For three days at the end of last year, health policy researchers and health policy makers around the United States gathered. The annual meeting of this time discussing current health policy research in the United States with a primary focus on the implementation of health financing policy.
These activities include the development of partisanship and ideology discuss health policies in the United States, a discussion between the researchers and the resident's decision (policy makers) about the considerations in deciding how to decide a policy and the policy; discuss research methods in the field of health policy, policy research delivery technique , and ethical aspects of health policy research publications, as well as develop a network of health policy in the United States.
Health Financing
Understanding healthcare costs is the amount of funds to be provided to organize and / or take advantage of various health measures needed by individuals, families, groups and communities. From the definition above, there are two parties involved in the health care providers (providers) and users of health services. For the organizers, related to the amount of funds to implement health efforts in the form of investment funds and operational funds, while for users of services related to the amount of funds expended to utilize a health efforts.
Financing the health of a country considering the private sector than the government as health service delivery. The total cost of the government's count of the amount of funds spent by the government (expence) for the provision of health services, not on the amount of funds spent by service users (government income). So the total cost is the sum of the cost of health care from the government sector to the amount of funds expended user services to the private sector.
In general, the cost of healthcare is divided based on the cost of medical services and health care costs. The cost of medical services is the cost to organize and or utilize medical services with the main aim more towards treatment and recovery (curative-rehabilitative aspects) with funding from government and private sectors.
While the cost of health care is the cost to implement and / or make use of public health services with the main aim more towards health promotion and prevention (preventive-promotive aspects) with funding primarily from the public sector. Source of funding from central and local government (provincial and district / city) comes from taxes (general and sales), financial deficit (foreign loans) as well as social insurance. Financing from the private sector is being sourced from companies, private health insurance, charitable giving, and the household spending communan self help.
From various experiences in different countries, there are three models of health financing systems for people who applied nationally that social health insurance model (Social Health Insurance), commercial health insurance model (Commercial / Private Health Insurance), and model the NHS (National Health Services). Social Health Insurance Model developed in several European countries since Germany under Bismarck in 1882 and then to other Asian countries namely Philippines, Korea, Taiwan. The advantages of this system allows 100 percent coverage of the population and the relatively slow growth in health care costs.
While the model Commercial / Private Health Insurance in the U.S. thrive. This system failed to achieve 100% coverage of the population that the World Bank recommends the development of a model Regulated Health Insurance. The United States is the country with the highest health expenditure (13.7% of GNP) in 1997 while Japan only 7% of GNP but higher health status of Japan. Indicators of life expectancy gained for men 73.8 years and women 79.7 years in the United States was in Japan the life expectancy of men 77.6 years and women 84.3 years. Last model of National Health Services initiated after the British government since the second world war. This model also opens opportunities 100% coverage of the population, but health financing secured through the government budget would be a heavy burden.
Health insurance as a mandate Act as a solution to address the growing health financing. Development financing guarantees to eliminate barriers to health services, especially the poor and vulnerable. Solution to the problem of health financing leads to an increase in health funding to support health development. Increased health care costs complicate access to most communities in meeting health care. Many factors cause increase health financing such as the use of increasingly sophisticated medical technology, inflation, the pattern of chronic and degenerative diseases, etc. while providing the ability of government and public funding is very limited.
Health financing is strong, stable and sustainable a vital role for the organization of health services in order to achieve many important objectives of health development in a country such as equity and access to health services (equitable access to health care) and service quality (quality assured ).
Therefore, health policy reform in a country should provide an important focus for health financing policy to guarantee the sufficiency (adequacy), equity (equity), efficiency (efficiency) and effectiveness (effectiveness) of health financing itself. Planning and adequate health financing arrangements (health care financing) will help the government in a country to be able to mobilize the resources of health financing, rationally allocate and use it efficiently and effectively.
Health financing policy that promotes equity and pro-poor (equitable and pro-poor health policy) will support the achievement of universal access. In the broader aspects is believed that health funding has contributed to the social and economic development. Health services itself in lately become very expensive both in developed and in developing countries.
Excessive use of high-tech health care is one of the main causes. The cause of the other is dominated by the health care financing mechanism cash payment (fee for service) and a weak ability in the management of resources and the service itself (poor management of resources and services).
