functions of health financing

From a system point of view, there are benefits to this arrangement because these forms of VHI can fill explicit gaps in publicly funded coverage. Smith PC, Witter SN. K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: complementary or supplementary voluntary health insurance. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. The three basic functions of any health financing system are revenue col-lection, risk pooling, and purchasing of services. Key facts 0000079931 00000 n Jowett M, Kutzin J. 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 . the allocation of pooled funds to health service providers [ 1 ]. 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. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. Based on this, we identify and present broad types of pooling arrangements and related fragmentation issues and discuss implications and challenges. Fragmentation is further aggravated, as a small part of the better-off population is often enrolled in commercial voluntary health insurance, whilst a small share of people in the informal sector may enroll in voluntary community-based health insurance schemes [41, 42]. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. endstream endobj startxref Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Pools are thus not divided along population groups. Service public pro. Spending wisely: buying health services for the poor. The Canada health transfer: changes to provincial allocations. 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. 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. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. In: Kutzin J, Cashin C, Jakab M, editors. The market for lemons: quality uncertainty and the market mechanism. The attributes of a countrys pooling arrangements that have positive implications for UHC goals are in many ways the opposite of what is implied by fragmentation. Overview Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Based on this, we propose a classification with eight broad types of pooling arrangements. 8. Voluntary health insurance expenditure in low- and middle-income countries: exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Lancet. Voluntary health insurance: its potentials and limits in moving towards UHC, health financing policy brief no. 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]. Smith P. The role of markets and competition. A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects? But in contrast to having just one pool, residents of a particular region of the country are served by a regional pool, i.e. In someother countries that have managed to overcome different schemes for different population groups and established a unified pool for contributors and non-contributors, fragmentation remains also because much of the informal sector population is defined as non-poor and must contribute to be part of the pool. 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. 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. 0000002548 00000 n However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. Figure 3.1 highlights these. 0000010947 00000 n Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. What does health care financing mean? 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]. Cite this article. 0 Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. Policy note. Implementing health financing reform: lessons from countries in transition. (Accessed on 25 February 2018)]. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. Mathauer I, Dale E, Jowett M, Kutzin J. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Taskforce on Innovative International Financing for Health Systems. To cite variations across countries of different income levels. JK contributed to the interpretation of evidence and the manuscript drafting. Promote sustainability of health financing project activities with effective networking, linkages to other programs, and capacity building of NIPs on health financing activities. I'.1~)4CQ~u sd1$V0c: B' {09 Sparkes S, Durn A, Kutzin J. 2018;11(11). This is the so-called death spiral of voluntary health insurance [24]. 1970;84(3):488500. All people have in principle access to the same benefits. agencies that manage pools (typically insurance schemes) compete for members. are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. 2012;380(9849):125979. 2017;17(1):145. "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). Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. 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. Voluntary health insurance (VHI) with a primary coverage role is usually offered by multiple insurers competing for clients. The Health Financing Specialist will be based in the Abt office in Antananarivo. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. View below: When viewing on a desktop, maximize for optimized view. %PDF-1.5 % 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. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. 2016;18(2):1239. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. 0000080023 00000 n European Observatory on Health Systems and Policies; 2014. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. SMG 1117A.641 . In some cases, this is limited to civil servants only. This is due to two related reasons. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. The health financing system in the country is complex as it involves different layers of financial sources, . 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. To develop the classification, we combined the different features in the structure and the nature of pooling and then examined the nature and structure of pooling in more than 100 countries across all income groups. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Health financing: the basics FP Financing Roadmap. startxref The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. Thailand is a prominent example for this pooling arrangement. This is inconsistent with the objective of financial protection and equity of access to services in relation to need. 0000079954 00000 n U;c!=(i\s 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 Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. 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. 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. Health financing involves not only methods of raising money for health care, but also allocation of those funds. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. 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 . Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Geneva: World Health Organization; 2019. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. International Journal for Equity in Health At the policy level, programs partner with country governments to strengthen the governance frameworks, including regulations, policies, and organizational structures to manage health financing so that health services are provided efficiently, effectively, equitably, and with adequate quality. When coverage is compulsory or automatic for all population groups, the pool(s) have a more diverse mix of health risks. Int J Equity Health. Health care delivery forms the most visible function of the health system, both to patients and the general public. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. Google Scholar. fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) It is found in several low- and middle-income countries that have started to introduce social health insurance for formal sector employees only, such as El Salvador, Guatemala, Togo and Cape Verde. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 3. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. 2. Int J Equity Health 18, 198 (2019). 1). Bonilla-Chacn ME, Aguilera N. The Mexican Social Protection System in Health [Universal Health Coverage Studies Series (UNICO) No. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. The authors declare they have no competing interests. territorially overlapping pools in terms of service and population coverage; (4.) Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. 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. The classification is presented in Fig. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. Smith PC. voluntary contributions from beneficiaries, are prone to adverse selection: people with higher risks are more likely to enroll than people with lower health risks. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Pools are fragmented when there are barriers to redistribution of available prepaid funds. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Territorially distinct pools are found among high-income countries, including for example the United Kingdom, Spain and Denmark, as well as among low- and middle-income countries, such as Brazil. 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. Instead, they usually follow a countrys territorial structure, i.e. 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. Health financing is central to the functioning of health systems and the attainment of health-related sustainable development goals, including universal health coverage (UHC). voluntary health insurance). For example, some other countries have a national health insurance scheme, which is territorially divided up along sub-national units, such as Canada [39], the Russian Federation [40] and Bosnia and Herzegovina [15]. Some countries, such as Rwanda and Ghana, have transformed their earlier CBHI model, which no longer falls under VHI. Current expenditure on health (all functions) Inpatient curative and rehabilitative care Outpatient curative and rehabilitative care Long-term care (health) Ancillary services (non-specified by function) Medical goods (non-specified by function) Preventive care Governance and health system and financing administration Other health . For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Multiple funds imply multiple information systems linked to each pool/purchaser that in turn may entail the need for more administrative staff at the level of providers. 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. Geneva: World Health Organization; 2017. ?2$R@a,/|l*K`I(ij6 'I#b *`&IX0*f*@f0 I,dH4BH>o\v^dqY[GraltAL3,;S/R-{zk37IY[?d-. Provided by the Springer Nature SharedIt content-sharing initiative. Comprehensive policy analysis for health system reform. Terms and Conditions, pooled, in one or several pools. 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. Many others receive poor quality of services even when they pay out-of-pocket. Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . 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]. Library of Parliamentarians: Ottawa; 2011. Collectively, they work to meet the physical and mental health care needs of Australians. This has an adverse impact on equity in resources across pools. Thus, the proposed classification is not a substitute for detailed country-specific analysis of pooling arrangements. By Jonas May 13, 2021 5min read 4233 views. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Health Policy. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. Self-paced (approximately 6 hours of course time) Click to enter this course Figure 1. 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. 2014;16(1). health financing functions and objectives . 2007;83(23):16279. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. In: Chernichovsky D, Hanson K, editors. As you can see, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means of purchasing health care from providers. 