The first pillar: proposed objectives for health financing policy

The health financing policy objectives serve as criteria that we use to assess the attainment and performance of health financing systems and the effects of reforms. These are derived from the overall health systems performance goals described in The world health report 2000, by considering the goals that health financing arrangements influence. On this basis, we derive the following set of health financing policy objectives.

  1. Financing policy objectives that are essentially identical to broad health system goals, by
    1. promoting universal protection against financial risk; and
    2. promoting more equitable distribution of the burden of funding the system.
  2. Financing policy objectives that are instrumental, intermediate objectives to the broad health system goals, by
    1. promoting equitable use and provision of services relative to the need for such services;
    2. improving transparency and accountability of the health (financing) system to the population;
    3. promoting quality and efficiency in service delivery; and
    4. improving efficiency in the administration of the health financing system.

Protection against the financial risk of ill health, or financial protection, is a goal that can be summarized simply as follows: people should not become poor as a result of using health care, nor should they be forced to choose between their physical (and mental) health and their economic well-being. Indeed, this issue reflects one of the most direct associations between health and wealth: the extent to which people become impoverished by health expenditure or, conversely, the effectiveness of the health financing system in protecting people against the risk of becoming poor while enabling their use of services.

A related but distinct objective is that the health system should be equitably funded. This means that, relative to their capacity to pay, the poor should not pay more than the rich (the distribution should be progressive or at least proportionate to income). The objective of equity in funding is hence closely linked to the concept of solidarity. As with financial protection, equity analysis should consider all sources of health spending. These can be attributed back to the households from which they originated, both directly – in the form of OOPS and (voluntary and compulsory) pre-payments for health insurance – and indirectly, in the form of unearmarked taxation.

The objective of improving transparency and accountability of the system for the population also poses challenges in terms of interpretation and measurement. Conceptualizing these objectives and assessing the impact of reforms pose a challenge, so boundaries are required in order to make the concepts managerially useful. Transparency and accountability can be interpreted in many ways, but

for our purposes there are two principal areas of focus:

  1. transparency in terms of people’s understanding of the benefits to which they are entitled and their obligations under the benefits package (and the understanding of health workers as well), along with the extent to which these are realized in practice;
  2. transparency and accountability in the health financing agencies (for example, reporting requirements, audits, and so on).

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presentation icon  Blended Advocacy - Monitoring dan Evaluasi Program Jaminan Kesehatan Nasional Tahun 2015 (Individu)