Explore key patterns in the global health financing evidence base.

World Health Report 2010 definition. Revenue collection refers to the way money is raised to pay health-system costs. Money is typically received from households, organisations or companies, and sometimes from contributors outside the country (called external sources). Resources can be collected through general or specific taxation; compulsory or voluntary health-insurance contributions; direct out-of-pocket payments, such as user fees; and donations.

Health System Performance Assessment definition. Revenue raising refers to the ways in which money is brought into the health system. Revenue is collected through out-of-pocket payment at the point of service use, or through prepaid funds including insurance contributions and/or taxes. In part, the way money is generated for the health system depends on whether third-party payers in the system are public, and hence compulsory, or private, as either profit or not-for-profit models.

Revenue sources include those that are:

• Public: forms of taxation, which may or may not be specifically earmarked for health, including social health-insurance contributions, which are a form of earmarked tax.
• External: funds from external sources, usually as development assistance. This money is then channelled into the health system via the Ministry of Finance. Other forms of external funding may include foreign investment, though it is usually for capital investments.
• Private: funds from households or firms in the form of either voluntary prepayment or out-of-pocket payment. Health contributions from non-governmental organisations are also part of private revenue sources.

Schemes are the structural arrangements or systems through which money flows to health services and providers. Types of schemes include:

• Mandatory or automatic: participation for some or all people is mandatory by law and funded by obligatory contributions made by or on behalf of those individuals, or some people are automatically covered on a non-contributory basis from general budget revenues based on attributes such as citizenship, residence, poverty status or age.
• Voluntary: there are no government requirements; participation is voluntary.

World Health Report 2010 definition. Pooling is the accumulation and management of financial resources to ensure that the financial risk of having to pay for health care is borne by all members of the pool and not by the individuals who fall ill. The main purpose of pooling is to spread the financial risk associated with the need to use health services. If funds are to be pooled, they have to be prepaid, before illness occurs, through taxes and/or insurance, for example. All health-financing systems include an element of pooling funded by prepayment, combined with direct payments from individuals to service providers, sometimes called cost sharing, co-payments, user charges, user fees or co-insurance.

Health System Performance Assessment definition. Pooling refers to the accumulation of prepaid funds that can be used to purchase goods and services on behalf of a population. Some systems will have a single pool that may consolidate funding from different revenue-raising sources; other systems might have multiple pools. Pooling arrangements set the potential for prepaid funds to be redistributed across a particular population. Some form of resource-allocation or equalisation formula might be used to help ensure that each pool has an allocation appropriate for the population it covers.

World Health Report 2010 definition. Purchasing is the process of paying for health services. There are three main ways to do this. One is for government to provide budgets directly to its own health-service providers, integrating purchasing and provision, using general government revenues and, sometimes, insurance contributions. The second is for an institutionally separate purchasing agency, such as a health-insurance fund or government authority, to purchase services on behalf of a population. The third is for individuals to pay a provider directly for services. Many countries use a combination. Within these broad areas, health-service providers can be paid in many different ways. Purchasing also includes deciding which services should be financed, including the mix between prevention, promotion, treatment and rehabilitation.

Health System Performance Assessment definition. Purchasing, or commissioning, refers to payers using funds to pay for health care on behalf of a population; it reflects actual expenditures on behalf of different individuals in the population. Purchasing differs from procurement. Purchasing refers specifically to payment for services or items such as medicines and other supplies used in care provision, whereas procurement is the process of obtaining inputs and includes both commodities, such as medicines and laboratory supplies, and aspects of capital investment, such as medical devices. Procurement issues are considered under recurrent financing for the procurement and distribution of supply-chain inputs.

Active purchasing includes choosing to purchase only from accredited providers, purchasing only cost-effective services, and using payment mechanisms that incentivise more or less provision.

Passive purchasing includes arrangements in which funds, such as historical budget allocations or unmanaged fee-for-service payment to a provider, are not influenced by provider performance or efforts to influence the quantity or quality of health services.

Benefit design determines who can benefit from prepaid spending. Coverage policies determine who is covered, what the pooled public revenues will pay for, and any restrictions or conditions of access. All countries limit health-service entitlements in one way or another. Coverage-policy decisions determine the specifics of how benefits are rationed, and so influence health-system performance and progress towards universal health coverage goals.

Public financial management refers to the set of rules and mechanisms that govern the allocation, use and accountability of public funds. With respect to the health system in particular, the public financial management system plays a key role in the budgetary formulations that determine the level and allocation of public funding for health; the execution of that budget in terms of effectiveness and targeting of spending; and financial monitoring and transparency.

The policies and practices to acquire, upgrade or maintain infrastructure across the health system, inclusive of physical facilities, such as health centres and hospitals, medical equipment and digital infrastructure.

The policies and practices to train or grow the health workforce, inclusive of specialists, doctors, nurses, community health workers, carers and other health workers, and invest in the production of health products such as medicines and vaccines.

The policies and practices necessary to provide financial resources to the supply chain, and ensure their optimal use, in order to achieve health-system goals. Supply chains include not just the commodities in the supply chain, but all the physical and informational resources required to deliver a good or service to the final consumer, including infrastructure such as warehouses, staffing, management, logistics and data systems. Policies and practices span four phases:

• Planning: developing strategic and operational plans to forecast demand, allocate resources and optimise supply-chain processes for effective health-care delivery.
• Procurement: managing the sourcing, contracting and procurement of health commodities to ensure continuous availability and minimise supply disruptions.
• Delivery: coordinating logistics, warehousing, transportation and inventory management to facilitate the efficient and timely distribution of health-care products.
• Monitoring: assessing supply-chain performance by tracking product and information flows and using data and technologies, human resources and financial management.