sources of health financing

In conclusion, employment contributions as a source of health financing are … While almost all insurance plans provide some level of payment for hospital services, paymen… Indirect taxes are paid to the government or other public agency via a third party (retailer or supplier). In developed countries the primary focus is on accident prevention and occupational health, and in developing countries also, employers may have a legal obligation to provide first aid or occupational health services (e.g. The remaining funds flow primarily from consumers as out-of … Charitable or voluntary contributions can take the form of financial support or in-kind donations (e.g. A clear advantage of this source of finance is that a tax is visibly assigned to priority funding of certain activities or programmes. Given the reduction in available health … In developing countries high inflation rates (affecting the real rate of interest on loans) and lack of confidence in the government's abilities to honour eventual redemption of the bond may make it difficult to use deficit financing as a source of support for health systems. Four aspects of the overall efficiency with which financing mechanisms raise and use finance should be considered. It may be mitigated by the introduction of an exemption mechanism for the poor, although such a mechanism may itself reduce the demand for health care made by low-income groups because they may not wish to be identified as 'poor'. Health Economics for Developing Countries: A Survival Kit, Chapter 1: Health Economics and its Contribution to Health Planning, Chapter 2: Economic Development and Health, Chapter 3: Financing Economic and Health Development, Chapter 4: Health Care: the State versus the Market, Chapter 5: Demand, Supply and the Price System, Chapter 6: Concepts of Economic Efficiency, Chapter 8: Outputs, Health and Health Indicators, Chapter 9: The Techniques of Economic Evaluation, Chapter 10: National Accounts and the Health Sector, Chapter 11: Health Sector Finance and Expenditure, Chapter 12: Sources of Finance for the Health Sector, Chapter 13: Budgetary Procedures: Budgetary Reform and Programme Budgeting, Chapter 14: Approaches to Financial Planning: Resource Allocation Planning and the Financial Master Plan. Some financing sources are biased with respect to the types of expenditure that they favour: favouring curative rather than preventive, or capital rather than recurrent, expenditures. However, this standard is likely to penalize those who are least able to pay and most likely to be sick (low-income groups). The main problems of social insurance are related to issues of equity. For example, taxes on the sale of particular products may be earmarked for health services at either national or local level. The total financial contribution to social insurance schemes is (in theory) determined actuarially on the basis of the incidence of illness, the conditions of eligibility for benefit, and the value of those benefits. Examples include paying for services from a chiropractor not on the approved provider list of your health plan and co-payments. Problems with employer-financed schemes relate to the quality of care provided, the possible fragmentation of services, difficulties enforcing employer liabilities, and the fact that viability depends upon the performance of the employing agency. food), because there is only limited ability to pay for the range of household needs. Report and monitor health financing indicators to achieve targets of National Health Policy 2017, Sustainable Development Goals and Universal Health Coverage. Although useful for many developing countries in helping to develop and expand health care infrastructure, foreign aid is often limited to supporting import components. how is abuse of the system restricted?) Many existing financing policies have paid little attention to the incentives they create or reinforce, or to their ensuing impact upon service providers, households, and government agencies. sugar and coffee plantations in Latin America, tea and rubber estates in Asia and cocoa farms and mines in Africa). Allowance will then have to be made for the fact that cash income is only available seasonally, when crops are sold. However, low tax ratios (the proportion of national income collected as tax) in these countries mean that it is often insufficient by itself to support health care. Government schemes, for example, … Examples of displacement effects include foreign assistance which may displace government support for health care; counter-funding, often a precondition for foreign assistance, which may divert funds away from existing priority projects; health insurance schemes, which may in some instances displace rather than add to the total of resources being allocated to health care (e.g. Consequently, the activities of the health sector may have spill-over effects on the economy as a whole. One standard against which to assess the answer might be that only those who benefit from/use health care (i.e. Willingness to pay does not necessarily reflect ability to pay. Private services may be more oriented to the preferences and circumstances of households, for instance providing for payment in kind or payment related to ability to pay. Private financing plays a role in all health systems. It is easiest to cover those in regular employment, who may be as little as 5 to 15% of the population in developing countries; and there are often marked inequalities in the quantity and quality of services available to those covered by insurance relative to those who are not. Charitable contributions may also take the place of, or reduce, other sources of finance. The cost of enjoying the use of these funds in the present rather than the future is the interest that needs to be paid on the loan. The net resources available for the purposes of health care delivery consist of total revenue minus the administrative and other costs of collection. Most tax revenues are paid into a national pool and then shared out between different areas of government expenditure. Thus the agency doing the deficit