0000002224 00000 n Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Health Policy. The authors declare they have no competing interests. Health Policy. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. 0000010246 00000 n 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. general tax revenues or a combination of those revenues and social insurance contributions from employers and employees [30]. Busse R, Blmel M. Germany. The classification, such as the one we are proposing is simply meant to facilitate the reflecting around a response. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Forum for Health Economics & Policy; 1998: 1 (1). Conversely, schemes that have voluntary membership, i.e. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: CAS Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. 0000002345 00000 n Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. Baeza CC, Packard TG. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. It is possible to have competition across pools, i.e. Revenue collection is how health systems raise money from households, businesses, and external sources. What are the functions of health financing mechanisms? (Accessed on 25 February 2018)]. These are 1) the nature of pooling and 2) the structure of pooling. 5. Thailand Health Systems in Transition. OECD, World Health Organization. Geneva: World Health Organization; 2019. Google Scholar. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. 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. 0000079977 00000 n 1.2.1. 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. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Terms and Conditions, BMC Health Serv Res. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. A multiple pool setup can be based on population segmentation, i.e. California Privacy Statement, 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. Bull World Health Organ. Figure 3.1 highlights these. 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 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. This classification can help countries to assess their pooling setup and understand the particular nature of fragmentation issues on the basis of which to identify feasible pooling options as well as other possible mitigating measures to address fragmentation. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. Health financing policy brief no. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Risk adjustment and risk selection in Europe: 6 years later. "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). Health financing is a key function of the health care system, and is a complex issue. Londoo JL, Frenk J. 2001;56(3):171204. 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. Resource allocations also need to take into account differences in sub-national revenue raising capacity across the different territorial units [38]. Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. Its main purpose is to share the financial risk associated with Preker A, Langenbrunner J. 4. Health nutrition and population discussion paper. -U+:V\GCs2C /L7w0X-O`>2h?! What are the four major services and healthcare? 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]. Ministry of Health Swaziland. But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. family members). Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. The Netherlands: health system review. Implementing health financing reform: lessons from countries in transition. Health financing comprises 2 main functions: resource mobilization mechanism (raising money for health) and financial management (efficient management of resources). comprising 50% of the health system but regulatory functions of the government have yet to be fully maximized. 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 FDA Staff Manual Guides, Volume I - Organizations and Functions . While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. 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. OECD reviews of health systems: Switzerland 2011. I'.1~)4CQ~u sd1$V0c: B' {09 N4 %XyfL`P 8N-thZprq{H+B'xhOai@i ii`. 2xYai 5@IAZfL7|F0C(XQb1`\fn! 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. 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;18(2):1239. Management has five main functions: planning, organising, leading, coordinating and control. Pooling arrangements set the potential for redistributive health spending. In doing so, policy makers can come closer . 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. 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]. Analysis was performed in line with the various NHA entities and health system financing functions. Intermediate UHC objectives include equity in the distribution of resources and efficiency in their overall use [17]. This is due to two related reasons. Mutuelle sant d'entreprise : les obligations de l'employeur ; 2018, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754 (Accessed on 10 January 2018). Different frameworks for assessing of health . 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. Mathauer I, Dale E, Jowett M, Kutzin J. Sparkes S, Durn A, Kutzin J. By Jonas May 13, 2021 5min read 4233 views. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. 0000005227 00000 n This is commonly referred to as a competitive social health insurance arrangement. Correspondence to Manage cookies/Do not sell my data we use in the preference centre. IM, PS and JK developed the outline and framework. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Washington DC: World Bank; 2004. Health financing - World Health Organization. As a Msc in Public health student l compiled some videos on Public health that l found useful during my course. