Article Baeza CC, Packard TG. Further pooling reforms may not be needed, but other health financing reforms in the areas of revenue raising or purchasing can serve to preserve or actually realize the potential set by this pooling arrangement so as to maximize financial protection, equitable access and efficiency. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Health financing policy brief no. 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. . 0000008166 00000 n 0000001864 00000 n In many countries, different pools exist for different socio-economic groups, creating a highly fragmented system with population segmentation. Heal Policy Plan. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. While independent attributes, these often go together, as larger pools are more likely to include a greater diversity of risks. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. What are the three main functions of health financing? This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. Table1 outlines the respective features under each. The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Cashin C, Sparkes S, Bloom D. Earmarking for health: from theory to practice. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. This overlap turns into duplication of service coverage particularly in big cities, with the main policy consequence being large inefficiencies in the form of excess provider capacity [15]. Purchasing to improve health system performance. The resources allocated to these different pools may come from a mix of centrally and sub-nationally raised revenues, with allocations often based on a consistent formula applied across the country. PubMed are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. Figure 3.1 highlights these. Jowett M, Brunal MP, Flores G, Cylus J. Health financing policies are marked by confusion between policy tools and policy objectives, especially in low and middle income countries. The nature of pooling by which individuals are included in pools has important implications for their redistributive capacity. In 1985, the government commissioned the first of a . Meaning of terms Revenue Collection is the way health systems raise money from households (e.g. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. JK contributed to the interpretation of evidence and the manuscript drafting. Geneva: World Health Organization; 2010. Conversely, schemes that have voluntary membership, i.e. Inke Mathauer. "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). Capacity strengthening of the MSP will also be an important component of this program. Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform, Bulletin World Health Organization (forthcoming). When each level of government in a decentralized setting pools for a distinct level of health services, then it is organized in a territorially distinct way. In contrast, the public budget through the Ministry of Health offers theoretically free health services for the rest of the population. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. hbbd``b` "$8@B\HHo \Q u 88b``g T First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. management and disbursement for financing the availment of a basic minimum package and other . As such, the overall risk profile of the pool is much more financially sustainable than under voluntary enrollment. World Health Organization. Health financing for universal coverage and health system performance: concepts and implications for policy. A desciptive framework for country-level analysis for health care financing arrangements. It also describes Ghana's health financing system. Correspondence to Health financing has three key functions: revenue collection, pooling of resources, and purchasing of services. HGF guidance document no. Advances in health economics and health services research, volume 21. Fragmentation in pooling arrangements. Sometimes, these arrangements include a purchaser-provider split. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. 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. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . there are different funds for different population groups, with the affiliation being based on socio-economic or (socio-) demographic criteria. Mathauer I, Dale E, Jowett M, Kutzin J. 0000014440 00000 n This leads to duplication of health facilities, particularly in big cities. Frenk J. Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. When people have access to publicly financed coverage schemes, this VHI is duplicating. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. The better-off groups - those in formal employment benefit from much higher per capita funding and a much higher level of benefits compared to the rest of the population with much lower levels of financial protection. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. The market for lemons: quality uncertainty and the market mechanism. Sagan A, Thomson S. Voluntary health insurance in Europe: country experience. Geneva: World Health Organization; 2008. Cutler DM, Zeckhauser RJ. PubMed Central 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. Cite this article. Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. This can take many forms with different implications and challenges, as outlined below. The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. While the issue of segmentation first emerged in Latin America [43], it is not limited to that region. Health Spending as % of GDP. %%EOF Stewardship includes ensuring oversight, regulation, and accountability of all actors engaged in health financing functions of resource mobilization, pooling, and purchasing. It is the provision of money to the population for health services (preventive as well as curative), family planning activities, nutrition activities, and emergency aid designated for health. 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. Healthcare organizations must be able to minimize costs in order to be financially successful. Article 0000002224 00000 n Maximum redistributive capacity from prepaid funds is achievable in these settings. Understand the mechanism of healthcare financing, which is as complex as healthcare delivery system in the country. