The first aspect of UHC defined above (use of needed services of good quality) corresponds closely to the concept of effective coverage, i.e. One important concept illustrated in the figure is that the health financing system does not act alone in affecting the intermediate objectives and final goals; coordinated policy and implementation across health system functions are essential for making progress on the desired objectives, such as improving the quality of care. Aterido R, Hallward-Driemeier M, Pags C. Shengelia B, Tandon A, Adams OBR, Murray CJL. These other health system functions exert an important influence on the goals, but examining this influence is beyond the scope of this paper, which is focused on health financing policy. Thus, for example, introducing a purchaserprovider split or changing how pooling arrangements are organized are not only issues for so-called insurance systems. . Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance and the transformation of health financing in Kyrgyzstan and Moldova. La unidad sobre la cual se deben analizar las metas y objetivos debe ser la poblacin y el sistema sanitario en conjunto. Universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. In other words, UHC emphasizes that everyone has equal . To date, this has been done only in the case of individual health conditions and interventions, such as immunization coverage (e.g. Such schemes do not naturally evolve to include the rest of the population. This e-learning course comprises six modules which cover the core functions of health financial policy as conceptualised by WHO. As shown in Fig. Whats the universal health coverage push really about? Just over a decade out from the SDG deadline of 2030, many developing countries are not on track to meet Universal Health Coverage (UHC) targets to ensure access to quality, affordable health services to all. As India progresses towards universal health coverage, it is . The sixth section contains a discussion of the unit of analysis for UHC and of the practical importance of understanding the distinction between schemes and systems. Download (Free: 2.21 MB ) ADB is committed to assisting its members achieve Sustainable Development Goals, including the priorities of . [Posted 10 November 2010]. Bishkek: Center for Health System; 2007 (Policy Research Paper No. WHOs approach to health financing focuses on core functions: In addition, all countries have policies on which services the population is entitled to, even if not explicitly stated by government; by extension those services not covered, are usually paid for by patients (sometimes called co-payments). Yang B-M. Health insurance in Korea: opportunities and challenges. The fact that scheme members have better financial protection and increased access does not mean that these have improved for the entire population. The World Bank Blog [Internet]. Health financing for UHC reflects how health financing arrangements (and reforms to these) can influence UHC goals and intermediate objectives. . . The way health financing arrangements are organized often affects other social goals. The general challenge for health policy is reflected in the arrow in the middle of Fig. HHS Vulnerability Disclosure, Help The specific label attached to a given system should not be used to limit thinking with regard to reform options. A key dimension of a health system's performance is the fairness of its financing system. This means that the whole population of the country, including foreign nationals, refugees, asylum seekers and stateless persons can access medical attention or healthcare through the National Health Service (Sistema Nacional de Salud or "SNS") in specific . 42. Health Financing Policy Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Written by Jenny Berg. progressing on the intermediate and final objectives associated with UHC is relevant to every country, so too do all health financing systems include the functions of collection, pooling and purchasing, and face decisions on the rationing of benefit entitlements. Participating in EIT Health 2017 obtained very positive results, in total 350.000 of funding. . more money for health (raising more funds); strength in numbers (larger pools); and. 2, health financing influences the final goals and intermediate objectives of health systems. Universal coverage can be justified from a political perspective as a reflection of underlying values such as social cohesion, the belief in every individuals right to the highest attainable level of health (as per the WHO Constitution), or as a right to health or right to equitable access to health services, specified in many national constitutions. A concern only with specific schemes is not a universal coverage approach. The definition of UHC from The world health report 2010, quoted in the introduction, embodies one of the ultimate goals of health systems financial protection as well as intermediate objectives associated with improved health system performance: that all people obtain the health services they need (i.e. How a particular financing scheme affects its members is not of interest per se; what matters is how the scheme influences UHC goals at the level of the entire population. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. By positioning efficiency as an intermediate objective, we make explicit the point that health systems can become more efficient at promoting financial protection and increased, equitable utilization of health services relative to need (and conversely, that inefficiencies undermine these objectives). Many countries have identified Universal Health Coverage (UHC) as the goal for their health systems, and health financing reforms are at the core of strategies to move in this direction. Implications for Financing Universal Health Coverage in Low-Income Settings. 