Table 5.
Pooling Architecture
| Country | Single/multiple pool (s) for different population groups | Sub-pools at sub-national levels | Integrated/separate fund for the subsidized | Type of membership of the non-subsidizeda |
|---|---|---|---|---|
| Bolivia | Multiple: For the formal sector employees: 9 different social health insurance schemes [78] For the subsidized: SUMI et SSPAM, and since December 2013the “Integrated Health Service of the Plurinational State” Government Program [52, 70] |
Sub-pools at the municipal levels [70] | Separate scheme for the subsidized | Mandatory |
| Chile | Multiple: Fondo Nacional de la Salud, FONASA for 80% of the population [31] 7 private Health Insurance Institutions (Instituciones de Salud Previsional, ISAPREs) for 16% of the population that opted out [27] |
Regional health entity pools that determine the budget for all public health care providers in their area [71] | Integrated: Subsidized, semi-contributive and contributory regimes form FONASA | Mandatory [71] |
| Colombia | Multiple: Solidarity and Guarantee Fund (Fondo de Solidaridad y Garantía, FOSYGA) at national level, with two separate accounts: 1) Contributory scheme (Regimen Contributivo) 2) Subsidized scheme (Regimen Subsidiado) FOSYGA also operates as a cross-subsidization mechanism between the contributory and subsidized scheme 21 |
Multiple competing purchaser structure with a twofold fragmentation: From national to municipal level and from the municipalities to the purchasers (both risk-adjusted) [79] | Separate scheme, but receives 64% of FOSYGA funds (including 1.5% of revenues from formal sector contributions as cross-subsidization) [21] | Mandatory [80] |
| Costa Rica | Single [27] | No sub-pools | Integrated into the National Insurance Fund | Mandatory [75]; Voluntary for self-employed [46] |
| Dominican Republic | Multiple: Contributory scheme Subsidized scheme 32 “Catastrophic illnesses fund” for the subsidized (Fondo para enfermedades catastróficas) [81] |
No sub-pools | Separate scheme for the subsidized | Mandatory [32] |
| Mexico | Multiple: “Mexican Social Security Institute” (Instituto Mexicano del Seguro Social, IMSS) for the formal sector; “Institute for Social Security and Services for Government employees” (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) [27] “Seguro Popular”, which consists of 3 pools - Fund for Allocations of Health Services (Fondo de Aportaciones para los Servicios de Salud, FASSA), - Fund for Protection against Catastrophic Expenses (Fondo para la Protección contra Gastos Catastróficos, FPGC), - Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG) [36] |
State level sub-pools [36] | Separate scheme for the subsidized | Mandatory |
| Peru | Multiple: Social Health Insurance (Seguro Social de Salud, EsSalud) for formal sector workers, Separate funds for the Armed Forces and the National Police respectively, Seguro Integral de Salud, SIS for the subsidized regime and the semi-contributive regime and “Intangible Solidarity Fund for Health” (Fondo Intangible Solidario de Salud, FISSAL) for catastrophic diseases of the subsidized [34] |
No sub-pools | Separate scheme for the subsidized | Mandatory for formal sector employees; voluntary for self-employed [34] |
| Uruguay | Multiple “National Health Fund” (Fondo Nacional de Salud, FONASA) A separate fund for the Armed Forces (Sanidad Militar) and the National Police (Sanidad Policial) respectively [68] |
No sub-pools | Integrated into FONASA | Mandatory for formal sector workers [68] |
aThis usually includes formal sector employees and pensioners as well as the self-employed paying income tax