Pooling financial resources for universal health coverage: options for reform
Pooling financial resources for universal health coverage: options for reform
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DOI：
10.2471/blt.19.234153
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发表时间：
2020-02-01
影响因子：
11.1
通讯作者：
Hanson, Kara
中科院分区：
文献类型：
--
作者：
Mathauer, Inke;Torres, Lluis Vinyals;Hanson, Kara
全民健康覆盖意味着所有人都可以获得高质量的卫生服务，而不会遇到经济困难。三个卫生筹资职能-筹集收入、汇集资金和购买卫生服务-对全民健康覆盖至关重要。这篇文章的重点是汇集：预付财务资源的积累和管理。即使无法为全民健康覆盖筹集额外收入，集中也能为重新分配资源创造机会，以支持公平获得所需服务和更大的财政保护。然而，在许多国家，联营安排非常分散，这对再分配造成了障碍。本文的目的是概述汇集改革备选方案，以支持正在探索如何加强资金再分配的国家。我们概述了四种广泛类型的集合改革，并讨论了它们在解决卫生筹资分散问题方面的潜力和挑战：（一）向人人强制或自动覆盖转变;（二）合并不同的集合，以增加集合成员的数量和集合成员健康需求和风险的多样性;（三）交叉补贴那些收入较低、健康风险较高的成员的集合; ㈣统筹基金之间的统一，如福利、支付方法和费率。各国可以将若干改革要素联合收割机结合起来。通过联营改革是否能真正实现再分配的潜力，还取决于联营结构与收入筹集和购买安排的一致性。最后，改革的范围受到体制和政治可行性的限制，围绕集中改革的政治经济需要加以预测和管理。
Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions - revenue raising, pooling of funds and purchasing health services - are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.