To have any chance of becoming comprehen-sive and potentially universal, social protection requir... more To have any chance of becoming comprehen-sive and potentially universal, social protection requires societies to adjust unequal risks and differences in financial capacities between their members. Especially in welfare states, various equalisation mechanisms exist for balancing dif-ferent social risks and unequally distributed pur-chasing power. These apply often, but by no means exclusively, to formal social security ar-rangements and are an integral part of social he-alth protection schemes based on the principle of solidarity. Moreover, competitive health insu-rance markets require risk structure equalisation mechanisms in order to prevent or at least re-duce risk selection. Beyond social protection systems as such, fi-nancial compensation mechanisms can be ap-plied in broader settings at national and inter-national levels. This paper will present two well-established examples illustrating the operating mode and the potential of inter-regional and inter-state equalisation mechani...
International health service research reveals a uniform tendency in practically all industrialise... more International health service research reveals a uniform tendency in practically all industrialised countries: an increasing shift of costs from solidarity-based financing to private households. Legislators and advisors usually justify this policy through the need to encourage cost-consciousness and especially individual responsibility. Economists consider cost-sharing in health care to be necessary to prevent abuse of the welfare state. They expect user charges and co-payments to motivate a more rational utilisation of health care and, thus, the financial stabilisation of health systems. Many politicians and economists base their assumptions about the health market on the theorem of demand-side moral hazard. This model transforms patients into rational utility maximisers consuming services beyond their needs thereby causing welfare losses to society as a whole. Moral hazard in health insurance belongs to the standard repertoires of economic textbooks. The present study analyses the ...
Good governance has increasingly attained priority in international cooperation and health-system... more Good governance has increasingly attained priority in international cooperation and health-system performance. Governance refers to all steering activities by public entities to influence the behaviour and activities of stakeholders involved. In the health sector, governance refers to a wide range of functions related to guidance and rule-making carried out by governments or other public decision-makers. More specifically, governance in the health-financing system applies to two different aspects: in addition to the approaches, strategies and policies determining how financial flows are implemented, managed and supervised according to rules- or outcome-based indicators, health-financing governance encompasses the question of how far resource generation, pooling and allocation are organised in an equitable, fair and sustainable manner. Individual and collective financial sustainability, burden sharing and social coherence or solidarity are essential parts of health-financing governance and depend deeply on societal priorities and values. Fairness of financing, transparent risk pooling and accountable purchasing of health services are intrinsic elements of governance in health financing and critical for achieving universal health coverage. The government is ultimately responsible for implementing an appropriate framework for a transparent, accountable and reliable health-financing system, for ensuring that the intermediate institutions can perform their functions, for executing effective and powerful supervision, and for providing civil society with the means to demand transparency and good financial governance. Health-financing indicators show the system’s ability to effectively mobilise and allocate resources, implement social protection and pooling schemes, and distribute the financial burden of care equitably. Essentially two groups of indicators exist for assessing governance in the health financing system: rules-based approaches consider the existence of appropriate policies, strategies, and codified approaches for governance; outcome-based indicators measure whether rules and procedures are effectively implemented or enforced and health-financing targets achieved.
To have any chance of becoming comprehen-sive and potentially universal, social protection requir... more To have any chance of becoming comprehen-sive and potentially universal, social protection requires societies to adjust unequal risks and differences in financial capacities between their members. Especially in welfare states, various equalisation mechanisms exist for balancing dif-ferent social risks and unequally distributed pur-chasing power. These apply often, but by no means exclusively, to formal social security ar-rangements and are an integral part of social he-alth protection schemes based on the principle of solidarity. Moreover, competitive health insu-rance markets require risk structure equalisation mechanisms in order to prevent or at least re-duce risk selection. Beyond social protection systems as such, fi-nancial compensation mechanisms can be ap-plied in broader settings at national and inter-national levels. This paper will present two well-established examples illustrating the operating mode and the potential of inter-regional and inter-state equalisation mechani...
International health service research reveals a uniform tendency in practically all industrialise... more International health service research reveals a uniform tendency in practically all industrialised countries: an increasing shift of costs from solidarity-based financing to private households. Legislators and advisors usually justify this policy through the need to encourage cost-consciousness and especially individual responsibility. Economists consider cost-sharing in health care to be necessary to prevent abuse of the welfare state. They expect user charges and co-payments to motivate a more rational utilisation of health care and, thus, the financial stabilisation of health systems. Many politicians and economists base their assumptions about the health market on the theorem of demand-side moral hazard. This model transforms patients into rational utility maximisers consuming services beyond their needs thereby causing welfare losses to society as a whole. Moral hazard in health insurance belongs to the standard repertoires of economic textbooks. The present study analyses the ...
Good governance has increasingly attained priority in international cooperation and health-system... more Good governance has increasingly attained priority in international cooperation and health-system performance. Governance refers to all steering activities by public entities to influence the behaviour and activities of stakeholders involved. In the health sector, governance refers to a wide range of functions related to guidance and rule-making carried out by governments or other public decision-makers. More specifically, governance in the health-financing system applies to two different aspects: in addition to the approaches, strategies and policies determining how financial flows are implemented, managed and supervised according to rules- or outcome-based indicators, health-financing governance encompasses the question of how far resource generation, pooling and allocation are organised in an equitable, fair and sustainable manner. Individual and collective financial sustainability, burden sharing and social coherence or solidarity are essential parts of health-financing governance and depend deeply on societal priorities and values. Fairness of financing, transparent risk pooling and accountable purchasing of health services are intrinsic elements of governance in health financing and critical for achieving universal health coverage. The government is ultimately responsible for implementing an appropriate framework for a transparent, accountable and reliable health-financing system, for ensuring that the intermediate institutions can perform their functions, for executing effective and powerful supervision, and for providing civil society with the means to demand transparency and good financial governance. Health-financing indicators show the system’s ability to effectively mobilise and allocate resources, implement social protection and pooling schemes, and distribute the financial burden of care equitably. Essentially two groups of indicators exist for assessing governance in the health financing system: rules-based approaches consider the existence of appropriate policies, strategies, and codified approaches for governance; outcome-based indicators measure whether rules and procedures are effectively implemented or enforced and health-financing targets achieved.
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Papers by Jens Holst