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Risk Pooling in Health Care Financing : The Implications for Health System Performance

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dc.contributor.authorSmith, Peter C.
dc.contributor.authorWitter, Sopie N.
dc.date.accessioned2013-05-29T19:57:44Z
dc.date.available2013-05-29T19:57:44Z
dc.date.issued2004-09
dc.description.abstractPooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. The arguments in favor of risk pooling in health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population health, can increase productivity, and reduces uncertainty associated with health care expenditure. The report considers four classes of risk pooling: no risk pool, under which all expenditure liability lies with the individual; unitary risk pool, under which all expenditure liability is transferred to a single national pool; fragmented risk pools, under which a series of independent risk pools (such as local governments or employer-based pools) are used; and integrated risk pools, under which fragmented risk pools are compensated for the variations in risk to which they are exposed. It notes that small, fragmented risk pools, which are the norm in developing countries, contribute to seriously adverse outcomes for health system performance.en
dc.identifierhttp://documents.worldbank.org/curated/en/2004/09/5638380/risk-pooling-health-care-financing-implications-health-system-performance
dc.identifier.doi10.1596/13651
dc.identifier.urihttps://hdl.handle.net/10986/13651
dc.languageEnglish
dc.language.isoen_US
dc.publisherWorld Bank, Washington, DC
dc.relation.ispartofseriesHealth, Nutrition and Population (HNP) discussion paper;
dc.rightsCC BY 3.0 IGO
dc.rights.holderWorld Bank
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/igo/
dc.subjectACCESS TO HEALTH CARE
dc.subjectADVERSE SELECTION
dc.subjectBANK PUBLICATIONS
dc.subjectBUDGET CONSTRAINTS
dc.subjectBURDEN OF DISEASE
dc.subjectCAPITATION
dc.subjectCAPITATION SYSTEM
dc.subjectCLINICS
dc.subjectCOMMUNICABLE DISEASES
dc.subjectCOVERAGE
dc.subjectCREAM SKIMMING
dc.subjectDEVELOPMENT INDICATORS
dc.subjectDRAFTS
dc.subjectECONOMIC STATUS
dc.subjectEMPLOYMENT
dc.subjectEXCESSIVE CONSUMPTION
dc.subjectEXPENDITURES
dc.subjectEXPOSURE
dc.subjectEXTERNALITIES
dc.subjectFEE FOR SERVICE
dc.subjectFINANCIAL RISK
dc.subjectFINANCIAL VIABILITY
dc.subjectHEALTH CARE
dc.subjectHEALTH CARE COSTS
dc.subjectHEALTH CARE FINANCE
dc.subjectHEALTH CARE FINANCING
dc.subjectHEALTH CARE INSURANCE
dc.subjectHEALTH CARE POLICY
dc.subjectHEALTH CARE RESOURCES
dc.subjectHEALTH CARE SERVICES
dc.subjectHEALTH CARE SPENDING
dc.subjectHEALTH CARE UTILIZATION
dc.subjectHEALTH CENTERS
dc.subjectHEALTH CONDITIONS
dc.subjectHEALTH ECONOMICS
dc.subjectHEALTH EXPENDITURE
dc.subjectHEALTH FACILITIES
dc.subjectHEALTH FINANCING
dc.subjectHEALTH GAIN
dc.subjectHEALTH INSURANCE
dc.subjectHEALTH INTERVENTIONS
dc.subjectHEALTH RISK
dc.subjectHEALTH RISKS
dc.subjectHEALTH SECTOR
dc.subjectHEALTH SERVICES
dc.subjectHEALTH STATUS
dc.subjectHEALTH SYSTEM
dc.subjectHEALTH SYSTEM PERFORMANCE
dc.subjectHEALTH SYSTEMS
dc.subjectHUMAN DEVELOPMENT
dc.subjectHUMAN RESOURCES
dc.subjectINCOME
dc.subjectINDEBTEDNESS
dc.subjectINDUCED DEMAND
dc.subjectINFECTIOUS DISEASES
dc.subjectINFORMATION SYSTEMS
dc.subjectINSURANCE CONTRACTS
dc.subjectINSURANCE FUNDS
dc.subjectINSURANCE PREMIUMS
dc.subjectINSURANCE SYSTEMS
dc.subjectINSURERS
dc.subjectINTEGRATION
dc.subjectINTERVENTION
dc.subjectLESSONS LEARNED
dc.subjectLIABILITY
dc.subjectLIFE CYCLE
dc.subjectLOW INCOME
dc.subjectLOW-INCOME COUNTRIES
dc.subjectMANAGED CARE
dc.subjectMANAGED COMPETITION
dc.subjectMEDICAID
dc.subjectMEDICAL EQUIPMENT
dc.subjectMEDICAL SAVINGS ACCOUNTS
dc.subjectMEDICARE
dc.subjectMORAL HAZARD
dc.subjectNUTRITION
dc.subjectOLDER PEOPLE
dc.subjectPATIENTS
dc.subjectPAYMENT SYSTEMS
dc.subjectPOOLS
dc.subjectPREMIUMS
dc.subjectPREPAYMENT
dc.subjectPRIVATE INSURANCE
dc.subjectPROGRAMS
dc.subjectPROMOTING HEALTH
dc.subjectPUBLIC HEALTH
dc.subjectPUBLIC HEALTH INSURANCE
dc.subjectPUBLIC SECTOR
dc.subjectRATES
dc.subjectRISK PROFILES
dc.subjectRISK SHARING
dc.subjectSAFETY
dc.subjectSAVINGS
dc.subjectSERVICE DELIVERY
dc.subjectSOCIAL INSURANCE
dc.subjectSUB-SAHARAN AFRICA
dc.subjectTUBERCULOSIS
dc.subjectTUBERCULOSIS PATIENTS
dc.titleRisk Pooling in Health Care Financing : The Implications for Health System Performanceen
dspace.entity.typePublication
okr.date.doiregistration2025-05-05T11:36:40.544014Z
okr.doctypePublications & Research::Working Paper
okr.doctypePublications & Research
okr.docurlhttp://documents.worldbank.org/curated/en/2004/09/5638380/risk-pooling-health-care-financing-implications-health-system-performance
okr.globalpracticeGovernance
okr.guid642661468780615380
okr.identifier.externaldocumentum000090341_20050303151244
okr.identifier.internaldocumentum5638380
okr.identifier.report31595
okr.language.supporteden
okr.pdfurlhttp://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2005/03/03/000090341_20050303151244/Rendered/PDF/315950HNP0Chap1tterRiskPoolingFinal.pdfen
okr.topicHealth Monitoring and Evaluation
okr.topicHealth Systems Development and Reform
okr.topicInsurance and Risk Mitigation
okr.topicHealth Economics and Finance
okr.topicLaw and Development::Insurance Law
okr.volume1 of 1
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