Risk Pooling in Health Care Financing : The Implications for Health System Performance

Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each con...

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Bibliographic Details
Main Authors:	Smith, Peter C., Witter, Sopie N.
Format:	Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2013
Subjects:	ACCESS TO HEALTH CARE ADVERSE SELECTION BANK PUBLICATIONS BUDGET CONSTRAINTS BURDEN OF DISEASE CAPITATION CAPITATION SYSTEM CLINICS COMMUNICABLE DISEASES COVERAGE CREAM SKIMMING DEVELOPMENT INDICATORS DRAFTS ECONOMIC STATUS EMPLOYMENT EXCESSIVE CONSUMPTION EXPENDITURES EXPOSURE EXTERNALITIES FEE FOR SERVICE FINANCIAL RISK FINANCIAL VIABILITY HEALTH CARE HEALTH CARE COSTS HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE INSURANCE HEALTH CARE POLICY HEALTH CARE RESOURCES HEALTH CARE SERVICES HEALTH CARE SPENDING HEALTH CARE UTILIZATION HEALTH CENTERS HEALTH CONDITIONS HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH FACILITIES HEALTH FINANCING HEALTH GAIN HEALTH INSURANCE HEALTH INTERVENTIONS HEALTH RISK HEALTH RISKS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEM PERFORMANCE HEALTH SYSTEMS HUMAN DEVELOPMENT HUMAN RESOURCES INCOME INDEBTEDNESS INDUCED DEMAND INFECTIOUS DISEASES INFORMATION SYSTEMS INSURANCE CONTRACTS INSURANCE FUNDS INSURANCE PREMIUMS INSURANCE SYSTEMS INSURERS INTEGRATION INTERVENTION LESSONS LEARNED LIABILITY LIFE CYCLE LOW INCOME LOW-INCOME COUNTRIES MANAGED CARE MANAGED COMPETITION MEDICAID MEDICAL EQUIPMENT MEDICAL SAVINGS ACCOUNTS MEDICARE MORAL HAZARD NUTRITION OLDER PEOPLE PATIENTS PAYMENT SYSTEMS POOLS PREMIUMS PREPAYMENT PRIVATE INSURANCE PROGRAMS PROMOTING HEALTH PUBLIC HEALTH PUBLIC HEALTH INSURANCE PUBLIC SECTOR RATES RISK PROFILES RISK SHARING SAFETY SAVINGS SERVICE DELIVERY SOCIAL INSURANCE SUB-SAHARAN AFRICA TUBERCULOSIS TUBERCULOSIS PATIENTS
Online Access:	http://documents.worldbank.org/curated/en/2004/09/5638380/risk-pooling-health-care-financing-implications-health-system-performance http://hdl.handle.net/10986/13651

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Summary:	Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. The arguments in favor of risk pooling in health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population health, can increase productivity, and reduces uncertainty associated with health care expenditure. The report considers four classes of risk pooling: no risk pool, under which all expenditure liability lies with the individual; unitary risk pool, under which all expenditure liability is transferred to a single national pool; fragmented risk pools, under which a series of independent risk pools (such as local governments or employer-based pools) are used; and integrated risk pools, under which fragmented risk pools are compensated for the variations in risk to which they are exposed. It notes that small, fragmented risk pools, which are the norm in developing countries, contribute to seriously adverse outcomes for health system performance.

Risk Pooling in Health Care Financing : The Implications for Health System Performance

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