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

Kutzin, Joseph

doi:10.2471/blt.12.113985

Cited by 373 publications

(362 citation statements)

References 21 publications

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“…Based on the UHC dimensions of coverage, benefits and financial risk protection [12], the three dimensions identified by Cashin and colleagues [13] for sustaining progress towards UHC, and Kutzin’s [14] attempt to describe the role of health financing in achieving UHC (and thus fit UHC into the existing health system frameworks), we divided both the following section and the Discussion section into (i) the role and impact of PhilHealth in financing health care and (ii) the role and impact of PhilHealth in service quality and utilization.…”

Section: Resultsmentioning

confidence: 99%

The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

Obermann

Jowett

Kwon

2018

Global Health Action

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Background: Achieving Universal Health Coverage (UHC) has by now become a key health policy goal in many countries and some form of National Health Insurance (NHI) is often used for this. The Philippines has had more than 50 years’ experience with social health insurance and in 1995 established PhilHealth, the country’s national health insurer. Objectives: Analyzing the role of the Philippine NHI scheme in moving towards UHC, identifying potential avenues for improvement as well as indicating challenges and areas for further development. Methods: This paper is based on a mixed methods approach including extensive literature search, data from PhilHealth and other sources, and key informant interviews with staff at PhilHealth, health care providers, and policy experts at national and international level. Results: Major achievements were the expansion of population coverage using an earmarked revenue source (‘Sin Tax’), the introduction of the no-balance-billing to prevent co-payments, and the Health Facilities Enhancement Program to improve quality. The share of PhilHealth in total health expenditures is still only 14%, managing quality and cost of providers remains insufficient, the benefit coverage does not reflect the country’s burden of disease, and financial protection for PhilHealth members is low. The UHC bill would provide a massive jump forward as all Filipinos would then be automatically enrolled in and thus entitled to the benefits of PhilHealth. Conclusions: For expanding a contribution-based NHI beyond formal employment there needs to be a large increase in budget transfers to cover for citizens unable to contribute. The Philippine UHC bill shifts from the idea of contribution leading to entitlement to the idea of citizenship leading to entitlement and can thus be seen as a paradigmatic change in thinking about NHI. There are three areas that we believe are of key importance in developing further NHI: (i) governance, (ii) financial impact, and (iii) strategic purchasing.

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Section: Resultsmentioning

confidence: 99%

The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

Obermann

Jowett

Kwon

2018

Global Health Action

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“…Jaminan kesehatan menurut laporan Badan Kesehatan Dunia (WHO) tahun 2010, bertujuan untuk memastikan semua orang mendapatkan akses ke layanan kesehatan yang dibutuhkan (upaya promotif, preventif, kuratif dan rehabilitatif) dengan kualitas yang baik dan efektif dan untuk memastikan bahwa seluruh layanan kesehatan dapat mencakup orang-orang yang kesulitan secara finansial (Kutzin, 2013).…”

Section: Pendahuluanunclassified

“…Sistem pembiayaan kesehatan di pengaruhi oleh beberapa fungsi yaitu pengurusan dan p e n g a w a s a n o l e h p e m e r i n t a h / p i m p i n a n , sumberdaya fisik dan manusia, pelayanan kesehatan dan pembiayaan. Secara spesifik pada fungsi sistem pembiayaan kesehatan, mencakup pengumpulan pendapatan, penggabungan dalam anggaran dan belanja anggaran yang secara langsung bermanfaat untuk pelayanan sesuai dengan kebutuhan, efisiensi, kualitas serta transparansi dan akuntabilitas (Kutzin, 2013).…”

Section: Tinjauan Teoritisunclassified

“…Norma kapitasi bervariasi yaitu berkisar antara Rp 4.500 sampai dengan Rp. 6.000, dengan jumlah peserta sangat bervariasi dengan standar "Makaya di tiap puskesma tidak sama, ada jumlah peserta dia 32.000, ada yang 16.000 ada 10.000 ada 8.000 " (9) Terkait dengan tarif kapitasi, kondisi menunjukkan disparitas antar puskesmas yang menunjukkan kualitas dan kuantitas sumber daya di puskesmas yang berbeda.…”

