Table 1. Example of rules and organizations that may influence a country’s health financing functions.
| Type of rule | Legislation and other regulatory provisions of rules | Organizations |
|---|---|---|
| Revenue collection | ||
| Taxation rules | Income tax rates range from 15–40%. | MoF or revenue collection authority |
| SHI contribution rules | 6% contribution rates to be shared 50/50 by employer/employee; informal sector workers with an annual household income of more than US$ 1200 pay a flat amount of US$ 40. | For payroll deductions: SHI fund and MoF; for informal sector: NGOs, district authorities, microfinance institutions |
| Membership/registration rules | All formal sector employees and civil servants are mandatory members of the SHI scheme; informal sector workers can join voluntarily in a group of more than 20 workers in the same professional area. | SHI fund/registration department; NGOs involved in outreach activities |
| MoH schedule of user fees | The noninsured pay the established user fees at public and private health facilities. | Public and private health service providers |
| Pooling | ||
| Pooling across MOH and SHI fund | 1% of SHI income is transferred to the MoH to subsidize services rendered to the non-insured. | MoH, MoF, SHI fund |
| Risk equalization rules among SHI funds | Additional resources are provided to SHI funds with high health risk by those SHI funds with low health risks, based on a specific risk adjustment formula. | Risk equalization agency |
| Pooling within the SHI scheme | Contribution rates are income-related and not risk-related; access is based on need. | SHI fund |
| Purchasing | ||
| SHI rules on purchasing | The SHI can purchase from both public and private facilities; the SHI must contract all facilities that meet the accreditation standards. | SHI fund/contracts department, health providers associations or health providers, accreditation agency |
| SHI rules on type and rate of provider remuneration | The SHI remunerates providers on the basis of a case-payment, with pre-defined rates that vary according to the facility level. | SHI fund/remuneration department, health providers |
| MoH rules on type and rate of provider remuneration | MoH allocates global budgets to sub-national levels based on rational criteria (population characteristics, epidemiological profile, poverty rates within that sub-national unit). | MoH, subnational MoH units such as health districts, MoF |
| Rule on MoH benefit package | MoH provides an essential health services package with services at the primary, secondary and tertiary levels. | MoH |
| Rule on benefit package definition of MoH | Services are included based on cost-effectiveness, analysis results and considerations of equity of the disease burden; the benefit package is reviewed every 2 years. | MoH or a national benefit package committee |
MoF, Ministry of Finance; MoH, Ministry of Health; SHI, social health insurance; NGO, nongovernmental organization.