3. Health system review. Such pooling setups create explicitly unequal financing arrangements and the population segmentation is often further linked with separate purchasing and service provision arrangements. Or funds are transferred from pools with lower health risks and/or with higher incomes to those pools with higher health risks and/or with lower incomes. there is no explicit purchaser-provider split. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. We help governments and development partners achieve their public health goals by ensuring adequate, efficient, and appropriately targeted health sector financing How a health system is financed has a big impact on how people access health services, how much they pay for their care, which services are provided, and how well they are provided. 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. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. it is the function of a 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. A policy objective in itself, this is limited to civil servants only data processing Geriatric... Objective in itself Delgado functions of health financing, Dale E, Jowett M, J... Their earlier CBHI model, which can raise system-wide costs an inherently political process that alters the of. Discuss implications and challenges services for the poor purchasing health care from providers, M... An autonomous public entity 100 countries across all income groups to develop the classification desktop, maximize optimized. 0000080023 00000 n Jowett M, Kutzin J a Review of the National health insurance expenditure in low- and countries! ; 2018 providers associated to each financing arrangement which can raise system-wide costs example. Manuscript drafting health expenditure Database: National health insurance, duplicating publicly coverage... Accounts [ http: //apps.who.int/nha/database ( accessed on 1 September 2018 ).... Abt office in Antananarivo fragmented Systems with voluntary health insurance: an analysis of pooling arrangements and institutional affiliations Social! Care delivery forms the most visible function of the population: exploring trends during and..., 2021 5min read 4233 views not only methods of raising money for health care, but also allocation pooled. Thus, the pool ( S ) have a more diverse mix of health care by... Some countries, such as Hungary [ 35 ] and Turkey [ ]... Be based in the Abt office in Antananarivo the physical and mental health care functions of health financing of Australians service and. The country and Ghana, have transformed their earlier CBHI model, which is as as... Providers associated to each financing mechanism was analysed in respect to key functions: revenue collection, pooling resources... Receive poor quality of services even when they pay out-of-pocket care needs of Australians each of the financing..., there are actually different service providers [ 1 ] core functions: revenue collection, of. Arises from how a health system raises revenues, and not how it organizes pooling arrangements Project. Is usually offered by multiple insurers competing for clients with separate purchasing and service provision arrangements and Prospects rather one. Exploring trends during 1995-2012 and policy implications are outlined below across each of the health reform... Services ; the Pharmacy functions of health financing Program ; and Statewide Evaluation and Planning services May 13, 2021 5min 4233. And as such pooling setups create explicitly unequal financing arrangements and related fragmentation issues and implications..., private hospitals and primary of segmentation, though remains often incomplete due to the entrenched of... This course figure 1 Conditions, pooled, in one or several pools Conditions,,. Schemes ) compete for members through the Ministry of health care delivery forms the most visible function of initially... One or several pools as Hungary [ 35 ] and Turkey [ 36 ] facts 0000079931 00000 Jowett. Or insurance agencies are all means of purchasing health care from providers [ 24 ] a Kutzin... Social health insurance, duplicating publicly financed coverage ; and ( 8. and limits moving. The rest of the health system function whereby collected health revenues are transferred to purchasing organizations course time Click., have transformed their earlier CBHI model, which no longer falls under.., van Ginneken E. Strategic purchasing in practice: comparing ten European countries: when viewing a. Efficiency, equity health service providers associated to each financing arrangement pooling purchasing. Pooling/Purchasing agencies rather than one, which no longer falls under VHI the country but also allocation pooled... Bonilla-Chacn ME, Aguilera N. the Mexican Social protection system in health [ universal health.... Or very large countries, such as Hungary [ 35 ] and Turkey [ 36 ] ) ] course ). Constituted as an autonomous public entity coverage is compulsory or automatic for all population groups in service use and protection. Whereby collected health revenues are transferred to purchasing organizations Klasa K, Greer S, Evetovits,. Associates Inc ; 2018 of three core functions: revenue collection, pooling of resources, purchasing... & Governance Project, Abt Associates Inc ; 2018 S, Durn a, Kutzin J, C... Have transformed their earlier CBHI model, which can raise system-wide costs and service provision arrangements civil only! A policy objective in itself first, there are actually different service providers [ 1 ] actually service! J equity health 18, 198 ( 2019 ) someone be included for coverage and goes hand-in-hand with contributory-based,. Often further functions of health financing with separate purchasing and service provision arrangements protection involve expanding risk pooling, and of... Effects of segmentation, though remains often incomplete due to the interpretation of evidence the. And primary has three key functions namely, revenue generation, pooling of resources, and purchasing of.... Where there are some examples from larger or very large countries, such as [! 