子模块6.2：政府医疗保健融资计划

Module 6:The financing dimension 6.2:Submodule Government health care financing schemes Content •HF – Government health care financing schemes [HF.1.1]•FS – Revenues of government schemes•FA – Financing Agents managing government schemes•FS.RI – Classification of institutional units providing resources•Frequently used data sources•How to identify each government scheme•Accounting notes for government schemes•Challenges Additional Content: •Questions and Answers•Suggested reading Government health care financing schemes [HF.1.1] Government schemesare established by a law or a regulation and have a designated budget, and a government unit with overallresponsibility for them, as is the case of the schemes managed by the Ministry of Health (MOH). In any given country, there may be one or several government schemes, operating at the same time, for example: Schemes which offer a comprehensivehealth care basket to the populationincluding stewardship of the health system Schemes which offer selected servicesto specific population groups Schemes with a specific focus In theNetherlands, theresponsibility of the MOH schemeat national level is governance andhealth system administration,while local authorities handlepublic health at a local level. One of the schemes of MOH inArgentina, covers uninsuredpopulation for preventive andprimary health care services,through the SUMAR program. InMyanmar, the governmentscheme of the MOH is responsiblefor health care provision to thetotality of the population. Characteristics of government schemes HF.1.1. Government schemes Mode of participation Benefit entitlement Typicallynon-contributory[do not requireindividuals to contribute to the scheme]. Automaticfor all citizens /residents or a specificgroup of the population [e.g.the poor] defined bylaw or regulation Government schemes do not necessarily cover the total price of theservices and goods provided, and can involvecost-sharing, as householdOOP [discussed in submodule 6.4]. The MOH in Bhutan has a policy of free universalaccess to PHC. Universalor for aspecificpopulation group United Kingdom has a National Health Service (NHS), with freecare at the point of use. Some services, such as dental and opticalcare, may not be completely free, although the populationbenefits from subsidies and discounts for these services. Characteristics of government schemes HF.1.1. Government schemes Basic method for revenue collection Pooling Pooling of fundscombines resources into fewer andlarger pools, which improves risk sharing and equity. Compulsory:general revenues [primarily taxes], throughthe Ministry of Finance allocated to health. Pooling of government schemes can be atNational, sub-national, orprogram level In some countries, general revenue also includes externalaid or natural resources revenue. It may include earmarkedrevenues, such as those collected by taxes on tobacco,alcohol, and sugar sweetened beverages. Aid revenues can have a general or specific purpose [e.g. HIV], and canalso be matched with national funds, and/or pooled with health budgetfor national purposes. As in Indonesia, Philippines, Thailand, Egypt, and UK. In Uganda, where the Joint Programme (UNAIDS) integrates effortsof UN agencies like UNHCR, UNICEF, and WHO. It supported themobilization of funding from both PEPFAR and the Global Fund toexpand and sustain the HIV response. Main types of government schemes Government schemes [HF.1.1]have a jurisdictional coverage and may be located both at central and subnational levels. •Atcentral level [HF.1.1.1],MOH usually has prime responsibility for government health care financing schemes, including health system governance[HF.1.1.1.1]. Central level programs in general have a national coverage, although, exceptions may include a specific targeted purpose. The MOH malaria program in Bhutan is active only in the high-risk southern border districts [seven out of the 18 in the country]. •Other ministries’ schemescan also finance health care, usually at the central level. The Angolan Armed Force and Ministry of the Interior scheme finances andprovides health care to military personnel and their families. •In some countries, thegovernment employeesmay have a specific scheme [HF.1.1.1.2] •Subnational schemesexist mainly in state/regional/local governments [HF.1.1.2]with specific characteristics. In Canada some provinces, such as Québec, have specific provincial healthschemes [HF.1.1.2], additional to the national scheme. Example of financial flowsrelated to Governmentschemes (HF) The complete flow can be represented in asingle chart. In this example, themain flowsrelated to government schemes are included,notably from government domestic andexternal revenue. FA:FINANCINGAGENTS Revenues of government schemes (FS) [1] Revenuerefers to the inflow of funds to a health financing scheme, generated through specific contribution mechanisms. Depending on the countrycontext, the revenue type