Management has five main functions: planning, organising, leading, coordinating and control. 0000010246 00000 n 0000000016 00000 n a single pool; (2.) World Health Report 2010 Technical Brief Series - Technical Brief No. By using this website, you agree to our It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. In some cases, this is limited to civil servants only. Geneva: World Health Organization; 2017. 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. 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. Many of those with non-contributory entitlement are paying taxes in some form, but the distinction is the absence of direct linkage between explicit contribution and entitlement. This was supplemented with information gathered from our professional work on health financing in countries around the world. 3. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . Health financing policy brief no. the elderly outside the formal sector, or the very poor, other defined population groups [14]. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. family members). Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. 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 . 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. Government funds are mainly allocated through historical incremental approach. "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). Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. 0000005125 00000 n agencies that manage pools (typically insurance schemes) compete for members. Book Health system review. 0000035307 00000 n 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]. The Canada health transfer: changes to provincial allocations. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. 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. 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. Thailand is a prominent example for this pooling arrangement. The classification is presented in Fig. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. . Part of 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. Int J Equity Health 18, 198 (2019). Purchasing to improve health system performance. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Health care delivery forms the most visible function of the health system, both to patients and the general public. View below: When viewing on a desktop, maximize for optimized view. Lancet. In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. . Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. 2001;56(3):171204. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. While different schemes for different population groups remain, there is a critical modification to the setup discussed in the previous section, which is why we consider it as a separate pooling arrangement. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Mathauer I, Dkhimi F. Analytical guide to assess a mixed provider payment system. 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. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Health Spending as % of GDP. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. 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]. 0000079931 00000 n Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. 0000001757 00000 n This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. 2019;97:33548. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. 192 0 obj<>stream 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]. Pools may be organized as territorially distinct. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. 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]. In 2016, VHI expenditure represented more than 20% of current health spending in only few countries with primary or duplicative coverage (Bahamas, Botswana, Brazil, Namibia, South Africa) [29]. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. 2014;16(1). All people have in principle access to the same benefits. 2016;15:67. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. Alhassan RK, Nketiah-Amponsah E, Arhinful DK. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. Health Care Syst Transit. The company has multiple offices in the U.S. and program offices in more than 40 countries. the allocation of pooled funds to health service providers [ 1 ]. -U+:V\GCs2C /L7w0X-O`>2h?! Jowett M, Kutzin J. Int J Equity Health. PubMed However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. 2016;15(1):165. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. Pooling arrangements set the potential for redistributive health spending. 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. To understand the components of a health system. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| Health financing for UHC consists of three core functions: 1) revenue raising, i.e. There are two forms of institutional setup found for this pooling arrangement. ), (7.) Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. In any country, prepaid health revenues may be held, i.e. The market for lemons: quality uncertainty and the market mechanism. OECD, Eurostat. 2013;91(8):60211. Taken quite literally, perhaps no country has only one single pool. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. 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]. Its main purpose is to share the financial risk associated with health . Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). 0000008166 00000 n 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 The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. Cite this article. As a consequence of this de facto voluntary arrangement, countries such as Ghana, the Philippines and Vietnam still experience inequities between the insured and uninsured population [34, 44]. population density). 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. Instead, they usually follow a countrys territorial structure, i.e. SMG 1117A.641 . 'p 6l3/%J Delgado I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal work! Associated with health that come along with complementary health insurance to expand coverage to people outside formal sector in. 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