Pooling arrangements in health financing systems: a proposed classification

Area of Science:

• Health Policy and Systems Research
• Health Economics
• Public Health

Background:

• Health pooling arrangements are critical for achieving universal health coverage (UHC).
• The policy potential of pooling mechanisms has been underexplored.
• Fragmentation in pooling can hinder progress towards UHC objectives.

Purpose of the Study:

• To classify country pooling arrangements for health financing.
• To analyze how fragmentation manifests in different pooling types.
• To identify challenges associated with pooling for UHC.

Main Methods:

• A review of published and grey literature from PubMed, Google, and Google Scholar.
• Analysis of health financing policies and pooling structures in over 100 countries.
• Development of a classification system for country pooling arrangements.

Main Results:

• Eight broad types of pooling arrangements were identified, ranging from single to multiple competing pools.
• Fragmentation can occur through territorial distinctions, population segmentation, or voluntary insurance duplication.
• The effectiveness of pooling depends on alignment with revenue raising and purchasing functions.

Conclusions:

• Pooling arrangements significantly influence the potential for redistributive health spending.
• Realizing efficiency and equity gains requires careful alignment of pooling with other health financing functions.
• Country-specific analysis is essential for addressing pooling fragmentation and its consequences.