CHAPTER FIVE Who pays for Health ystems Choices for financing health services have an impact on how fairly the burden of payment is distributed. Can the rich and healthy subsidize the poor and sick? In order to ensure faimess and financial risk protection, there should be a high level ofprepayment; risk should be spread(through cross-subsidies from low to high health risk); the poor should be subsidized (through cross-subsidies from high to low income); the fragmentation of pools or funds should be avoided; and there should be strategic purchasing to improve health system outcomes and responsivenessWho Pays for Health Systems? 93 CHAPTER FIVE
ho ays for ealth ystems? Choices for financing health services have an impact on how fairly the burden of payment is distributed. Can the rich and healthy subsidize the poor and sick? In order to ensure fairness and financial risk protection, there should be a high level of prepayment; risk should be spread (through cross-subsidies from low to high health risk); the poor should be subsidized (through cross-subsidies from high to low income); the fragmentation of pools or funds should be avoided; and there should be strategic purchasing to improve health system outcomes and responsiveness. 93