Intermediate
Performance Measures

Performance Goals

Health System Financing

Health system financing is the process by which revenues are generated and pooled to pay for health services. Revenue generation determines where money comes from — taxes, insurance premiums, out-of-pocket payments, or external aid. Risk pooling determines how those funds are aggregated so that the financial risk of healthcare costs is shared across a population rather than borne by individuals at the moment of illness. The choice of financing mechanism fundamentally shapes who has access to care, how much financial protection people receive, and what incentives providers face.

Financing: Revenue Generation

Financing: Risk Pooling Scenarios

Empirical Evidence

Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment
Manning et al. (1987) · The American Economic Review · United States
Randomized Controlled Trial (RCT)

Found that higher cost-sharing significantly reduced overall healthcare utilization (Efficiency) but had little to no significant impact on objective Health Status for the average adult, demonstrating the price elasticity of health behavior.

Medical Savings Accounts: Lessons from Singapore
Hsiao (1995) · Health Affairs · Singapore
Comparative institutional analysis of Singapore's three-tier financing system (Medisave, MediShield, Medifund).

Singapore achieved low health expenditure (3–4% of GDP) with strong health outcomes, but the system depends critically on complementary catastrophic insurance (MediShield) and a government safety net (Medifund). MSAs alone cannot handle rare catastrophic events. The system also benefits from heavy government involvement in hospital supply and pricing — MSAs operate within a tightly regulated environment, not a free market.

Tax, Price and Cigarette Smoking: Evidence from the Tobacco Documents and Implications for Tobacco Industry Marketing Strategies
Chaloupka et al. (2002) · Tobacco Control · Multi-country
Systematic review of econometric evidence and industry documents on price elasticity of tobacco demand.

The consensus price elasticity of cigarette demand is approximately -0.4 in high-income countries and -0.4 to -0.8 in low- and middle-income countries. A 10% price increase reduces consumption by 4–8%. Youth and low-income populations are most price-responsive. Industry documents confirmed that companies viewed tax increases as the greatest threat to consumption.

Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan
Lu & Hsiao (2003) · Health Affairs · Taiwan
Pre-post natural experiment analysis

Demonstrated that a single-payer model could achieve universal coverage (Access) and high Financial Risk Protection while maintaining remarkably low administrative costs (Efficiency) below 2% of total health expenditures.

Household catastrophic health expenditure: a multicountry analysis
Xu et al. (2003) · The Lancet · 59 Countries (Cross-national)
Cross-country regression analysis of household survey data.

Catastrophic payment rates varied widely across countries. Three preconditions were identified: (1) availability of health services requiring payment, (2) low capacity to pay, and (3) absence of prepayment or insurance mechanisms. Countries relying on out-of-pocket financing had the highest incidence.

Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment
Gertler (2004) · American Economic Review · Mexico
Randomized Controlled Trial (RCT) with 506 rural communities randomly assigned to early treatment or delayed-entry control.

Children in treatment households experienced approximately a 23% reduction in the incidence of illness, an 18% reduction in anemia, and a 1–4% increase in height. Preventive health care visits increased by more than half.

Community-based health insurance in low-income countries: a systematic review of the evidence
Ekman (2004) · Health Policy and Planning · Multi-country (LMICs)
Systematic review of 36 studies covering CBHI schemes across Sub-Saharan Africa, South Asia, and Latin America.

CBHI schemes modestly reduced out-of-pocket spending and increased utilization of health services among members, but enrollment remained low (typically under 10% of target populations) and schemes suffered from adverse selection. Financial sustainability was fragile — most schemes required external subsidies to remain solvent. Evidence of impact on health outcomes was minimal.

Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme
King et al. (2009) · The Lancet · Mexico
Cluster-randomized evaluation: treatment randomly assigned within 74 matched pairs of health clusters representing 118,569 households, with 10-month follow-up.

Intention-to-treat estimates showed a 23% reduction in catastrophic expenditures (1.9 percentage points). Effects were stronger among poor households (3.0 pp reduction) and experimental compliers (6.5 pp reduction, a 59% decrease). No significant effects on health outcomes or utilization over the short follow-up period.

Europe and Central Asia's Great Post-Communist Social Health Insurance Experiment: Aggregate Impacts on Health, Health Care, and Health Inequality
Wagstaff & Moreno-Serra (2009) · Journal of Health Economics · Eastern Europe / Central Asia (28 countries)
Difference-in-differences exploiting the staggered adoption of SHI across transition economies (1990-2004), with controls for GDP, democratization, and other reforms.

SHI adoption was associated with increased health expenditure but no significant improvement in health outcomes. Out-of-pocket spending as a share of total health expenditure did not decline, and in some specifications increased. SHI did not achieve the anticipated improvements in financial protection or equity.

Public financing of health in developing countries: a cross-national systematic analysis
Lu et al. (2010) · The Lancet · Sub-Saharan Africa
Panel regression analysis using data from the WHO National Health Accounts and OECD DAC databases (1995-2006), with instrumental variable approaches to address endogeneity.

Each dollar of DAH displaced approximately $0.43-$1.14 of domestic government health spending in Sub-Saharan Africa, depending on the specification. Governments reduced their own health allocations when external aid increased, partially offsetting the intended funding boost. The fungibility of aid was highest in countries with weak governance.

The Oregon Experiment — Effects of Medicaid on Clinical Outcomes
Baicker et al. (2013) · The New England Journal of Medicine · United States
Randomized Lottery (RCT)

Winning the lottery completely eliminated catastrophic out-of-pocket medical expenditures (Risk Protection) and increased healthcare utilization (Access), but did not generate statistically significant improvements in measured physical Health Status over the first two years.

Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities
Rasella et al. (2013) · The Lancet · Brazil
Fixed-effects negative binomial regression of panel data across 2,853 Brazilian municipalities (2004–2009), adjusting for socioeconomic covariates and primary care coverage.

Under-5 mortality showed a dose-response relationship with BFP coverage: approximately 17%, 32%, and 53% reductions at intermediate, high, and consolidated coverage levels respectively. Effects were strongest for poverty-related causes (malnutrition and diarrhea).

How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program
Brown et al. (2014) · American Economic Review · United States
Regression discontinuity and difference-in-differences exploiting the 2004 MA risk adjustment reform.

Improved risk adjustment reduced favorable selection into MA plans by 15–20%. However, plans responded to the new formula by intensifying diagnostic coding — upcoding increased, with MA enrollees showing 6–16% higher risk scores than comparable fee-for-service beneficiaries, representing billions in excess payments.