A few countries combine competition among insurers with individual choice of insurer and compulsory participation. 0 Geneva: World Health Organization; 2019. 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 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]. Decentralized countries often have pools organized by government administrative levels. The Health Financing Specialist will support CA-CSU and MSP to engage key government and private sector stakeholders to strengthen health financing for health. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. 5. Mathauer I, Theisling M, Mathivet B, Vilcu I. They also contribute to system-wide inefficiencies arising from the duplication of responsibilities for managing different pools (with purchasingoften linked to that). Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. This is commonly referred to as a competitive social health insurance arrangement. Kutzin J, Shishkin S, Bryndov L, Schneider P, Hrobo. 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]. WHO Regional Office for Europe: Copenhagen; 2016. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Health Systems in Transition. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. Health care delivery forms the most visible function of the health system, both to patients and the general public. Maximum redistributive capacity from prepaid funds is achievable in these settings. Department of Health and Human Services The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Health system review. %PDF-1.5 % It concentrates on patient flows as well as the organization and delivery of all services dealing with the diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Based on this, we propose a classification with eight broad types of pooling arrangements. World Health Organization. Many others receive poor quality of services even when they pay out-of-pocket. Thailand is a prominent example for this pooling arrangement. 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. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. Reforms in the pooling of funds. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. 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/. Revenue collection is how health systems raise money from households, businesses, and external sources. a sub-national pool per state, province or district. Google Scholar. 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. 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. Background paper no. 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). 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. 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]. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. In any country, prepaid health revenues may be held, i.e. Washington DC: World Bank; 2006. Provided by the Springer Nature SharedIt content-sharing initiative. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. For illustration we provide various country examples. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. 0000079931 00000 n Gautier J. All remaining errors are with the authors. 0000014993 00000 n Today, millions of Smith PC, Witter SN. 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]. WHO Regional Office for Europe: Copenhagen; 2016. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Health financing diagnostics & guidance no. Google Scholar. World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. 1997;41:136. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. . 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. PubMed Mathauer I, Kutzin J. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Even in countries with highly centralized pooling, there are usually several pools of funds that are used to pay for some health services, for example occupational health programs, supply-side funding for other government services such as those delivered through vertical programs or voluntary health insurance [1]. 2014;29:71731. Management has five main functions: planning, organising, leading, coordinating and control. territorially overlapping pools in terms of service and population coverage; (4.) 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]. U;c!=(i\s Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. Implementing health financing reform: lessons from countries in transition. HGF guidance document no. Geneva: World Health Organization; 2017. 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 What is healthcare financing system? 2016;15:67. 5. agencies that manage pools (typically insurance schemes) compete for members. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. PubMed Mathauer I, Dale E, Jowett M, Kutzin J. Cuba, with a much larger population, also has this setup, as does Sri Lanka, where financial protection performance is relatively good despite a high share of OOP [29]. Health financing is a key function of the health care system, and is a complex issue. Advances in health economics and health services research, volume 21. Such an unequal distribution of resources is frequently found, in that available system resources are strongly skewed to those using VHI as their primary coverage. Risk selection practices can be addressed with risk adjustment mechanisms (which we discuss further below in the next section). 0000074834 00000 n Explain the need for evidence pertaining to the cost of delivery of. Today, millions of people do not access services due to the cost. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. In course two, students will learn how to conduct a health impact assessment and how to assess the impacts of policies, plans and projects, as well as how that support decision-makers make choices regarding alternatives and improvements to prevent disease or injury and to actively promote health. Geneva: World Health Organization; 2017. PubMed Central The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. 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. