Table 4.
Financing Arrangements
| Country | Financing sources of the subsidization scheme (s) | Calculation logic of subsidy | Type of transfer mechanism | Level of subsidization |
|---|---|---|---|---|
| Bolivia | General government revenues; District and municipal revenues; Earmarked revenues from a tax on hydrocarbons [70] |
Until 2013: For SUMI, 10% of central government’s transfers to the municipalities; for SSPAM, a premium of 56 USD per older person [53] Since 2013 under the Integrated Health Services Program: Budget allocations, and 15.5% of municipal fiscal sources |
Lump-sum [53] | Full subsidization |
| Chile | General government revenues, partly earmarked tax revenues: 1% increase in value added tax, tobacco tax, customs revenues; sale of the state’s minority shares in public health enterprises; Contributions of partially subsidized [71] |
Ministry of Finance defines a “Universal Premium” according to available funding and based on inflation-linked currency units [72] | Lump-sum | Full subsidization [27] |
| Colombia | General government revenue (49% of revenues of subsidized scheme) [73]; Solidarity contributions from the Solidarity and Guarantee Fund (36%) [24]; District and municipal revenues (14%) (including earmarked municipal tax on gambling) [21, 24] |
Capitation Payment Unit per subsidized member, prospectively calculated, risk-adjusted based on age (children under 1 year of age, women aged 15–44 and others), sex, and geographic area [74] The average Capitation Payment Unit was US$302 in 2011 (US$506 for those contributing) [35] |
Individual-based | Full subsidization |
| Costa Rica | Earmarked tax revenues on luxury goods, gambling, alcohol and tobacco (80% of subsidy amount) Transfers from the Social Development and Family Assignation Fund (20%), with its funds coming from value added tax and a 5% payroll tax [75]; Contributions of the partially subsidized |
Negotiated between the National Social Health Insurance and the Ministry of Finance based on the current minimum wage | Individual-based | Full subsidization; partial subsidization: contributions range from 3.75 to 11.00% of income (depending on the earned amount) [76] |
| Dominican Republic | General government revenues [32] | n/a | Individual-based | Full subsidization |
| Mexico | Federal funding: Social contribution (~33% of revenues of Seguro Popular) and the federal solidarity contribution (~49.5%) from general taxes State funding: State solidarity contribution similar in all states (~16.5%) Household contributions (~1%, not implemented) [20] |
Three steps: 1) Social contribution is a fixed allocation per enrolled family, amounting to US$70 in 2011 [20] Federal solidarity contribution (FSC): on average 150% of the social contribution (~US$105) [36] State solidarity contribution: Fixed allocation of 50% of the social contribution (~US$35) 2) FSC adjusted based on enrolled individuals, health needs, and performance 3) FSC addresses inequalities among states: if FSC is lower than general federal transfers to states, FSC turns out as an additional budget transfer [20] |
Individual-based | Full subsidization [36]: Partial subsidization (although not applied in practice): contributions range from US$60 to US$950 [22] |
| Peru | General government revenues (over 90% of the subsidized scheme’s revenues); Regional state revenues; International donor funding; Contributions from household for the semi-subsidized (less than 5%) [23] |
Ministry of Economy and Finance transfers a pre-determined budget on a historical basis and controls its expansion [30, 34] | Individual-based | Full subsidization; Partial subsidization in the semi-contributive regime: about two thirds of the average expenditure per insured, approxi-mately US$67/year per insured [34] |
| Uruguay | General government revenues [77] | “Health Quota” per subsidized member, adjusted for sex and age using a formula that reflects evolution of domestic prices, exchange rates and wages [77] | Individual-based | Contributions are fully subsidized |