Although each country has different health financing reform depends on the issues and the challenge itself, but in many respects essentially the same characteristics as that directed everyone to support the achievement of national health development objectives, regional and international levels.
A world health organization (WHO) itself should focus on health financing strategy that includes key issues, challenges, key policy objectives and action programs in general are in the following areas:
1) increase investment and public expenditure on health,
2) pursue the achievement of universal participation and strengthening permeliharaan poor health,
3) pre-financing scheme development efforts including social health insurance (SHI),
4) excavation of national and international support,
5) strengthening regulatory frameworks and functional interventions,
6) the development of health financing policy that is based on scientific facts and data, as well as
7) monitoring and evaluation.
Implementation of health financing strategies in a country directed towards some basic things namely; sustainable financing of priority health programs, reducing individual health financing in cash (out of pocket funding), eliminating the cost barriers to health services, equity in access to services, improving the efficiency and effectiveness allocation of resources (resources) as well as an adequate quality of service and acceptable to service users.
Accordingly, the strategic plan of the Ministry of Health clearly stated that improving health financing is one of the four main strategies in addition to moving the health department and empowering people to live healthier, improve community access to quality health care and improving surveillance systems, and information moitoring health.
The main strategy was described in 17 development targets. Furthermore, the main goal of improving the health financing strategy are:
1) development of health gain adequate budgeting by central and local governments (sararan 15),
2) government health budgets are preferred for prevention and health promotion (target 16), and
3) the creation of a health financing system, especially for the poor (target 17).
The purpose of health financing is the availability of health financing in an amount sufficient, equitably allocated and utilized successfully and efficiently-to-order, to ensure the implementation of health development in order to improve public health are the highest.
We all know that the source of funding for the provision of health facilities involves two main parties, namely the government (public) and private (private). Health is still being debated whether it was actually public or private goods given that health facilities are held by private parties (private) tend to be commercial.
In most areas of the United States, the private sector dominates the provision of health facilities, more than half of the available hospital is a private hospital, and about 30-50 percent of all forms of health services provided by the private sector (a decade ago only about 10 per cent) . This course will be an obstacle, especially for the lower middle class. The high health costs to be incurred if using private health facilities are not comparable to the economic capacity of most Indonesian people belonging to lower middle.
On the other hand, healthcare is expensive stuff, the need for health care but are not limited to the provision of funds for the financing of health facilities is very limited. One source alone will not suffice. That requires a combination of different sources.
Source of health funding:
1. Government
Funds from the central government, provincial, district, city, government's stake in state-owned enterprises, premiums for poor health card which is paid by the government
2. Private or public
CSR (Corporate Social Responsibility), household spending that is paid either in cash or through the insurance system, foreign aid, grants or donor of the NGO.
Sources of funding for health (Based on the ideology of a country):
1. Socialist and welfare state
Fully funded by the government (state holding full patient welfare), not for profit, public coverage is
2. Liberal - capitalist
Price left to the market mechanism (no haggling), profit oriented, fully private (no government intervention)
3. Combination (a combination of both, the most widely applied)
The combination of government funding, private and public, the social insurance system, public private mixed
Management of health financing consists of:
- Input (resources that are limited, health needs are not limited to)
- Process management (efficient use of resources, the selection of an effective wellness program)
- The output or outcomes (budgeting policy and health financing systems, status or health status)
The role of private sector in health financing is quite important. Funds allocated by the government to finance public health Indonesia still not sufficient. It is therefore necessary in health financing partnerships between the private sector and government, in which the private sector can still hold sector health facilities administration, while the government continues to hold oversight by issuing policies to regulate private parties in the administration of health services while considering the ability the local economy, for example: Health Insurance enforces the Private Hospital. Given that the poor are expected to continue to receive care from private health facilities.
The issue of effective and efficient health financing is the most important thing. An effective health financing policy and efficient, if the amount sufficient to conduct health services needed by distributing funds according to needs and the use of a carefully regulated so that no excessive increase in costs. Thus, economic and social aspects of health financing policy can be efficient and effective for all people who need it.
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