OBJECTIVES The function of pooling and the ways that countries organize this is critical for countries' progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. METHODS The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. FINDINGS We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. CONCLUSION Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

中文翻译：

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卫生筹资系统中的统筹安排：拟议的分类。

目标 汇集的功能以及各国组织汇集的方式对于各国在实现全民健康覆盖方面取得进展至关重要，但其作为政策工具的潜力尚未受到太多关注。我们对国家联合安排进行了简单的分类，并讨论了各个联合安排中碎片化表现的具体方式以及相关全民健康覆盖目标的典型挑战。这可以帮助各国评估其资金池设置，并有助于确定解决碎片化问题或减轻其后果的政策选择。方法 本文基于对 PubMed、Google 和 Google Scholar 中已发表文献和灰色文献的回顾，以及我们从各国卫生融资政策专业工作中收集的信息。我们研究了 100 多个国家所有收入群体的统筹性质和结构，以制定分类。研究结果 我们提出八种主要类型的联合安排： (1.) 单一联合池；(2.) 地域不同的池；(3.) 服务和人口覆盖范围方面存在地域重叠；(4.) 针对不同社会经济群体的不同池，并进行人口细分；(5.) 针对不同人群的不同池，并明确覆盖所有人；(6.) 多个竞争池，跨池进行风险调整；并结合类型(1.)-(6.)、(7.)分散的自愿健康保险系统，重复公共资助的覆盖范围；(8.) 补充或补充自愿健康保险。然而，我们认识到任何分类都是对现实的简化，并不能替代针对具体国家的统筹安排的分析。结论 统筹安排为医疗支出的再分配创造了潜力。特定资金池安排所带来的潜在再分配和效率收益在实践中实现的程度取决于其与收入筹集和购买等其他卫生筹资职能的相互作用和协调，包括资金池与其所提供的服务福利和人口之间的联系。覆盖。