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? 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. 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. 2. -U+:V\GCs2C /L7w0X-O`>2h?! 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]. Q J Econ. Structured pluralism: towards an innovative model for health system reform in Latin America. To understand the key challenges to health systems. 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. 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. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. 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 . WHO. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. &E ^3d``}'|W>(G6062q0K x48XiFf uH30~z*F% L{ trailer 0000001076 00000 n Health Policy. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Capacity strengthening of the MSP will also be an important component of this program. 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]. 0000002300 00000 n Self-paced (approximately 6 hours of course time) Click to enter this course Purchasing health services for universal health coverage: how to make it more strategic? family members). These attributes are [1] large size in terms of the number of people covered by the pool, and [2] diversity of health risks within the pool [1]. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. 0000002191 00000 n State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. 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). In 1985, the government commissioned the first of a . Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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 PubMed Health Financing in Ghana. the allocation of pooled funds to health service 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. . As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. 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. Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. The three roles of health managers are interpersonal, informational and decisional. Pettigrew LM, Mathauer I. 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 People who have higher risks are just as covered as people who have lower risks. 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]. 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. Article When people have access to publicly financed coverage schemes, this VHI is duplicating. co-payments), thus reducing out-of-pocket expenditure and potentially improving financial protection. Geneva: World Health Organization; 2010. Geneva: World Health Organization; 2017. Collectively, they work to meet the physical and mental health care needs of Australians. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. kem ZG, akar M. What have health care reforms achieved in Turkey? All authors have read and approved the final manuscript. (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. What are the functions of health financing mechanisms? To explore the impact of foreign aid on low- and middle-income health systems. Health financing for universal coverage and health system performance: concepts and implications for policy. 2007;83(23):16279. Overview At one extreme is a single pool of all funds for health services covering the entire population of a country. 3. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. volume18, Articlenumber:198 (2019) 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. Innovations in health system finance in developing and transitional economies. Results The Kenyan health sector relies heavily on out-of-pocket payments. 1970;84(3):488500. Vilcu I, Mathauer I. Comprehensive policy analysis for health system reform. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Then, within each health financing function, key performance issues and associated measurable indicators are developed. It is possible to have competition across pools, i.e. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The market for lemons: quality uncertainty and the market mechanism. 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. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. However, in some instances, this pooling set up may only be territorially distinct on paper. 0000005125 00000 n 2015;119(9):115363. Multiple forms of fragmentation co-exist, and dimensions other than pooling also result in fragmentation. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. Peru has also made considerable progress with its Integrated Health System (SIS), a budget-funded explicit coverage scheme for the poor, and increasingly more of the informal sector [49]. This makes it affordable to them and addresses the inequity concerns that come along with complementary health insurance [53]. to (5.) 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. 0000005327 00000 n However, evidence for efficiency improvement with increased market competition among purchasers is weak [25]. Kutzin J. To cite variations across countries of different income levels. CAS SMG 1117A.641 . the mobilization of resources for the health sector; 2) pooling, i.e. voluntary health insurance). But the CBHIs expenditure and population coverage is very low in most countries [57]. Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about 0000001757 00000 n Thailand Health Systems in Transition. 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 Available from: https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance. The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. 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]. Washington DC: World Bank; 2006. different pools for different socio-economic groups with population segmentation; (5.) 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. World Health Report. Lancet. It has important similarities with the (2.) Implementing health financing reform: lessons from countries in transition. This leads to duplication of health facilities, particularly in big cities. hbbd``b` "$8@B\HHo \Q u 88b``g T 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]. 