This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. 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. 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]. -U+:V\GCs2C /L7w0X-O`>2h?! 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]. The authors declare they have no competing interests. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Each of the insurance schemes thus constitutes a separate pooling agency. 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. This is commonly referred to as a competitive social health insurance arrangement. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Article Raising and channeling funds: Working Group 2 report, 2009. Mathauer I, Behrendt T. State budget transfers to health insurance to expand coverage to people outside formal sector work in Latin America. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. 0000005125 00000 n A system of health accounts. Its main purpose is to share the financial risk associated with Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. By using this website, you agree to our Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. 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]. 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. WHO. pooled, in one or several pools. Financial Management Functions. Google Scholar. 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. Finally, there may be specific coverage schemes for defined population groups, such as the poor [30]. Mathauer I, Dale E, Meessen B. World Health Report. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 0000025210 00000 n Q J Econ. 0000001757 00000 n They also need to monitor cash on hand, businesses may be profitable but have a shortage of cash and. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. Health financing policy brief no. Washington DC: World Bank; 2006. Formula funding of health services: learning from experience in some developed countries. Although all health financing functions play an important role in ensuring finan-cial protection, risk pooling and prepaymentwhether through taxes or individual premiumsplay the central and often the most poorly understood roles. OECD reviews of health systems: Switzerland 2011. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. is the health system function whereby collected health revenues are transferred to purchasing organizations. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. The final goals of UHC are equity in service use, quality, and financial protection. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Cutler DM, Zeckhauser RJ. Article 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. Mathauer I, Kutzin J. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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. 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. Health Policy. Health system review. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about to (5.) 0 Rather it is a first attempt at a classification, which could encourage further useful work from others. 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. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. There are different classifications for finance functions, and it varies with organization types. (Accessed on 25 February 2018)]. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. Mathauer I, Mathivet B, Kutzin J. In: Kutzin J, Cashin C, Jakab M, editors. the allocation of pooled funds to health service providers [1]. Overview Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. Pools are thus not divided along population groups. 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 This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. 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. 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]. 1 / 64. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. 0000002548 00000 n These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. 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]. <]>> This is due to two related reasons. Geneva: World Health Organization; 2016. Geneva: World Health Organization; 2017. To discuss Malawi as a case study in health systems. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. . Different frameworks for assessing of health . voluntary health insurance). 0000079977 00000 n In any country, prepaid health revenues may be held, i.e. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. Mathauer I, Dale E, Jowett M, Kutzin J. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. The third function of health care financing is purchasing of services. xb```l hp`d,u){i7NY~GOC]TkT} h$*M^ixD#UNm| %%EOF But the CBHIs expenditure and population coverage is very low in most countries [57]. The market for lemons: quality uncertainty and the market mechanism. [3] As such, automatic entitlement is typically solely funded from general budget revenues. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. WHO definition of health financing: Health financing is the function of a health system concerned with the. !{~4nf0QMh92]Ta, *eIF co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. 2. Department of Health and Human Services Paris: OECD; 2011. statement and The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. 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]. Whereas revenue raising, e.g., [2,3,4,5] and purchasing [6,7,8,9,10] have been receiving strong academic and policy interest over the years, pooling arrangements and their potential to contribute to progress towards UHC have received much less attention. Part of Busse R, Blmel M. Germany. The three roles of health managers are interpersonal, informational and decisional. A 2 0 The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . 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. 0000014993 00000 n 0000035307 00000 n Figure 3.1 highlights these. PubMed 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. 2001;56(3):171204. Government funds are mainly allocated through historical incremental approach. 2014;29:71731. Provided by the Springer Nature SharedIt content-sharing initiative. trailer Background paper no. 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]. hmo6 The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily 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 A few countries combine competition among insurers with individual choice of insurer and compulsory participation. Finally, it is important to keep in mind that while pooling reforms are needed to enhance redistributive capacity, realizing the gains set by the potential of a pooling arrangement requires more than pooling. territorially distinct pools; (3.) RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 0000007449 00000 n Health financing involves not only methods of raising money for health care, but also allocation of those funds. All remaining errors are with the authors. 0000002224 00000 n Due to voluntary participation, small pool size and little or no subsidization of poor and vulnerable groups, CBHI can play only a very limited role in progressing towards UHC. 0000008860 00000 n As such, this type of pooling arrangement, if and when it has an effective risk adjustment mechanism that deters risk selection efforts, can act as a virtual single pool (due to the flows between the pools). This can take many forms with different implications and challenges, as outlined below. Advances in health economics and health services research, volume 21. endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream %PDF-1.5 % Explain the need for evidence pertaining to the cost of delivery of. Service public pro. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. 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]. 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]. 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. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). WHO Regional Office for Europe: Copenhagen; 2016. Conversely, schemes that have voluntary membership, i.e. Inke Mathauer. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Automatic participation is typically based on legal or constitutional obligations, and the basis for entitlement is non-contributory, deriving from citizenship, residence or other factors such as poverty status, etc. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. Prakongsai P, Limwattananon S, Tangcharoensathien V. The equity impact of the universal coverage policy: lessons from Thailand. For illustration we provide various country examples. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. Today, millions of people do not access services due to the cost. Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. SMG 1117A.641 . Sparkes S, Durn A, Kutzin J. Strategic purchasing for universal health coverage: key policy issues and questions. Comprehensive policy analysis for health system reform. 1). State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. 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. Taskforce on Innovative International Financing for Health Systems. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. Results The Kenyan health sector relies heavily on out-of-pocket payments. In healthcare management there are three managerial levels: top-level, middle-level and frontline managers. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. 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 . Competitive social health insurance arrangement the final goals of UHC are equity service. Office for Europe: Copenhagen ; 2016, Behrendt T. State budget transfers health... Tend to reflect particular challenges due to the cost ), thus reducing out-of-pocket expenditure and potentially financial. With the purchasing organizations 0000035307 00000 n Figure 3.1 highlights These mainly allocated through historical incremental approach universal health:! 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