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Health Systems in Low- and Middle-Income CountriesAn economic and policy perspective$
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Richard D. Smith and Kara Hanson

Print publication date: 2011

Print ISBN-13: 9780199566761

Published to Oxford Scholarship Online: January 2012

DOI: 10.1093/acprof:oso/9780199566761.001.0001

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Revenue collection and pooling arrangements in financing

Revenue collection and pooling arrangements in financing

(p.77) Chapter 4 Revenue collection and pooling arrangements in financing
Health Systems in Low- and Middle-Income Countries

Di McIntyre

Joseph Kutzin

Oxford University Press

This chapter focuses on two of the key functions of a health sector financing system: revenue collection and fund pooling. It uses as its starting point the World Health Organization resolution calling for health care financing systems to provide universal coverage and financial protection for citizens. Revenue collection concerns the sources of funds, contribution structures, and the means by which they are collected, while fund pooling addresses the need to spread the risk of incurring unexpected health care costs over as broad a population group as possible. In terms of revenue collection, the chapter reviews the equity, sustainability, and feasibility of alternative financing mechanisms (e.g., donor and tax funding, a range of health insurance mechanisms, and out-of-pocket payments) and highlights key lessons from recent research in low- and middle-income countries on these mechanisms. It also highlights the importance of carefully considering who the most appropriate revenue collection organization may be in different political contexts. The main focus of the section on fund pooling is on alternative strategies for reducing fragmentation in health care financing in order to maximize both income and risk cross-subsidies in the overall health care financing system. Such cross subsidies are critical to achieving universal coverage and adequate financial protection.

Keywords:   health care financing, health sector, revenue collection, fund pooling, World Health Organization, universal coverage, alternative financing

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