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Identification of the Main Elements of Single Payer System Website: http: jebhpme.ssu.ac.ir EBHPME 2019; 3(2): 139-53 pISSN: 2538-5070 EBHPME COMPARATIVE STUDY Evidence Based Health Policy, Management & Economics Health Policy Research Center, Shahid Sadoughi University of Medical Sciences Identification of the Main Elements of Single Payer System; A Comparative Study Ali Aboutorabi 1, Saman Ghasempour 2*, Behzad Najafi 3, Sirous Panahi 4 1 School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 2 Health Management and Economics Research centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 3 School of Health Management and Information Sciences, Tabriz University of Medical Sciences, Tehran, Iran 4 School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran A R T I C L E I N F O A B S T R A C T Article History: Background: Progress towards universal coverage requires adequate capital in health Received: 22 Jan 2019 sector. Investing and optimal allocation of resources in this sector will contribute to the Revised: 27 Mar 2019 development and reduction of poverty in countries in order to achieve the goals of Accepted: 26 June 2019 health system. Therefore, the more people contribute to risk sharing, we have lower financial risks in facing the issue. The single payer system as a public health coverage *Corresponding Author: model seeks to expand the insurance coverage scope at community level. The present Saman Ghasempour study aimed to identify the main elements of S-PS to conduct a comparative study. Health Management and Methods: A comparative study was conducted to describe the fundamental of Economics Research centre, financing and the provision of services in selected countries - Germany, Thailand, School of Health Turkey, and Colombia, as well as to achieve the main elements of S-PS. In addition, Management and Information the health system of Iran has been studied. The basis for selection of countries was Sciences, Iran University of health system Garden typology. The main criteria for selection or rejection of studies Medical Sciences, Tehran, were the separation of health services provider from financial functions; has allowed a Iran. single department to purchasing process. Email: Results: single payer system in two functions of health system, namely, financing and [email protected] providing health care; consolidation resources (reducing fragmentation by creating a Tel: single pooled fund and achieve massive purchase of health care through the insurance +98-9388310017 agent as single purchaser) and ensuring community health (delivery of services by the network of providers represented by Health Promotion Organization) represents 12 main organizational elements. Conclusion: the multiple insurers and payers of health care in Iran are both inequity and ineffective. And its integration is not a simple task. Iranian financing policies should aimed to achieving universal health coverage by creating greater risk pooling Downloaded from jebhpme.ssu.ac.ir at 18:24 IRST on Friday October 1st 2021 [ DOI: 10.18502/jebhpme.v3i2.1225 ] and becoming aware of the important tasks of insurance system; take advantage of the strength in numbers, setting the principles of cross-subsidy and preventing adverse reaction. It is important not to put together a long-term, coherent plan to reach the S-PS. Keywords: consolidation, Health Insurance funds, health care reform, multiple pools, Single Payer System Citation This paper should be cited as: Aboutorabi A, Ghasempour S, Najafi B, Panahi S. Identification of the Main Elements of Single Payer System; A Comparative Study. Evidence Based Health Policy, Management & Economics. 2019; 3(2): 139-53. Copyright: ©2019 The Author(s); Published by Shahid Sadoughi University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Identification of the Main Elements of Single Payer System Aboutorabi A, et al. Introduction ccording to the World Health Organization, transferring resources to insurance funds, how to A three ultimate goals of health systems, pool them and how to allocate those resources (9). including population-based health promotion, The pattern of many countries shows that, in line responding to public expectations, and protecting with economic and justice developments, health and against costly health (1). Therefore, progress welfare categories was initiated on the government towards universal coverage requires investment in agenda (4). Over the past three decades, bad health sector and government encouragement (2). experiences have arisen in health sector financing Investment and optimal flow of resources (especially from Out-of-pocket payments method); allocation in this sector to achieve the goal of moreover challenges remain both in terms of health healthy individuals leads to development and outcomes and systems performance (2). The reason reduction of poverty in countries (3). for reform of twentieth century was not only the A set of control levers, including financial sanction of health system, but the efficiency; the support, the payment system, organization, equity of the referral system and responding to regulations, and behavior of citizens can help people’s expectations; were also the goals of these health systems in achieving these goals (4). reforms (1). Meanwhile, financing as one of government Resource strategy in most countries follows a concerns (5) plays a prominent role in performance combination of financing methods for determining of their health systems (6); since the success of health system credentials (6). This combination is financing system is a direct consequence of three directly the result of determinants of financing in components: availability of funds, proper financial those countries (10).The model of health systems incentives for providers, and ensuring that all based financing method and origin of resources, people have access to health care services(1). which has a strong impact on reform in that area. Therefore, health systems will not be solely The results show that countries without significant responsible for improving the individuals' health, changes in the sources of health funds have been but will be obliged to protect populations with high able to make important reforms in the financing expected health care use, and do not suffer system after seeking unit insurance. Mainly the financial hardship paying for them (5). In order to merger and engagement of tax policies has taken ensure that people have access to services they place with the financial goals of a wider need- targeting based on social categories and macroeconomic level (7). Similar to Thailand and medical condition- consolidation in health Spain (11), the transition took place from a largely insurance funds, integration purchasing power and worker-employer contribution system to a single provision services is a vital financing functions model of regional financing (general taxation). In that directly related to protection against financial the Republic of Moldova (12), the National risks (1, 7). Therefore, make contribution to health Insurance Company, by drawing main sources of system (taxes and/or insurance) as soon as funds (payroll tax and general revenue); pooling Downloaded from jebhpme.ssu.ac.ir at 18:24 IRST on Friday October 1st 2021 [ DOI: 10.18502/jebhpme.v3i2.1225 ] contribute to risk sharing (2). This will ensure that general budget revenues with a Compulsory Health health system is equity in pooling and minimized Insurance Fund. Indonesia (13) and South Korea potential financial risks in facing the issue (3,6). (14, 15), National Health Insurance – Based health Demographic profiles, social values, system; as well as Costa Rica (16, 17), benefiting environmental factors, economic activity and from comprehensive social security system, political structure are important determinants of achieving universal coverage through S-PS. In both mandated and external pressures that have these countries, according to the General Health strongly influence on health financing (8). In Insurance Act, there is a single framework for addition to the impact of these factors, the main pooling income tax and mandatory insurance issue in financing health sector is the effectively contribution that led to complete merging of all 140 Volume 3, Issue 2, June 2019; 139-53 Identification of the Main Elements of Single Payer System Aboutorabi A, et al. insurance funds and creating a single scheme. spending more than developed countries in Iranian Turkey (18, 19) with its Health Transformation health system, there are poor technical efficiency Program are moving to reduce fragmentation in the with growing costs of health care services (26, 27) way resources in health insurance system. The and there is no insurance coverage for a large results of these comprehensive reforms was merge group of people (28). It seems that universal various funds, integration of insurer's scheme and coverage can only be attempted with a moving reveal the existence of cross-subsidy, which towards the single payer system. S-PS as a model quickly reached the frontier of universal coverage of UHC (20) seeks to convert OOPs payments into than many European countries. prepaid funding; expand
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