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Analazing Changes in Health Financing Arrangements in High-Income Countries: A Comprehensive Framework Approach

Busse R, Schreyögg J, Gericke CA
Health, Nutrition and Population (HNP) Discussion Paper




cover: Analazing Changes in Health Financing Arrangements in High-Income Countries

This review is one in a series of analytic efforts designed to inform the policy debate related to health financing. The authors review evidence on health financing arrangements in high income countries as well as reforms over the last 30 years and to identify key policy lessons from this experience for low and middle income countries.
Methodology: The review is based on a conceptual framework of health financing “functions”. 25 high-income countries have been grouped for comparative evaluative purposes into three groups, based on the main mechanism of financing health care (social health insurance, taxes, private). Decisions on coverage and benefit entitlements as well as various functions of health care financing (i.e. collecting, pooling and purchasing) are described and analyzed.
Results: The pooling function is most essential in order to provide coverage to as many individuals as possible, thus reducing their financial risk being the principal aim of public health financing. Both SHI contributions and taxes are ways to collect resources, which are publicly administrated and flow into one or several public pools. Private health insurance, medical savings accounts and other forms of private resource collection can only be supplementary models for increasing universal coverage. The evolution of health financing schemes towards universal coverage was pretty similar in the included countries. Since it is difficult to attribute outcomes to certain financing mechanisms a best practice to design health financing arrangements – e.g. tax-based or SHI – cannot be defined.
Next to the precondition of economic growth, the most essential lessons are to initiate pilots for health insurance schemes on a voluntary and/or local basis, to foster the ability to administrate, to ensure political commitment to expand population coverage, to iii combine expansion of population coverage with risk-pooling and to ensure evaluation of products and services at each stage.

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