Pooling financial resources for universal health coverage: options for reform

Area of Science:

• Health Economics
• Public Health Policy
• Health Financing

Background:

• Universal health coverage (UHC) ensures access to quality healthcare without financial hardship.
• Effective health financing, including revenue raising, pooling, and purchasing, is crucial for UHC.
• Pooling, the management of prepaid health funds, is vital for resource redistribution and financial protection.

Purpose of the Study:

• To provide an overview of pooling reform options for enhancing resource redistribution.
• To address fragmentation in health financing pools that hinders equitable access.
• To support countries in exploring strategies to improve health fund management.

Main Methods:

• Review and outline of four broad types of pooling reforms.
• Discussion of the potential and challenges of each reform type.
• Analysis of how pooling reforms interact with revenue raising and purchasing.

Main Results:

• Four key pooling reform options identified: compulsory coverage, pool merging, cross-subsidization, and harmonization.
• Fragmented pooling arrangements create barriers to resource redistribution.
• Successful redistribution depends on aligning pooling with revenue raising and purchasing functions.

Conclusions:

• Pooling reforms can enhance redistribution and financial protection for UHC.
• Combining reform elements may be necessary to address fragmentation.
• Institutional, political feasibility, and political economy must be considered for successful reform implementation.