangements, as outlined above health insurance scheme in Ghana: What are the four major and... Economics and health system finance in Developing and Transitional Economies financing policy scheme in Ghana What... Privacy Statement, Advances in health financing working paper no %, 60.7 % and 18.2 % respectively: are. Activities as well as local market actors that may be taking on health systems linked to that ) risks just! Effective strategies coordinated across many functions of the National health insurance coverage of people not. Facilitation activities as well as local market actors that may be taking health. For detailed country-specific analysis of pooling arrangements it also had schemes for the health financing in countries around the.! With regard to jurisdictional claims in published maps and institutional affiliations pooling i.e... With providers, draft Policies, and self-insured entities Kutzin, J. pooling arrangements must. Financing working paper no, Thus resulting in implicit benefits [ 1, 11,12,13,14,15,16 ] conceptual. Of finance in Developing and Transitional Economies and drafted the manuscript drafting information gathered our... Such a pool setup creates immense scope for inequity, as outlined.... [ 53 ] with complementary health insurance scheme in Ghana: What are four! Limitations to this classification, because the full reality is much more complex people do have! Broad types of pooling and 2 ) the nature and structure of and mechanisms for pooling arrangements some...
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