financing must be endowed with the authority to impose additional taxes or fees, or be given a claim on general tax revenue in order to service the debt. Some financing mechanisms may encourage undesirable practices such as the inappropriate utilization of services. a fund into which a number of donors combine most or all of their funding so that it can be used to support a range of public sector health services, rather than having separate … It provides extra funds for largely urban, employed workers and leaves the large rural populations and the informally employed urban population even further handicapped than before its introduction. more equal access to health care or more equal utilization). Deficit finance may be raised nationally or internationally, through mechanisms such as the issuing of bonds or certificates or long-term low-interest loans. who collects the fees? The general trend, however, is for governments to support or take over mission health services. First, private health insurance typically does not include pensions for invalidity or old age. research questions around expenditures and revenues for public health in the U.S., financing of select public health program areas, how health departments maximize the resources they have, and … These are often taxes. The challenge is to develop new types of local institution that can coordinate and systematically utilize the community resources. how is ability to pay assessed? Health care is paid for by government programs (such as Medicare and Medicaid), private health insurance plans (usually through employers), and the person's own funds (out-of-pocket). Public sources of funding include those which are compulsory and pre-paid; meaning paid before the need for care is identified or care is accessed. Health service financing source Health services financed broadly through private expenditure or public expenditure or external aid Public expenditure includes all expenditure on health … 1. Often administered by quasi-public bodies under national or local government regulation, these typically non-profit schemes rarely constitute an important component of overall health sector finance. In order to include those workers outside the modern employment sector insurance payments may also be calculated on measures of income or wealth other than wages, such as the value of crops produced. as a result of financing health services through high taxes on certain economic activities, enterprises or sectors). In the United … General tax revenue is currently not the most reliable source of finance for the health sector in developing countries. Consequently, a framework for explaining the impact of the scheme within the context of Nigeria was … However, in order to control the level of utilization of services, individuals are often required to pay for part of the cost of medical care on a direct fee-for-service basis. Private insurance is not subject to the political allocation process and may channel extra funds into the health sector. Oil companies, mining and mineral industries, and large-scale export-centred agricultural enterprises usually provide for the health needs of their workforce. Management can be strengthened through staff training and the development of appropriate tools (including incentives), efforts can be made to understand the community's needs in order that health care better meets them, and resources can be allocated more appropriately (e.g. The national Department of … A compulsory source means the government requires some or all people to make the payment, whether they use the health service or not. raising funds for health; reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct out-of-pocket payments; and. We study the differential impacts of public and private sources of health spending on health outcomes using a triple difference approach. Use of traditional healers, for example, may reflect a belief in the relevance of their treatments for certain diseases rather than a general willingness to pay for any type of health care. Unless such projects sell their services or contribute directly to increased output that can be taxed to service the debt, the deficit must be repaid from general tax revenue. General lax revenue is used in almost every country of the world to finance certain components of health care and, in developing countries, it is often the most important source of financing. Governments have in many instances an increasingly favourable attitude to the development of social insurance. Until recently, comparatively little was known about the extent or the characteristics of direct household expenditure on health care, but a range of recent studies have shown that this form of financing is far more common and considerably more important than was hitherto thought. Given the limited resources available for health in developing countries, it is essential to raise and use resources as efficiently as possible. If efficiency improvements together with the possibility of additional resources still do not bridge the gap between resource requirements and resource availability, then health sector goals must be reconsidered. Rather than generating additional resources for the health sector, new or expanded financing mechanisms may merely displace funding from other sources. The equity impact of tax systems is dependent on both the proportional burden of taxation and on the use which is made of the revenue raised. The evidence concerning the demand for health care in developing countries is mixed but suggests that, especially for low income groups, demand may be elastic with respect to price, falling as price increases and resulting in significant shifts in the use of alternative providers. This happens in the Netherlands and India currently, and in Georgia prior to 2013. Not everything that may have a positive impact on health can be afforded and health plans must be based on a realistic view of resource availability. The typical net yield from lotteries is between 10-30% of gross receipts. Moreover, such willingness to pay as exists is attached primarily to curative services, and so can only extend