Section: Hasilunclassified

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Analisis Kebijakan Pemanfaatan Dana Kapitasi JKN pada FKTP Puskesmas di Kabupaten Bogor Tahun 2016

Hasan

Adisasmito²

2017

JKKI

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oleh pengadaan, potensi overlapping kapitasi dengan BOK dan kualitas pelayanan dokter menurun pada rasio dokter per peserta besar. Kesimpulan dan saran : Rasio dokter dengan peserta masih dibawah standar 1:5000 peserta perlu upaya pemerataan, porsi kapitasi 60% untuk Jasa dan 40% opersional lain, ketercukupannya berbeda perlu ada backup dana operasional untuk yang kurang, adanya disinsentif jasa pelayanan perlu dikaji ulang, kapitasi porsi 40% dapat komplementer dengan BOK, sisa anggaran menguntungkan bila alternatif kegiatan mampu efektif efisien sesuai kebutuhan masyarakat, perlu perbaikan mekanisme pengadaan obat, dalam fleksibilitas anggaran perlu didorong PPK-BLUD pada puskesmas. Kata kunci : kapitasi; FKTP; Puskesmas PendahuluanJaminan kesehatan menurut laporan Badan Kesehatan Dunia (WHO) tahun 2010, bertujuan untuk memastikan semua orang mendapatkan akses ke layanan kesehatan yang dibutuhkan (upaya promotif, preventif, kuratif dan rehabilitatif) dengan kualitas yang baik dan efektif dan untuk memastikan bahwa seluruh layanan kesehatan dapat mencakup orang-orang yang kesulitan secara finansial (Kutzin, 2013).Di Indonesia, dana kapitasi untuk pembayara layanan kesehatan diperoleh dari premi peserta JKN yang sebagian cara pembayaran layanan kesehatannya melalui kapitasi. Sistem Kesehatan Nasional Indonesia memang menyebutkan bahwa upaya kesehatan perorangan pembayarannnya bersifat privat, kecuali masyarakat miskin dibayar pemerintah. (Kemenkes, 2009 Results: There is a high disparity of capitation funds for puskesmas covering participants, capitation norms, number of doctors and the ratio of doctors between various puskesmas. In-depth interviews found the difficulty of fulfilling the ideal physician ratio, low capitation norms indicated the low quality of the puskesmas, not all the puskesmas did the proper planning process, the small capitation clinics were difficult in the operational and the overwhelming operational and potentially piled up, Drug fulfillment is constrained by procurement, the potential for overlapping capitation with BOK and the quality of physician services decreases in the ratio of physicians per large participant. Conclusions and suggestions: The ratio of physicians to participants is still below the standard of 1: 5000 participants need equalization effort, 60% capitation portion for services and 40% other opersional, different sufficiency there should be operational fund backups for the less, the disincentives of service need to be reviewed, Capitation of 40% portion can be complementary with BOK, the rest of the budget is advantageous if the activity alternative can be effectively efficient according to society requirement, need improvement of drug procurement mechanism, budget flexibility need to be pushed PPK-BLUD at puskesmas.

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“…Healthcare purchasing plays a vital role in the healthcare financing (1,2). One of the most important purchasing types recently introduced is VBP (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Proposing a Model of “Hospital Value-Based Purchasing” in Selected Teaching Hospitals in Isfahan, Iran: 2015 - 2016

Mousavi

Gorji

Delgoshaei

2017

Iran Red Crescent Med J

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Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 -16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 -16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5,5,25,20,15,15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings.

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

Cited by 373 publications

References 21 publications

The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

Analisis Kebijakan Pemanfaatan Dana Kapitasi JKN pada FKTP Puskesmas di Kabupaten Bogor Tahun 2016

Proposing a Model of “Hospital Value-Based Purchasing” in Selected Teaching Hospitals in Isfahan, Iran: 2015 - 2016

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