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. Health Systems in Transition. Three key health financing system functions Resource Mobilization: PubMed Yet, the function of pooling and the different ways that countries organize this is critical for countries progress towards UHC. !{~4nf0QMh92]Ta, *eIF <]>> 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. Health Systems in Transition. There are two forms of institutional setup found for this pooling arrangement. territorially overlapping pools in terms of service and population coverage; (4.) type of pooling arrangement, namely territorially distinct pools. Klasa K, Greer S, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. This mitigates some of the effects of segmentation, though remains often incomplete due to the entrenched power of the initially insured population groups. Under the second form of institutional setup, countries have established a single national fund that is managed by a separate pooling and purchasing agency, usually with a purchaser-provider split. Vilcu I, Probst L, Dorjsuren B, Mathauer I. Adverse Selection in Health Insurance. Health financing is a key function of the health care system, and is a complex issue. This is the so-called death spiral of voluntary health insurance [24]. Geneva: World Health Organization; 2017. World Health Report. Kutzin J. This was, and in some places remains, one of the main drivers of large inefficiencies in the health systems of the ex-USSR countries [15]. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. Mathauer I, Theisling M, Mathivet B, Vilcu I. The company has multiple offices in the U.S. and program offices in more than 40 countries. Higher income persons are usually more likely to have this form of VHI [51]. 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). Indeed, these arrangements put in place for health financing further exacerbated existing inequalities in these countries rather than compensating for them. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. 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. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. Google Scholar. What are the types of health care financing? Paris: OECD; 2011. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. 2013;91(8):60211. Sagan A, Thomson S. Voluntary health insurance in Europe: role and regulation. complementary or supplementary voluntary health insurance. Paris: OECD; 2011. (Accessed on 25 February 2018)]. 0000002191 00000 n 5. In practice, only a few countries have this pooling arrangement alongside a low share of out-of-pocket expenditure (OOP) (<20% of total health spending). Click the card to flip . The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. The authors declare they have no competing interests. Thailand Health Systems in Transition. Structured pluralism: towards an innovative model for health system reform in Latin America. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. Finally, we are grateful for valuable comments from two anonymous peer reviewers. Health care delivery forms the most visible function of the health system, both to patients and the general public. Agency's Mandate and Functions Mandate. Innovations in health system finance in developing and transitional economies. 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. IM is a senior health financing specialist; JK is the coordinator of the Health Financing Team, they both work in the Department of Health Systems Governance and Financing at the World Health Organization in Geneva. Kutzin J, Jakab M, Shishkin S. From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova. What are the functions of health financing mechanisms? Definition. Part of Indonesia is also undertaking efforts to shift towards a single national health insurance pool, but there is still a significant part of the population that is not yet enrolled in the pool. 0000080023 00000 n In any country, prepaid health revenues may be held, i.e. WHO. PLoS ONE. All remaining errors are with the authors. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Revenue collection is how health systems raise money from households, businesses, and external sources. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. 0000012547 00000 n Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. 3. The Canada health transfer: changes to provincial allocations. The agency is typically labelled as a national health insurance fund and constituted as an autonomous public entity. A key principle of this pooling arrangement is compulsory or automatic coverage for the whole population. European Observatory on Health Systems and Policies; 2014. Preker A, Langenbrunner J. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. 2. Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care Google Scholar. Implementing health financing reform: lessons from countries in transition. trailer State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European region. It also had schemes for the low-income population and the elderly and a subsidized voluntary insurance program for the rest of the population. As such, pooling is also a distinct policy instrument, because a health systems pooling arrangement greatly influences the extent to which progress can be achieved independent of the overall level of prepaid funding available. Conversely, there is no population segmentation when coverage and participation in a pool is independent of peoples socio-economic or (socio-)demographic criteria. To discuss Malawi as a case study in health systems. Discussion paper. World Health Organization. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 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]. Geneva: World Health Organization; 2017. In: Chernichovsky D, Hanson K, editors. When pooling also follows the countrys administrative structure, the mandates for service coverage (and hence population coverage) of different government level pools may overlap, thus creating an additional layer of fragmentation. 1). We also like to thank Lisa Seidelmann, Carlo Schmid Fellow and volunteer with the Department of Health Systems Governance and Financing at the time of producing this draft for her research assistance. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. statement and Council for Medical Schemes (CMS). Policy note. 0000025210 00000 n BMC Health Serv Res. Geneva: World Health Organization; 2017. there is no explicit purchaser-provider split. a&x1r LBt\5Nly{"(e]P fN!"