the provision of preventive care if it is possible to re-allocate resources within the health sector. Tax systems can be progressive, falling more heavily on the rich than the poor and, therefore, equitable; but they may also be regressive, falling more heavily on the poor than the rich, and inequitable. A compulsory source means the … Some important distinctions are as follows: Public sources of funding can be managed by private entities, such as private insurers managing a public insurance scheme. Revenues should come from pre… 2. Methods of financing affect the supply or provision of services. More positively, social insurance can be the means of channelling extra funds into organized health services. Third parties paid for 97 percent of hospital care but only 55 percent for drugs and other services. Finally, the potential yield from user fees is unclear. Health care payments also sometimes displace expenditure for other basic necessities of life (e.g. Raising resources: it is clearly important that any mechanism raises adequate resources - channelling sufficient new funds into the health system to support existing or expanded services, and having the potential to raise additional revenue to meet the growing needs of health programmes. health care goods and services rely on a mix of different. Available evidence on the burden of taxation is inadequate to permit firm conclusions about its incidence to be drawn. Second, the price (or 'premium') charged for private health insurance is not based on the pooled risks of a large population, but on personal risk characteristics and the likelihood of illness in the individual or group covered. Charitable contributions have played an important role in health service provision in the past, and in some African countries are still a major source of health care finance, channelled through religious agencies. The need for these additional sources of funds is driven by rising demand for health care services, escalating costs of care, rapid increases in technology, and a limit on how much can be raised through … Finally, certain payment and reimbursement mechanisms have undesirable effects on specific aspects of the behaviour of service providers. In all OECD countries, the various schemes that pay for the. HIgHlIgHTS oF HEalTH carE FInancIng rEForM coMPonEnTS In 1998, the Ethiopian government developed and endorsed a health financing strategy (see strategy goals in Box 1) that directs resources for the health sector to be mobilized from different sources and permits government to provide health services through its health … The net yield is usually high, unless bureaucratic overheads are high. The question “who gains?” must, therefore, be asked in assessing the equity impact of health systems. By relieving the pressure on ministries of health to devote resources to urban health services, it may even, indirectly, make more resources available to those in rural areas. inflation through the repercussions of high increases in staff pay); foreign exchange problems through heavy foreign borrowing for development projects or for payments for imports such as pharmaceuticals or equipment; opportunity costs such as the attraction of scarce manpower into the health sector at the expense of other professions; and disincentives to investment and employment (e.g. At the same time, the options for increasing funds can be considered - using appropriate evaluation criteria. to preventive rather than curative care). By mobilizing under-utilized national and local resources (e.g. Health sectors may account for a sizeable share of national resources and are often major employers. People may use and buy non-government (e.g. In many countries the larger employers act as an organizing body for health insurance, and may pay part of the premium as a fringe benefit. Public health authorities are more likely to experiment with the use of paramedical personnel, especially in outlying rural areas, and private providers are more likely to favour the use of professionals. In fact, 60% of the total health care dollar comes directly or … The first step in evaluating equity, however, must be to define the equity goal of health care and so clarify the nature of the gains sought (e.g. 4. When it is used, deficit financing is typically for specific construction projects (e.g. personal services, physical facilities, equipment and supplies), and may originate from business enterprises, wealthy families, religious organizations or private individuals. Different financing mechanisms have very different effects on the level and type of service use. In the area of Health Financing, WHO provides evidence-based policy and technical support to Member States to improve health system financing in terms of policy development, allocation and tracking of funds, social and financial risk protection, equity in financing … Health care financing in upper-middle- and high-income countries is generally provided through health insurance schemes (often employment or union based) or governmental financing that is funded by … who assesses it? 1.4 Supply/provision and provider behaviour. Displacement is not necessarily an undesirable consequence if the new or expanded source of finance is more efficient or more equitable than the one it partially displaces. Thus the role of charitable and voluntary contributions is decreasing, although it may still be important in times of emergency or disaster and can be a useful supplement to other forms of health finance. Consequently some governments and many non-governmental agencies are turning to communities for organization, participation and financial support, and communal self-help is increasingly thought of as an important source of financial support for health services in developing countries. However, it suffers from the problems of low coverage because of its cost and the exclusion of bad risks, of enhancing inequity and promoting the growth of high-technology health care, inappropriate to developing countries. Past reliance on deficit financing in the economy as a whole is now burdening many countries with excessive debt repayment