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. Thus, even if UHC can never be fully achieved, moving towards UHC is relevant to all countries. But from a narrower health systems performance perspective, UHC as defined in The world health report 2010 is desirable because it embodies both a final goal of health systems and intermediate objectives with strong links to ultimate goals. Given that all health systems face resource constraints, improving efficiency (i.e. Keeping this distinction between policy objectives and policy instruments is essential for conceptual clarity and practical decision-making. So to put this somewhat more precisely, how does the way the system is designed and operating affect the extent to which the goals are attained, given the impact of extra-sectoral factors in a given country context? In what ways are shortcomings in attainment linked to health system problems, and conversely, how can deliberate changes in how the health system operates (i.e. a countrys income, education levels, political factors, etc.). Individual modules can also be used as part of a programme of blended capacity building. For technical issues please contact the helpdesk at:https://accesswho.campusvirtualsp.org. Jerant A, Fiscella K, Franks P. Health characteristics associated with gaining and losing private and public health insurance: a national study. Careers, Unable to load your collection due to an error. Independent Oversight and Advisory Committee, For more information see policy framework, For more information see the topic page on revenue raising, For more information see the topic page on pooling, For more information see the topic page on purchasing and provider payment systems, For more information see the topic page on benefit package, e-Learning Course on Health Financing Policy for universal health coverage (UHC), Health financing policy and universal health coverage, Beyond health financing: the wider health system and economy, What UHC brings to health financing policy, Efforts to increase public spending on health, Desirable characteristics of pooling arrangements, Institutional arrangements and purchasing instruments, Benefits, rationing and policy objectives, Select the course on health financing policy for UHC. Amanda Glassman. Background: Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Health Financing and the Pandemic Response, Implementing health financing reforms in fragile and conflict-affected settings, Addressing the political economy of health financing reform, Providing guidance to countries on institutionalizing Health Technology Assessment, Improving efficiency across health programmes, Pooling revenues and reducing fragmentation, Leveraging public financial management for better health, Fostering fiscal dialogue between finance and health, Assessing country progress in health financing for UHC. For WHO employees, you can register on iLearn, The course is designed to work on a wide range of devices, operating systems, and browsers. There is a difference between a new insurance scheme designed for the purpose of making its members better off, and one intended to serve as an agent of change to improve equity in the use of services, service quality and financial protection for the entire population. Financial access and financial protection are enhanced for scheme members, but at the expense of others in the population who do not have the opportunity to benefit from this. Each countrys pathway will differ depending on the local context, however the above lessons are essential for equitable and effective progress. This is followed by a discussion of the three dimensions of coverage. However, there are lessons from international experience that allow a number of guiding principles for reforms which support progress towards UHC, to be specified. Duran A, Kutzin J, Martin-Moreno JM, Travis P. Understanding health systems: scope, functions and objectives. Murray CJL, Frenk J. This article provides an overview of health financing reforms across countries in the Western Pacific Region as progress is made toward universal health coverage (UHC). Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. Or conversely, corruption in the health sector can be seen as a source of inefficiency insofar as resources that could have been used to improve access, quality or financial protection are diverted to other uses.36. Int J Ment . Health system effectiveness in hypertension control in Kyrgyzstan. UHC embodies three related objectives: (1) equity in access to health services, (2) the quality of health services is good enough to improve the health of those receiving them, and (3) people using services are protected from risk of financial hardship. This paper aims to clarify what is meant by health financing for universal coverage; how UHC embodies specific health system goals and intermediate objectives, what is the appropriate unit of analysis for these, and, broadly, the ways in which health financing can influence progress towards UHC. transparency in terms of peoples understanding of their entitlements (rights) and their obligations with regard to health service use, as well as the extent to which these are realized in practice; and. Universal means universal, so for any country, the appropriate unit of analysis is the entire population and the system as a whole. The world health report 2010 depicted three dimensions of coverage as the axes of a cube: population, service and cost.1 The population axis describes the UHC objective of population coverage with both services and financial protection. In each case, the path to universality was designed into the reform from an early stage by putting payroll tax contributions and general revenue transfers into the same pool on behalf of both the formal and informal sector populations, and then using the new SHI funds to drive system-wide efficiency and equity gains through the combination of centralized pooling and output-based provider payment mechanisms.45,46. 2. , . Lessler J, Metcalf CJE, Grais RF, Luquero FJ, Cummings DAT, Grenfell BT. Hence, the pursuit of UHC is relevant to every country. As a library, NLM provides access to scientific literature. So there you have it! Conceptual framework for analysing health financing systems and the effects of reforms. Taking action for universal health coverage On the road to the UN HLM on UHC The 2023 UN High-level meeting on universal health coverage (UHC) provides countries and all stakeholders an opportunity to reinvigorate progress towards delivering health for all. All health financing systems perform these functions, and this is why, as stated in The world health report 2010, every country can do something to move towards universal health coverage. Conversely, where health insurance coverage is linked to ones place of employment and there is neither compulsory coverage nor uniform entitlement, as in the United States of America, many people are locked into a job because they risk losing coverage if they take a new position with a different company.11 In a study by Bansak et al., a reform that untied coverage from employment was shown to enhance peoples opportunities to switch jobs.12 There is also some evidence that publicly funded coverage programmes in Mexico13 and Thailand14 have slowed the pace of labour market formalization because they have reduced the need for people to make formal social security contributions to obtain good health coverage. WHO Global Learning Event: Financing facilities directly: how can it transform public budgets into services? . Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC.
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