$=Kwue2VTIVn^;AGX7t1W:@2DE ? The complex structure of Australia's . 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. In: Kutzin J, Cashin C, Jakab M, editors. Where service provision is integrated with pooling and purchasing within each government level, the different (horizontally organized) pools overlap and effectively serve the same population. These tend to reflect particular challenges due to the nature and consequences of fragmentation in each. 2014;16(1). In turn, this can help countries assess their pooling arrangements and contribute to identifying policy options to address fragmentation or mitigate its consequences. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The investments that competing insurers make to try and select preferred risks (or avoid high health risks) are inefficient from a social welfare perspective [11, 26], because the resources devoted to risk selection do not contribute to progress towards UHC, and in fact may detract from it. WHO. This type of pooling arrangement is also usually found in countries with relatively small populations, such as Costa Rica, Estonia, Lithuania, Moldova and Mongolia [31,32,33,34]. hmo6 Lancet. Its main purpose is to share the financial risk associated with the mobilization of resources for the health sector; 2) pooling, i.e. However, there are some examples from larger or very large countries, such as Hungary [35] and Turkey [36]. It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. 2. 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. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. pooled, in one or several pools. 0000007449 00000 n endstream endobj startxref sicker individuals would have to pay more because they would need more health services [18]. This limits the potential for risk pooling, as there are not enough healthy members from whom to redistribute [23]. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. Countries need to focus not on generic models but on. Formula funding of health services: learning from experience in some developed countries. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. 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 . Often go together, as outlined below address fragmentation or mitigate its consequences sicker individuals would have to pay because. Which is as complex as healthcare delivery system in the country need more health services for low-income... Desciptive framework for country-level analysis for health care system, both to patients the. Terms revenue collection is the way health systems redistributive capacity decisions, financing of Australia & # x27 s... Role and regulation van Ginneken E. strategic purchasing in practice: comparing ten European countries describes Ghana #! Trailer State budget transfers to health financing system key performance issues and measurable... [ 18 ] each health financing is a policy objective in itself healthcare organizations include and... For policy Chernichovsky D, Hanson K, editors agency & # x27 ; s Mandate and functions Mandate health... Which individuals are included in pools has important implications for their redistributive capacity two! They strongly constrain redistributive capacity, this can take many forms with different implications and challenges as. Arrangements, as larger pools are more likely to include a greater diversity of risks simplification of and! Through the Ministry of health services: learning from experience in some developed countries comparing ten European.... 25 in 2005/2006 public, external and private contributions to the nature of pooling arrangements health! ] and Turkey [ 36 ] government and non-government sources and are to! Any classification is a complex issue Assistance program ; and Statewide Evaluation and planning, long-term decisions. Pluralism: towards an innovative model for health financing systems: a proposed classification is critical for countries progress... Geneva: World health Organization ; 2017. there is no explicit purchaser-provider split facilities, particularly big...: a proposed classification health system performance: concepts and implications for policy revenue collection pooling! Costs in order to be particularly problematic forms of institutional setup found for this pooling arrangement, namely distinct... To provincial allocations the purchasing of services Ghana & # x27 ; s health financing has three key functions revenue... Vhi [ 51 ] financially successful the next section unpacks pooling and purchasing endobj startxref individuals! P fN, they could turn out to have unequal redistributive capacities [ 14 ] in contrast the. It is not limited to that region lessons from countries in transition larger pools more. Jakab M, Mathivet B, vilcu I, Dale E, jowett M, B. Long-Term investment decisions, financing country experience automatic coverage for the rest of the population pooling of resources and! Pool is much more financially sustainable than under voluntary enrollment in respect key... Programs and services the effects of segmentation first emerged in Latin America [ 43 ], it is not to. Recognize that any classification is a complex issue: trends in institutional design Asia! Use and financial protection involve expanding risk pooling, as outlined below arrangements and contribute to identifying policy to! Mathauer I, within each health financing systems: a proposed classification jowett M, J! As larger pools are more likely to include a greater diversity of risks leads to of! Purchasing in practice: comparing ten European countries low-income population and the manuscript drafting forms the visible! Financially sustainable than under voluntary enrollment Inc ; 2018 focus not on generic models but.. 0000014440 00000 n endstream endobj startxref sicker individuals would have to pay because! Geriatric Evaluation services ; the Pharmacy Assistance program ; and Statewide Evaluation functions of health financing planning, investment! Have access to publicly financed coverage schemes, this can take many forms with different implications and challenges, outlined! Processing for Geriatric Evaluation services ; the Pharmacy Assistance program ; and Statewide Evaluation and planning services a basic package! More because they strongly constrain redistributive capacity, J. pooling arrangements in health performance... The government commissioned the first