Show Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Glossary WHO building blocks: A WHO framework that defines the components of the health system. The six building blocks include: leadership, health care financing, health workforce, medical products, vaccines and technologies, information and research, and service delivery. Universal Health Coverage: The goal of ensuring access to quality essential health services (including prevention, promotion, treatment and rehabilitation) for an entire population without risk of financial hardship or impoverishment. Requires determining who is covered in the population, for which services, and for what portion of the direct cost. Health Financing: The process of managing health sector funds to maximize efficiency, equity, sustainability, and accountability. Health financing has three basic functions: revenue collection, pooling and purchasing. Financial management and improved alignment between health financing and public financial management systems is crucial to achieving health sector goals. Financial risk protection: Security from incurring catastrophic costs in case an insured event occurs. Primary Health Care: The provision of outpatient care, with a particular focus on ensuring the quality delivery of health interventions prioritized by countries and the global community against the highest disease burdens. Secondary Health Care: Medical care provided by a specialist or facility upon referral by a primary care physician that requires focused knowledge and equipment. Tertiary Health Care: Specialized consultative care usually for inpatients referred by primary or secondary physicians. Benefits package: A defined set of services and products that can be aligned with a particular level of care (i.e., primary, secondary or tertiary health care services). The benefits covered are a major driver of the overall cost of the scheme and its public acceptability. Clinical audit: A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against set criteria. An audit can lead to the implementation of recommended changes Health Insurance: Insurance as a concept guarantees benefits and protects the insured population from catastrophic health expenditure through some form of prepayment. Health insurance works best when risk pools are large and when the health risks associated with the covered population are diversified so that the healthy can subsidize the sick. Health insurance models are one way to describe how health financing systems are organized. Health financing systems can also be defined in part by characteristics of the three major health financing functions (See below). Insurance is itself comprised of a combination of various pooling, purchasing and revenue collection arrangements used to ensure the provision of a defined benefits package. Some models of health insurance include:
Definitions by health financing function Pooling: The accumulation and management of financial resources to ensure that the financial risk of having to pay for health care is borne by all members of the pool and not by individuals who fall ill.
Revenue collection: Refers to the sources and mechanisms for raising funds in support of health.
Purchasing: The process of payment for health services. There are three main ways to do this, often used in combination:
Why health insurance matters
References: Blanchet, N.; Kidane, R.; Makinen, M eds. (2015). Universal Health Coverage Primary Health Care Self-Assessment Tool. Joint Learning Network for Universal Health Coverage Primary Health Care Initiative. Cashin, C. ed. (2015). Assessing Health Provider Payment Systems: A Practical Guide for Countries Working Towards Universal Health Coverage. Joint Learning Network for Universal Health Coverage. Connor, C. and Wang, H. ed (2010). Africa Health Insurance Handbook – How to Make it Work. Authors: Hong Wnag, Kimberly Switlick, Christine Oritz, Catherine Connor, and Beatriz Zurita. Health Systems 20/20 project, Abt. Associates Inc. Heller, P. (2005). Understanding Fiscal Space, IMF policy paper, Fiscal Affairs Department Kutzin, J (2001) A descriptive framework for country-level analysis of health care financing arrangements. Health Policy, 56: 171-204. Kutzin, J (2013). Health financing for universal coverage and health systems performance: concepts and implications for policy. Bulletin, World Health Organization, 91: 602-611 Langenbrunner, J.; Cashin, C.; O’Dougherty, S. eds. (2009). Designing and Implementing Health Care Provider Payment Systems: How-To Manuals. World Bank, Washington DC WHO (2007). Everybody’s Business: strengthening health systems to improve health outcomes. WHO’s framework for action. Geneva: World Health Organization. World Health Organization; Geneva, Switzerland WHO (2010). The World Health Report- Health Systems Financing: the path to universal coverage. World Health Organization; Geneva, Switzerland World Bank (2013). Results-Based Financing for Health. Africa Health Forum financing and capacity for results, World Bank, Washington DC Which type of health insurance covers the most people?Of the subtypes of health insurance coverage, employment-based insurance was the most common, covering 54.4 percent of the population for some or all of the calendar year, followed by Medicare (18.4 percent), Medicaid (17.8 percent), direct-purchase coverage (10.5 percent), TRICARE (2.8 percent), and Department of ...
What services should be included in universal health coverage?UHC means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
What are the 3 dimensions of universal health coverage?The framework for analysis of UHC by the World Health Organization (WHO) identifies the three dimensions of measurement, including population coverage, service availability and financial protection.
What is the universal health coverage index?2019. The Universal Health Coverage (UHC) Index is measuredon a scale from 0 (worst) to 100 (best) based on theaverage coverage of essential services includingreproductive, maternal, newborn and child health,infectious diseases, non-communicable diseases andservice capacity and access.
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