Table 1 Institutional design features of government revenue transfer/government subsidization
Institutional design aspect | Related policy choices | Intermediate output indicators | UHC related performance indicators |
|---|---|---|---|
Eligibility and enrolment rules | |||
Groups eligible for exemption from contributions/subsidization | Definition of vulnerability (e.g. children, unemployed, pregnant women, informal sector workers, poor, near poor) | Share of the eligible among the bottom two income quintiles and other vulnerable groups | Total population coverage (comprehensiveness of the health insurance system), differentiated along income quintiles |
Targeting method | E.g. universal (based on a very broad criterion such as residence or no employment in the formal sector), indirect (based on socio-demographic, socio-economic or geographic characteristics usually correlated with poverty and vulnerability), direct (through a means assessment or proxy means testing); different targeting approaches can be in place at the same time for different groups | Share of the exempted/subsidized within total (insured) population; Share of the exempted/subsidized among those being targeted for exemption/subsidization (targeting effectiveness of the system) | |
Enrolment process | Active enrolment by the beneficiary or automatic enrolment by the authorities | ||
Organization responsible for identification of the exempted non-contributors/the subsidized | E.g., insurance company; central, regional, local government | ||
Type of enrolment/membership | Mandatory or voluntary | ||
Financing arrangements | |||
Degree of subsidization/co-contribution | Full or partial (a co-contribution is required) | Share of the exempted/subsidized within total (insured) population/those being targeted for subsidization (importance of government revenue) | |
Type of transfer mechanism | Individual-based (a specific amount is being paid for each exempted individual) or lump-sum (a lump sum transfer for the entire exempted population is made) | ||
Calculation logic to determine the amount being transferred | E.g., based on regular contribution levels, minimum or average wages, specific percentage of the government budget, negotiated by the government | Sufficient funding for a comprehensive benefit package | Financial protection (incidence of catastrophica/impoverishing health expenditure), also differentiated along income quintiles and other aspects; Access to services |
Level of cross-subsidization from contributions | |||
Source of government revenue transfers | E.g. general government revenues, earmarked government revenues, transfers from other health insurance funds or from contributors within the same pool (cross-subsidization), donor funding | ||
Pooling arrangements | |||
Type of pool(s) (general) | Single fund or multiple funds | Degree of fragmentation, | Equity in access; |
Type of pool (exempted/subsidized) | Exempted/subsidized integrated into existing fund(s) or separate fund for the exempted/subsidized | Size and composition of pools, | Equity in financing; |
Type of health insurance affiliation/membership of the contributors | Voluntary or mandatory | Level of cross-subsidization | Efficiency; |
Financial protection | |||
Purchasing arrangements and benefit package design | |||
Range of services covered by the benefit package | E.g. comprehensive, inpatient focus, outpatient focus, pharmaceuticals, dental care, indirect costs (e.g. transportation) | Financial protection; | |
Different or same package as contributors | Access (utilization rates); | ||
Equity in access | |||
Degree of cost-sharing | Cost-sharing mechanisms (e.g., co-insurance, co-payment, deductible) and rates | ||
Provider payment mechanisms | Type of provider payment and rates | Efficiency | |
Same or different rules around provider payment | |||