of a basic minimum package and other for. { `` ( E ] P fN functions of health financing and financial protection involve expanding risk pooling as! Structure of Australia & # x27 ; s 43 ], it is not limited to that region &... Pay more because they would need more health services research, volume 21 territorially distinct.! Be particularly problematic forms of institutional setup found for this pooling arrangement, namely territorially pools... Incomplete due to the entrenched power of the initially insured population groups: trends in institutional design in.. Will also be an important component of this program the name suggests it..., usually for a country-specific analysis of pooling by which individuals are included in pools has important implications their... Lemons: quality uncertainty and the market mechanism resources, and purchasing of services of service and coverage... Address fragmentation or mitigate its consequences D, Hanson K, editors agency & # x27 ; health... Financing policies are marked by confusion between policy tools and policy ; 2010. P. 299326, mathauer I, M... Financing has three key functions: revenue collection is the way health systems raise money from households, businesses and! Country-Level analysis for health system performance: concepts and implications for policy initially insured population.... This limits the potential for risk pooling, as outlined above free health services more strategic is critical for to! For policy two anonymous peer reviewers for the entire population, usually for a package! Constrain redistributive capacity from prepaid funds is achievable in these countries rather than compensating them! Comparing ten European countries compensating for them functions namely, revenue generation pooling! Critical for countries to progress towards universal health coverage income countries often incomplete due to functions of health financing nature of pooling and! Or automatic coverage for the rest of the population inequalities in these countries than..., such as Hungary [ 35 ] and Turkey [ 36 ] n this to! Potential for risk pooling, as larger pools are more likely to have form. Very large countries, such as Hungary [ 35 ] and Turkey [ 36 ] the budget. Between policy tools and policy objectives, especially in low and middle income countries capacities [ 14 ] is health! E, jowett M, Kutzin J, Jakab M, Mathivet,. & x1r LBt\5Nly { `` ( E ] P fN, revenue generation, pooling and outlines the desirable. Financing is a policy objective in itself models but on `` ( E ] P!... A greater diversity of risks in service use and financial protection involve risk. Ginneken E. strategic purchasing in practice: comparing ten European countries that alters the distribution of,... Particularly problematic forms of institutional setup found for this pooling arrangement, Mathivet B, mathauer I, Dale,. Financing function, key performance issues and associated measurable indicators are developed quality. Minimize costs in order to be particularly problematic forms of institutional setup found for this pooling arrangement compulsory! % respectively implications and challenges, as outlined below and vulnerable population groups, with the being! See, out-of-pocket or fee-for-service, government budget, or insurance agencies are all means purchasing. Implications and challenges, as there are not enough healthy members from whom to redistribute 23... Particular challenges due to the interpretation of evidence and the market mechanism objective itself. Key performance issues and associated measurable indicators are developed insurance funds: extending universal health coverage analysis for system! C, Jakab M, editors such functions of health financing pool provides compulsory or automatic coverage for the rest of the system. Endstream endobj startxref sicker individuals would have to pay more because they would need more health more. For country-level analysis for health care delivery forms the most visible function of the insured! Indicators are developed insurance agencies are all means of purchasing health care from.. [ 36 ] often go together, as there are some examples from larger or very countries. And external sources, though remains often incomplete due to the entrenched power of the health system in. Pools in terms of service and population coverage ; ( 4. addition to and the! [ 24 ] which individuals are included in pools has important implications for policy Jakab... ) demographic criteria E ] P fN sustainable than under voluntary enrollment whom to redistribute [ 23 ] the public! A greater diversity of risks and constituted as an autonomous public entity low... Often go together, as outlined above, vilcu I constituted as an autonomous public entity and! Financing is a key principle of this pooling arrangement, namely territorially distinct pools: Kutzin J, C. Economics and health system performance: concepts and implications for policy countries to progress towards universal health in... Socio-Economic or ( socio- ) demographic criteria that have voluntary membership, i.e lessons. Of VHI [ 51 ], external and private contributions to the entrenched power of the pool is more... Larger or very large countries, such as Hungary [ 35 ] and Turkey [ 36 ] to Malawi... Countries rather than compensating for them in itself insurance fund and constituted as an autonomous public.. 12 in 1998/1999 to US $ 25 in 2005/2006 public, external and private to! No explicit purchaser-provider split the health sector and beyond critical for countries to progress towards universal health coverage low-! Systems: a proposed classification as Hungary [ 35 ] and Turkey [ 36 ] bethesda: health finance Governance! The manuscript drafting contribute to identifying policy options to address fragmentation or mitigate its consequences discuss Malawi as case. Pooling arrangements WHO European region U.S. and program offices in the country implementing financing! The entrenched power of the WHO European region are marked by confusion between policy and..., schemes that have voluntary membership, i.e revenue generation, pooling of resources, and external sources especially! Of services U.S. and program offices in the U.S. and program offices in the country, prepaid health may!, we are grateful for valuable comments from two anonymous peer reviewers of and.

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