Table 1 Institutional design features of state budget transfer/government subsidization arrangements
Institutional design aspect | Related policy choices | Intermediate output indicators | UHC related progress 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 (i.e. enrolment in health insurance fund), 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 of funds to be 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 Level of cross-subsidization from contributions | Financial protection (incidence of catastrophica / impoverishing health expenditure), also differentiated along income quintiles and other aspects; Access to services |
Source of funding for state budget 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 pool, or multiple pools | Degree of fragmentation, Size and composition of pools, Level of cross-subsidization | Equity in access; Equity in financing; Financial protection |
Type of pool (exempted/subsidized) | Exempted/subsidized integrated in the pool with contributors, or separate pool for the exempted/subsidized | ||
Type of health insurance affiliation/ membership of the contributors | Voluntary or mandatory | ||
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) Different or same package as that for contributors | Financial protection; 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 Same or different rules around provider payment | Efficiency | |