They are certainly not pro-competitive. In most tropical nations, health care financing is supplied by a mix of governmental spending, private (mostly out-of-pocket) spending, and external aid. If more funds are available for treatment services, and preventive care is relatively underfunded, then treatment will have greater emphasis than prevention. In the established market economies, on average 9.3 percent of GDP goes to health, while the former socialist economies expend 3.6 percent, and developing countries generally under 4.5 percent. Additionally, PROs are required to provide quality improvement consultation to providers, including data analysis, educational materials, quality improvement consulting, custom assistance with local quality improvement activities, the dissemination of quality indicators and data collection instruments, and provider collaboration opportunities to improve care and reduce expenditures. In most markets, buyers and sellers trade directly. Health care finance is a branch of finance that helps patients and health care beneficiaries pay for medical expenses in the short and long terms. There are fundamentally three categories of system: market systems (whether private, public, or mixed); self-governing systems (with varying degrees of state regulation) (Arts and Gelissen, 2002), in which either guilds or organized functional interests or networks (of providers, financiers, and employees) organize the delivery of care. Some health care finance concepts have a general meaning, while others relate specifically to the health care sector. Patients will begin to have more choice and authority in spending for healthcare as rules for use common in managed care settings apply less and less, and restrictions are loosened as a result. Misallocation of resources between sectors within the health sector can lead to a wasteful and even counterproductive health system, such as excessive funding of tertiary care while primary care is lacking (Box 11.9). When multiple agencies are involved in health insurance or direct government granting systems for specific services, there are gaps (inadequate coverage or access) in services, usually for politically, geographically, and socially disadvantaged sectors of the population, who may have the greatest needs. v Table of contents Acknowledgements ii Foreword iii About the author iv Abbreviations and acronyms vii Glossary viii Executive summary xiii 1 Introduction 1 This situation applies to the USA and to many mid-level developing countries (see Chapter 13). Health insurance may cover doctor's visits, medical procedures, prescription drugs, and so forth. Accessed 2/19/2020. Expenditure on HP has been more or less stable at 3% of THE over the 5-year period from 1999 to 2003, with no significant change. Average spending on HP at 2.94% of THE was applied to data for those WHO members where information on HP was absent, especially for all WHO members in the Eastern Mediterranean region. The US Institute of Medicine reports that lack of adequate insurance is the cause of an estimated 20,000 excess deaths per year in the USA (IOM, 2008). This is a political decision which reflects the social and economic value placed on health by a nation. Health expenditure and financing—OCEP.stat collection from Joint OECD, EUROSTAT, and WHO Health Accounts SHA Questionnaires (JHAQ). Alternatively, it might seek to build in to the criteria for judging options (or even, to the options themselves) pragmatic or political factors (such as the political feasibility of an option in a particular political context). • NATIONAL HEALTH SERVICE (e.g. The range of services or programs requiring funding for a population group is indicated in Box 11.9. A person who wants to buy a loaf of bread pays the merchant for that bread. The divorce between such worlds is often responsible for extremes of optimism and disillusionment, respectively, in assessing policy ex ante and ex post, as with recent health reform programs in England, for example. Specific emphasis is placed on devising rules and norms, and the enforcement of regulations to implement more equitable and fair financing policies with integrity, that are based on accurate and reliable financial data and information. Financing is the process of funding business activities, making purchases, or investments. Allocation of resources requires a skillful planning process to balance spending on different subsectors of the system and to ensure equity between regions and various socioeconomic groups in society. Figure 11.4 shows the breakdown of health insurance coverage in the USA. Sources of Financing Health Services. The market solution has been a nonsolution to this point in that it has only succeeded in lowering costs without adequately addressing quality of service or the distribution and allocation of services. These insurance plans may pay less well than private insurance for the middle class and organized workers. When the Medicare Prescription Drug Improvement and Modernization Act was signed into law on December 8, 2003, the ability to create healthcare savings accounts (HSAs) became law. We assume that spending on HP is 2.94% of THE for those countries where information on HP is absent, in order to estimate expenditure on HP per capita. After a comprehensive review of financing health care and HP, the following summary remarks can be made. Incentives for improving health performance measures, including: Universal coverage through social security or tax-based system, Financing within national means for social benefits, Adequate overall financing (> 6 percent GNP), Shift from supply-side planning to costs per capita, Categorical grants to promote national objectives and specific health target programs, Increase financing at national, state, and local government levels (7–10 percent GNP), Define “basket of services” and consumer rights, Reduce acute care beds to < 3 per 1000 population, District health authorities with capitation funding, Disincentives for excess hospitalization, surgery. The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. 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