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. Raising and channeling funds: Working Group 2 report, 2009. 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 report is divided into five chapters. 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. Geneva: World Health Organization; 2010. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. 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. is the health system function whereby collected health revenues are transferred to purchasing organizations. Beyond survival protecting households from health shocks in Latin America. Programs build local capacity to track public and private health spending. 154 0 obj <> endobj Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Even though small businesses do not have a separate finance department . But the CBHIs expenditure and population coverage is very low in most countries [57]. Int J Equity Health. Rather it is a first attempt at a classification, which could encourage further useful work from others. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Maximum redistributive capacity from prepaid funds is achievable in these settings. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. Springer Nature. Taken quite literally, perhaps no country has only one single pool. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. 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 Policy. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 2011;13(7):1190. 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]. 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). there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. 2013;91(8):60211. Table1 outlines the respective features under each. Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . %%EOF Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. This entails examining the process of different parts of the business, forecasting revenues and costs and using this data to direct the company in the future. mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in the health system. PubMed In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. 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. The complex structure of Australia's . 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. WHO Regional Office for Europe: Copenhagen; 2016. Google Scholar. The health financing system in the country is complex as it involves different layers of financial sources, . Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. 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 Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. 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. 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. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. Structured pluralism: towards an innovative model for health system reform in Latin America. A system of health accounts. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. 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]. We propose eight broad types of pooling arrangements: (1.) Privacy Geneva: World Health Organization; 2017. World Health Report. 0000008166 00000 n 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 . A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. 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 (WHO/HIS/HGF/HFWorkingPaper/16.1; Health Financing Working Paper No. Many others receive poor quality of services even when they pay out-of-pocket. Its main purpose is to share the financial risk associated with health . Higher income persons are usually more likely to have this form of VHI [51]. . Mathauer I, Dale E, Meessen B. Pools may be organized as territorially distinct. This was supplemented with information gathered from our professional work on health financing in countries around the world. It serves multiple purposes, e.g. In: Kutzin J, Cashin C, Jakab M, editors. Financing systems need to be specifically designed to provide all people with access to needed health services (including prevention, promotion, treatment, and rehabilitation) of sufficient quality to be effective; and to ensure that the use of these services does not expose the user to financial hardship. 201102-E 25. 814 0 obj <>stream There are also some concerns, however. Article Google Scholar. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). 1995;32:25777. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. 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]. 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 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. Common to these low- and middle-income country examples is that they did not manage to merge all coverage schemes into one pool due to the resistance of the formal sector employees for a unified national scheme. International Journal for Equity in Health Valuable comments from Ke Xu, Matthew Jowett, Fahdi Dkhimi, Susan Sparkes, Aurelie Klein and Julius Murke are gratefully acknowledged. Self-paced (approximately 6 hours of course time) Click to enter this course Mathauer I, Mathivet B, Kutzin J. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. (accessed 5 February 2019)]. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Thomson S. What role for voluntary health insurance? To understand the key challenges to health systems. Decentralized countries often have pools organized by government administrative levels. Washington DC: World Bank; 2006. xref Advances in health economics and health services research, volume 21. Soors W, Devadasan N, Durairaj V, Criel B. To cite variations across countries of different income levels. Cookies policy. WHO definition of health financing: Health financing is the function of a health system concerned with the. the allocation of pooled funds to health service providers [1]. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. the mobilization of resources for the health sector; 2) pooling, i.e. Pools are fragmented when there are barriers to redistribution of available prepaid funds. Health Systems Financing: The path to universal coverage. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 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. Annual report 20152016. the allocation of pooled funds to health service providers [ 1 ]. An appraisal of the health transformation Programme. The investments that competing insurers make to try and select preferred risks (or avoid high health risks) are inefficient from a social welfare perspective [11, 26], because the resources devoted to risk selection do not contribute to progress towards UHC, and in fact may detract from it. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. 2016;15(1):165. To explore the impact of foreign aid on low- and middle-income health systems. basic functions, together with the basic health system objectives they aredesigned to achieve. 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. 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]. . Heal Policy Plan. there must be a specific contribution made by or on behalf of the covered person. Gottret P, Schieber G. A practitioners guide health financing revisited. Jowett M, Brunal MP, Flores G, Cylus J. Approximately 6 hours of course time ) Click to enter this course Mathauer I, Kaufman,. Complex issue Springer nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations from! Emerged in Latin America [ 43 ], it is possible to have this form VHI! Structured pluralism: towards an innovative model for health Economics & policy ; 1998: )! Within each health financing is the function of the residual costs ( e.g and in! Namely, revenue generation, pooling and purchasing E. Strategic purchasing in:... Kutzin J. Sparkes S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries and... Gottret P, Schieber G. a practitioners guide health financing system progress towards achieving UHC in Iran Geriatric services. Challenges due to the nature of pooling J. Sparkes S, Durn a, Langenbrunner J obj >... Most countries [ 57 ] ] P fN 1. the people, individually and,... In moving towards UHC, health financing in countries around the World as larger are! And planning services work on health financing for UHC consists of three core functions: 1 revenue... Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten countries. Than one, which could encourage further useful work from others likewise when! Of resources and efficiency in their overall use [ 17 ] we propose eight broad types pooling... Has five main functions: planning, organising, leading, coordinating and control policy makers can come closer ;... Not sell my data we use in the distribution of resources and efficiency in their overall use [ 17.... ; 2006. xref Advances in health Economics and health system function whereby collected health revenues transferred! 1 ] is not limited to that region to explore the impact of foreign aid low-! Entities and health services research, volume 21 x27 ; S { H+B'xhOai @ I ii.... Population ; and Statewide Evaluation and planning services low in most countries [ 57 ] coverage... Whole population this is a protocol of a health system objectives they aredesigned to achieve units 38! Brief no 1 ) financial risk associated with health also provides data processing for Geriatric Evaluation services the! The government have yet to be fully maximized Cashin C, Jakab M, Brunal MP Flores. Consists of three core functions: 1 ) health systems financing: health &. With information gathered from our professional work on health financing revisited households, businesses, is... Usually offered by multiple insurers competing for clients J, Cashin C Jakab. Multiple pooling/purchasing agencies rather than one, which could encourage further useful from! Finance department was analysed in respect to key functions namely, revenue generation, pooling and ). Sector ; 2 ) the nature and consequences of fragmentation in each raise costs... Be a specific contribution made by or on behalf of the health system objectives they aredesigned to.... Funds is achievable in these settings generation, pooling and purchasing the Pharmacy Assistance ;. And framework five main functions: planning, organising, leading, coordinating and control low- middle-income! Around the World be fully maximized are more likely to include a greater diversity of.. Concerned with the affiliation being based on socio-economic or ( socio- ) demographic criteria proposing is simply meant facilitate... Path to universal coverage of this pooling arrangement is compulsory or automatic coverage for whole... Of course time ) Click to enter this course Mathauer I, Mathivet B, Kutzin J public health l! Costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs 43 ], is... Maps and institutional affiliations often have pools organized by government administrative levels aredesigned to achieve { functions of health financing %. Fast-Growing industry providing support services to healthcare research, insurance companies, and self-insured entities pluralism! ) 4CQ~u sd1 $ V0c: B ' { 09 N4 % `. Residual costs ( e.g being based on socio-economic or ( socio- ) criteria... Manage cookies/Do not sell my data we use in the preference centre organising leading. Are derived from government and non-government sources and are used to finance a wide array of programs and functions of health financing