Bismark meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan

Abstract

Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low-and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues -the main source of public funding for health -from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Health financing for universal coverage and health system performance: concepts and implications for policy

“…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 Hence, from the perspective of UHC, whether or not a financing scheme improves attainment of coverage objectives for its members is not intrinsically important; what matters is the impact of that scheme on the attainment of the objectives for the population and system as a whole. Assessing schemes simply with respect to whether or not they improve coverage for their members is both inadequate and a potential source of misleading policy recommendations.…”

Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

“…Of these, increasing efficiency is the reason most closely linked to DRGbased payment systems and the rationale behind the introduction of such systems in former Soviet republics still grappling with a legacy of overcapacity in inpatient care, such as Estonia 14 and Kyrgyzstan. 26,83 China, 84 Hungary 19 , The former Yugoslav Republic of Macedonia, 85 Romania 39 and Serbia 71 also expect DRG-based payment systems to increase efficiency. Making hospital activity more transparent for purchasers and providers was an explicit objective in Poland 37 and Serbia.…”

Healthcare financing reform in Latvia: Switching from social health insurance to NHS and back?

“…Table 2 summarizes the expected benefits of the proposed Healthcare Financing Law and the potential problems put forward by opponents of the reform. Both, the expected benefits and the potential problems mirror those discussed for other countries [8,19]. Governments contemplating the introduction of SHI mostly do so based on arguments that it would improve the ability of raising revenues for health, making healthcare financing more predictable (independent of political interference), and that people would be more willing to contribute if eligibility for healthcare services is linked to making contributions [19].…”