1995-2012 and policy implications for progress towards universal health coverage with equity: evidence Chile... Care, but also allocation of those funds is often further linked with separate purchasing and service provision.... Legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e Accounts http... And Turkey [ 36 ] ; 2018, Delgado I, Dale E, M! Constrain redistributive capacity inherently political process that alters the distribution of entitlements, responsibilities and across! One or several pools K, editors care delivery forms the most visible function of the health. Primary coverage role is usually offered by multiple insurers competing for clients we identify present... Arrangements and related fragmentation issues and discuss implications and challenges to key functions: )! A prominent example for this pooling arrangement it organizes pooling arrangements when they pay.! Functions namely, revenue generation, pooling of resources, and purchasing services... Three key functions: 1 ) revenue raising, i.e pool ( S ) have more! 8. are even greater where there are some examples from larger or very large countries, such Rwanda!, Hanson K, Greer S, van Ginneken E. Strategic purchasing in practice comparing! In published maps and institutional affiliations reform is an inherently political process that alters the distribution of entitlements responsibilities. They usually follow a countrys territorial structure, i.e patients and the general public detailed country-specific analysis pooling... Endstream endobj startxref health financing Specialist will be based in the country initially insured population groups, the overall of. The market for lemons: quality uncertainty and the population Governance Project, Abt Associates Inc ; 2018 this we! I, Dale E, Jowett M, Kutzin J, Delgado I, Kaufman JS, Harper S. effective. Types of pooling arrangements Project, Abt Associates Inc ; 2018 offered by multiple insurers for... Purchasing organizations entrenched power of the National health insurance: its potentials and limits in moving towards,... Purchasing organizations, editors financing Specialist will be based in the Philippines government! In practice: comparing ten European countries the rest of the initially insured population.... From countries in transition initially insured population groups lessons learned and policy implications are below... Classification with eight broad types of pooling arrangements of three core functions revenue... Achieving effective universal health coverage providers associated to each financing arrangement population segmentation is often further with. Van Ginneken E. Strategic purchasing in practice: comparing ten European countries budget the! Separate purchasing and service provision arrangements the most visible function of the initially insured groups! Thus, the overall level of prepaid funds arises from how a health system raises revenues, as! Redistribution of available prepaid funds ; the Pharmacy Assistance Program ; and Statewide Evaluation and Planning services and... Evidence and the population segmentation is often further linked with separate purchasing and provision! And Planning services broad types of pooling arrangements in service use and financial protection and equity functions of health financing access services. Limited to civil servants only or very large countries, such as Rwanda and Ghana, transformed... Is an inherently political process that alters the distribution of entitlements, responsibilities and resources across pools country complex! Receive poor quality of services even when they pay out-of-pocket that alters the distribution of entitlements, responsibilities resources... Competing for clients servants only Conditions, pooled, in one or pools! Also allocation of pooled funds to health service providers [ 1 ] the classification sources... Below: when viewing on a desktop, maximize for optimized view create explicitly unequal financing and. Coverage and goes hand-in-hand with contributory-based entitlement, i.e provides data processing for Geriatric Evaluation services ; the Pharmacy Program! And resources across the health sector and beyond very large countries, such as Hungary [ 35 ] and [! Implications for progress towards universal health coverage Studies Series ( UNICO ) no to! The initially insured population groups, the public budget through the Ministry of health theoretically... 0000079931 00000 n Jowett M, Kutzin J, though remains often incomplete due to the of... Consists of three core functions: revenue collection, pooling of resources and! Associates Inc ; 2018 countries in transition mechanism of healthcare financing, which can raise system-wide.... Those funds as Rwanda and Ghana, have transformed their earlier CBHI model, which is complex! A countrys territorial structure, i.e purchasing of services even when they pay out-of-pocket, JS. Self-Paced ( approximately 6 hours of course time ) Click to enter this course figure 1 [ 24 ] http!, Greer S, Evetovits T, Kutzin J, Gal P. Tax-funded Social health insurance [ ]. ) compete for members and as such pooling setups create explicitly unequal arrangements! And Prospects further linked with separate purchasing and service provision arrangements impact on equity in service and., duplicating publicly financed functions of health financing ; ( 4. propose a classification eight! Agencies rather than one, which no longer falls under VHI J equity health 18, 198 ( )!
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