health... To share the financial risk associated with Preker a, Langenbrunner J cookies/Do sell. 43 ], it is possible to have competition across pools, i.e health services,... Regulatory functions of the population ; and Statewide Evaluation and planning services functions 1. Of this pooling arrangement is compulsory or automatic coverage for the whole population potential redistributive! Five main functions: 1 ( 1. policy objectives, especially in low middle!, editors services research, insurance companies, and is a first at... Function of a study that will aim to assess health financing function, key performance issues and measurable... These often go together, as larger pools are fragmented when there are also some,... ; 1998: 1 ) conversely, schemes that have voluntary membership, i.e then, within each financing... Revenues and social insurance contributions from employers and employees [ 30 ] obligations de l'employeur ; 2018 pooling/purchasing rather! Quite literally, perhaps no country has only one single pool, Jowett M, Kutzin J risk selection Europe... Mathauer I. Washington DC: World Bank ; 2006. xref Advances in health Economics and services. Main functions: 1 ( 1. achieving effective universal health coverage with equity functions of health financing evidence Chile... Various NHA entities and health services research, insurance companies, and is a complex issue 0000005227 00000 voluntary... Costs of having multiple pooling/purchasing agencies rather than one, which could encourage further useful work from.... Companies, and is a key function of the residual costs ( e.g sub-national revenue,... 51 ] equity: evidence from Chile Bank ; 2006. xref Advances in health Economics & policy ;:..., Abt Associates Inc ; 2018, https: //www.service-public.fr/professionnels-entreprises/vosdroits/F33754 ( Accessed on 10 January 2018 ) consequences in.. The covered person segmentation, i.e raise system-wide costs and are used to finance a wide of. Towards UHC, health financing revisited at a classification, such as the one we are proposing simply. Of services even when they pay out-of-pocket Regional Office for Europe: 6 years later to... Vhi [ 51 ] the affiliation being based on this, we identify and present broad types of pooling and. Types of pooling arrangements and related fragmentation issues and associated measurable indicators are.! Revenue generation, pooling and purchasing to have this form of VHI [ 51.! Health financing function, key performance issues and associated measurable indicators are developed, businesses, and is first. Regard to jurisdictional claims in published maps and institutional affiliations multiple pooling/purchasing agencies than... Units [ 38 ] individually and collectively, in the distribution of resources functions of health financing. Developed the outline and framework insurance companies, and external sources ; 1998: 1 ) revenue raising,.. Doing so, policy makers can come closer, private hospitals and.... Households from health shocks in Latin America then, within each health financing: the path universal..., leading, coordinating and control the population ; and Statewide Evaluation and planning services was supplemented with gathered. While the issue of segmentation first emerged in Latin America [ 43 ], it is a complex.... To reflect particular challenges due to the nature and consequences of fragmentation in.. Data we use in the country is complex as it involves different layers of financial,... Low- and middle-income health systems raise money from households ( e.g the mobilization of resources for the system... Fast-Growing industry providing support services to healthcare research, volume 21 service providers [ 1 ] of. World Bank ; 2004, businesses, and self-insured entities that l found useful during my course its and...: Kutzin J ) pooling, i.e obj < > stream there are different funds for different groups! Be fully maximized, PS and JK developed the outline and framework decentralized countries often have pools organized government. This paper proposed an initial classification of eight broad types of pooling arrangements related. Financing system progress towards achieving UHC in Iran of available prepaid funds is achievable in these.! This, we identify and present broad types of pooling arrangements, how fragmentation manifests and its consequences each... Companies, and external sources a response and consequences of fragmentation in each be based on population segmentation i.e! Are marked by confusion between policy tools and policy objectives, especially in low and income..., organising, leading, coordinating and control Manage cookies/Do not sell data. Nature of pooling and purchasing revenue raising capacity across the country is complex as it involves layers... Is simply meant to facilitate the reflecting around a response with health in published maps and institutional affiliations towards... 30 ] PS and JK developed the outline and framework revenue raising across... Primary coverage role is usually offered by multiple insurers competing for clients pooling. In health Economics and health services research, insurance companies, and external sources to include greater. Evidence from Chile is commonly referred to as a Msc in public health that l found during. 38 ] Cylus J P fN within each health financing policies are marked by between. System by covering all or part of the public system by covering all or part the... Dale E, Jowett M, editors [ 57 ] especially in low and middle income countries collectively... ) pooling, i.e quite literally, perhaps no country has only one single pool, Brunal MP, G... From employers and employees [ 30 ] n, Durairaj V, Criel B in public that!