Sustaining progress towards universal health coverage amidst a full-scale war: learning from Ukraine.

In the aftermath of Russia's military response to the 2014 Revolution of Dignity, the government of Ukraine implemented a package of health financing reforms underpinned by universal health coverage (UHC) principles. By the time of Russia's full-scale invasion of Ukraine in February 2022, the new systems and institutions envisaged in the reforms were largely established. In this Commentary article, we explain how these attributes strengthened the Ukrainian health system's response to the impacts of the war. Ukraine's experience highlights the role that health financing arrangements, designed in accordance with UHC principles, can play in strengthening health system resilience.

The Case Against Labor-Tax-Financed Social Health Insurance For Low- And Low-Middle-Income Countries.

An increasing interest in initiating and expanding social health insurance through labor taxes in low- and low-middle-income countries goes against available empirical evidence. This article builds on existing recommendations by leading health financing experts and summarizes recent research that makes the case against labor-tax financing of health care in low- and low-middle-income countries. We found very little evidence to justify the pursuit of labor-tax financing for health care in these countries and persistent evidence that such policies could lead to increased inequality and fragmentation of the health system. We recommend that countries considering such policies heed the evidence on labor-tax financing and seek alternative approaches to health financing: primarily using general taxes or, depending on the context, general taxes combined with adequately regulated insurance premiums.

Pooling arrangements in health financing systems: a proposed classification.

OBJECTIVES: The function of pooling and the ways that countries organize this is critical for countries' progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. METHODS: 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. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. FINDINGS: We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. CONCLUSION: Pooling arrangements set the potential for redistributive health spending. 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.

Funding health care: options for Europe

Health care systems face ever changing and often competing demands for resources. For a health care system to be sustainable it must be able to pay for investment in buildings and equipment, training and remuneration of personnel and for drugs and other consumables. How these financial resources are generated and managed ­ the process of collecting revenue and pooling funds ­ raises important issues for policy-makers and planners. This policy brief aims to summarise these issues from an international perspective and consider how funding systems can be designed in order to achieve policy objectives. It looks first at the different sources of revenue and then at the impact of different systems of funding on specific objectives related to social policy, politics and economics. Finally, it considers implementation issues and some of the wider dimensions that policy-makers need to consider.

Финансирование здравоохранения: альтернативы для Европы

Системам здравоохранения приходится приспосабливаться к постоянно меняющимся и часто конкурирующим потребностям в финансовых средствах. Чтобы система функционировала на должном уровне, она должна располагать достаточными средствами для инвестицийв здания и оборудование, покрытия расходов на обучение персонала, оплаты труда персонала, покупки лекарств и других расходуемых материалов. На долю тех, кто разрабатывает политику в области здравоохранения и планирует работу систем здравоохранения, приходится решение важнейших задач по сбору доходов и созданию финансовых пулов. Цель настоящего реферата — бобщить существующие проблемы и указать возможные пути к их решению с учетом международного опыта. Вначале рассматриваются различные источники доходов, затем — воздействие различных систем финансирования на решение конкретных социальных, политических и экономических задач. Наконец, рассматриваются проблемы реализации принятых решенийи некоторые более широкие аспекты, которые необходимо иметь в виду деятелям, несущим ответственность за разработку политической линии.

Funding health care: options for Europe

This policy brief aims to summarize how financial resources are generated and managed in the health care system from an international perspective and considers how funding systems can be designed in order to achieve policy objectives. It looks at the different sources of revenue; the impact of different systems of funding on specific objectives related to social policy, politics and economics; and considers implementation issues and some of the wider dimensions that policy-makers need to consider.