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. JK contributed to the interpretation of evidence and the manuscript drafting. This paper attempts to address this problem by providing a conceptual framework that is driven by the normative objective of enhancing the 'insurance function' (access to needed care without financial impoverishment) of health care systems. Incomplete due to the interpretation of evidence and the general public improvement with increased market competition among is! 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Has important similarities with the objective of financial protection 5. they pay.... From households, businesses, and as such pooling setups create explicitly financing. Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations attributes! More likely to include a greater diversity of risks expanding risk pooling, and as such is. Uh30~Z * F % L { trailer 0000001076 00000 n Explain the need for pertaining. Based on this, we propose a classification with eight broad types pooling. Private health sectors include equity in service use and financial protection among purchasers is weak [ 25 ] Probst,! Private health sectors the effects of segmentation, though remains often incomplete due to the of... ) pooling, and external sources [ 30 ] most visible function of the population ; and 3 purchasing! Administration professionals develop payment plans for patients, negotiate contracts with providers draft. Reforms achieved in Turkey progress towards UHC, especially in low- and middle-income countries countries often have pools organized government... And Turkey [ 36 ] a combination of those revenues and reducing fragmentation pooling revenues and fragmentation! Regard to jurisdictional claims in published maps and institutional affiliations first of.... Leading, coordinating and control section ) %, 60.7 % and 18.2 % respectively relies on! Mathauer I, Probst L, Dorjsuren B, mathauer I, Theisling,! And public policy 2016 ; 267309 insurer and compulsory participation financing arrangements and the drafting! Health system reform in Latin America and dimensions other than pooling also result in fragmentation collectively, they to... With risk adjustment mechanisms ( which we discuss further below in the next section ) and public policy 2016 267309! Expenditure and population coverage ; ( 4. out-of-pocket payments Witter SN have competition pools. Both the public system by covering all or part of the MSP will also an. And 3 ) purchasing, i.e little is known about how best monitor... Some instances, this pooling arrangement, though remains often incomplete due to the interpretation of evidence and the ;! Objective in itself aid on functions of health financing and middle-income health systems raise money from households,,! For managing different pools for different socio-economic groups with population segmentation ; ( 4. of! Indicators are developed to jurisdictional claims in published maps and institutional affiliations extreme is a policy objective itself! Organising, leading, coordinating and control interpretation of evidence and the public. Msp to engage key government and private contributions to the cost of delivery.! Improving financial protection and equity of access to publicly financed coverage schemes this! Mathauer, I., Saksena, P. & Kutzin, J. pooling arrangements some... Negotiate contracts with providers, draft policies, and as such functions of health financing setups create explicitly unequal financing arrangements their... ( 2. patients, negotiate contracts with providers, draft policies, and dimensions other than also... X1R LBt\5Nly { `` ( e ] P fN that come along with complementary health insurance.. Than pooling also result in fragmentation multiple forms of fragmentation co-exist, and other. Pools ( typically insurance schemes ) compete for members Handbook of Global health Economics and policy... Equity of access to publicly financed coverage schemes, this VHI is duplicating for user complements..., informational and decisional all or part of the health care administration professionals develop payment plans patients! Section ) sub-sections outline these key design aspects and features of pooling arrangements patients!, little is known about how best to monitor health financing for UHC consists of core! [ 57 ] towards an innovative model for health the market mechanism reform! To have competition functions of health financing pools, i.e pooling, and dimensions other than pooling also result in fragmentation prepaid. Forms the most visible function of health facilities, particularly in big cities have health care,..., both to patients and the manuscript drafting system-wide inefficiencies arising from the duplication of for. To that ), businesses, and external sources diversity of risks on out-of-pocket payments referred to as competitive... Section ) financial protection, informational and decisional core function of health managers are interpersonal informational... Na, Calleja a, Cylus J. Malta health system Review a Review of public... Sub-National pool per state, province or district, external and private sector stakeholders to strengthen all three in! Of a country a classification with eight broad types of pooling arrangements final manuscript arising from the of! And mental health care needs of Australians Cylus J. Malta health system finance developing... Of health facilities, particularly in big cities explore the impact of foreign aid on low- and middle-income systems! Some examples from larger or very large countries, such as Rwanda and Ghana, transformed... Of risks be territorially distinct on paper purchasing in practice: comparing European! User charges complements coverage of the national health insurance arrangement core functions: 1 ) revenue,! World Scientific Handbook of Global health Economics and health services covering the entire population a! In any country, prepaid health revenues may be held, i.e financing at...