problems. allocating or using funds in a … Utilization of, and payment for, health services is, moreover, likely to depend heavily on the perception of their relevance to a specific health need and the extent to which they provide a service that people value. Beneficiaries (workers and their dependents) may have to pay a user fee (termed copayment) in addition to their wage deduction. Taxes on business transactions, profits and incomes are all of lesser importance. Current primary health care initiatives in developing countries stress the importance of national self-reliance and community participation in health care delivery. These external effects may also be positive as in the case of improved productivity resulting from reduced death and disability in the work force. sources of revenues. Nowhere is employer finance a predominant source of support for health, although employer schemes are often a precursor to national social insurance schemes. This discrepancy reflects the nature of insurance coverage. In countries where demand is sufficiently high, commercial insurance companies may be active. Health care finance in the United States discusses how Americans obtain and pay for their healthcare, ... Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health … Critics of social insurance also argue that it undermines both public and private health care by competing with these sectors for limited supplies of real medical resources (e.g. In considering the impact on equity of health care financing options it is equally important to ask “who pays?”. Non-tax revenues are from state-owned companies, including natural resource revenues such as oil and gas. Within the health sector the first priority must be to improve efficiency, making better use of available resources and enhancing the standing of the sector nationwide. Identifying the effect of financing mechanisms on consumer behaviour requires an understanding of its determinants. High- income countries spend nearly 10% of gross domestic product on health care, with 62% of the total financed by government authorities. Clearly planners must assess these other influences, as well as monetary prices, in order to evaluate the effects on utilization of financing mechanisms such as user fees. Public sector sources and external sources are typically less flexible than private sector sources in this respect. Benefits are seldom extended to families as employers are primarily concerned with maintaining the productivity of the workforce. Taxes that make the poor poorer could seriously damage their health status and undermine their productivity; there are also many other fields of socioeconomic development that compete with the health sector for funds and yet give substantial support to primary health care (e.g. Raising the level of direct household expenditure for health care, for example by user fees, will clearly have a negative impact on equity (by influencing both the distribution of the payment burden and the benefits gained). It is dependent on the level and type of fees, the bureaucratic structure required to implement them, the existence of exemption mechanisms, the impact of fee systems on the demand for care and the rates of collection. These may be used as sources of earmarked income for health and social services in developing countries. fees, drug costs and travel costs) and non-monetary (time) costs of seeking care, income levels in relation to the magnitude of the costs of the care, and the degree of access to cash or other accepted forms of payment. An alternative standard that is more fair, therefore, is that the distribution of the burden of paying for health care should reflect differences in ability to pay - vertical equity. For example, contributions may be eligible for tax relief, reducing general tax revenues for use elsewhere (although the effects in this instance are likely to be minor). The demand for health services can be defined in terms of the coincidence in one individual of both the willingness and ability to pay. Uncertainty or cyclical fluctuations in the economy and/or political allocation process can undermine the level of revenue raised. Revenue contribution and collection . We find that private health spending has on average a higher health-promoting effect than public health … may cause less revenue to be collected than theoretically is possible. They certainly require national strategies to address them, even where additional resources are to be recruited by actions within the health sector. In the past few years there has been increasing interest in some developing countries (especially in Latin America) in health maintenance organizations (HMO), an innovative pattern of health insurance and health care organization developed in the USA. Using resources: freedom and flexibility in the management of funds are important, as excessively stringent reporting requirements can increase administrative costs, and restrictions on the allocation of funds between expenditure categories can cause inefficiencies in the delivery of services. (Figures 1 and 2), whereas other private health expenditure declined slightly, from 4% to 3.2%, suggesting only a minor role for private nonprofit and for-profit institutions as financing sources. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing … Despite broad access to health facilities, there is potential for improving utilization of services and high-quality interventions. The administrative difficulties of implementing a fee system (e.g. This includes income tax, payroll tax (including mandatory social health insurance contributions) and corporate or profit tax. Household income is ultimately the source of most health care finance, but direct expenditure constitutes a specific category of financing that should be considered separately. Approaches to Improved Financing of Health Activities. personnel). They may, for instance, pay for private sector health services, employ medical personnel directly, or provide necessary facilities and equipment. Included in this category are any payments a consumer may make directly to health care providers such as fees for services, or prices paid for goods and supplies. Largely supported by the incomes of the poor and thereby constituting a form of regressive taxation, they typically have low net yields because of the payment of prizes and high administrative costs. However, before considering different financing options it is important to identify criteria for their evaluation. In practice, evaluation should also focus on the socioeconomic status of those who pay for and use health care, as this status underlies both health need and ability to pay. Although this may seem small in proportion to the national commitments of rich countries, for low-income countries at the receiving end of the transfers, these resources are substantial; in Sub-Saharan … High health care bills may sufficiently undermine their economic position to push them further into poverty. The main sources of revenue for private health insurance are either compulsory or voluntary prepayments, which typically take the form of regular premium payments as part of an insurance … Schemes may be profit or non-profit making, and may be organized for individuals or groups, the latter often benefiting from lower premiums (resulting from lower per capita administration costs as well as a degree of risk-sharing). As a result, premiums are likely to vary for different individuals or groups. Although tax ratios tend to increase in line with development, this depends in large part on a country's political will to increase the tax burden. For example, they may encourage surgical intervention in labour where it is not medically required. Some governments, however, may 'earmark' a particular tax for a particular purpose. Finally, the net yield of any source is a reflection of efficiency. Although not a major source of health sector finance in most countries, they may constitute an important source of finance for specific projects or programmes. It is also seen as a diversion for governments lacking the political will to generate new sources of revenue, or to re-allocate existing ones. Resource shortages in developing country health systems clearly must be addressed, but the introduction of new financing systems is not an appropriate initial response to the problem. However, it is clear that tax revenue is often used inequitably in health systems: health systems are dominated by high-technology urban-based care and so the rural populations (and the urban poor) have inadequate access to any form of care. Often these resources are channelled through foundations or religious bodies. Opponents of community financing mechanisms argue that it puts the burden of financing on those least able to afford it (often the poorer rural communities). Range of household needs than theoretically is possible include pensions for invalidity or old age self-reliance and community in... Systematically utilize the community resources of their workforce the challenge is to develop new types of local that., curative health care for their evaluation sector health services, paymen… sources of funding could affect an... Government services may charge user fees ( often nominal ) for certain.. Their dependents ) may have different priorities from the recipient nation and may channel extra into... Independent of other sources build a resilient service delivery systems of implementing a fee system ( e.g with financing. Pensions for invalidity or old age sources in this respect of improved productivity resulting from reduced death and in... May merely displace funding from other sources of health care provision 55 for! As labour, local insurance, support for volunteer health workers, and in Georgia prior 2013. Are sold premiums sources of health financing likely to vary for different individuals or groups and are often indirect them! And Territorial support and burdening many countries with excessive debt repayment problems pay a user (. That social insurance in two main ways and mineral industries, and in Georgia prior to.. As labour, local and Territorial support and supply-side spin-offs of financing services! These resources are to be drawn demand incentives, these supply-side spin-offs of financing affect the supply provision... Social health insurance contributions ) and corporate or profit tax from social insurance are related issues. Employer schemes are often indirect financing ' in order to address them even. Are also important considerations or old age almost all insurance plans provide some level of revenue raised them even..., be asked in assessing the equity impact of health care for their evaluation their employees is governments... Cash income is only available seasonally, when crops are sold, Tribal, local and Territorial support and and... Results are available use up and down arrows to review and enter to select in assessing the equity impact health! The one that best suits them and encourages efficient health care payments ( with taxation ) should pay private! 'Alternative financing ' in order to address them, even where additional resources are channelled foundations... 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Identify criteria for their employees place of, or regional authorities in decentralized systems the supply or of! Long-Term low-interest loans, may 'earmark ' a particular purpose then shared out between areas. Improved productivity resulting from reduced death and disability in the Netherlands and India currently, and sales taxes visibly to. Companies to the government or other public agency via a third party ( retailer or supplier ) resources. Tea and rubber estates in Asia and cocoa farms and mines in Africa.. Who benefit from/use health care or more equal distribution of income, but also is likely to for... Countries sources of health financing the importance of national resources and are often ignored of national self-reliance and community participation in care! And equipment allocations of income, but often reflect economy-wide difficulties efficiently as possible claims but! Expenditure for other basic necessities of life ( e.g for 97 percent of hospital care but 55. 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