Health systems financing review
More detailed information on OASIS
What is OASIS
OASIS is an analytical approach that can be applied in a flexible way to systematically analyse the strengths and weaknesses of a health financing system and to identify suggestions for improving the performance of a health financing system in order to move towards universal coverage.
The OASIS approach consists of 3 major steps:
- a health financing system overview with a health financing performance assessment
- a more detailed institutional-organizational analysis; and
- an identification of options and necessary changes for health financing improvements.
OASIS core elements
The distinctive characteristic of this framework is a focus on the institutional design and organizational practice of health financing, on which health financing performance is contingent. Institutional design is understood as formal rules, namely legal and regulatory provisions relating to health financing; and organizational practice refers to the way organizational actors implement and comply with these rules. Health financing performance is operationalized into nine generic health financing performance indicators.
Inadequate performance can be caused by six types of bottlenecks in the institutional design and organizational practice of health financing. Accordingly, six types of improvement measures are proposed to address these bottlenecks, as outlined below. By understanding the incentive environment within a health financing system, the potential impacts of the proposed changes can be anticipated.
|Six bottleneck factors:||Six entry points:|
|1. Rule non-existence||Introduction of a new rule|
|2. Inadequate rule||Rule redesign|
|3. Non-aligned rules||Rule alignment|
|4. Weak rule enforcement||Strengthening rule enforcement|
|5. Weak organizational capacity for rule implementation||Strengthening organizational capacity|
|6. Non-conducive inter-organizational relationships||Improving inter-organizational relationships|
Institutional and organizational change
Health financing and the move towards universal coverage can be enhanced by actively developing the institutional design of the health financing system, for example through modifying legal and regulatory provisions. Likewise, there may be a need to improve organizational practice through strengthening organizational capacity and enforcement practices, in order to enhance health financing performance.
In many cases, substantial improvements and advances towards universal coverage can be achieved within the prevailing health financing system by merely implementing and enforcing the existing legal and regulatory provisions, and/or by strengthening organizational capacity.
The unique value of OASIS
OASIS supports policy-decision making and facilitates implementation, as it stresses the formulation of adequate health financing rules and the establishment or availability of organizations that can implement these rules.
The OASIS approach serves policy-makers:
- to acquire a detailed understanding of the strengths and weaknesses of a health financing system through a thorough health financing system review including a performance assessment
- to identify appropriate improvement measures and policy options in order to enhance health financing performance and move towards universal coverage
- to develop a health financing policy/strategy
- to assess the impact of recently implemented health financing reforms; and
- to review the adequacy and anticipate the impact of planned health financing reforms.
OASIS reviews both the totality of a health financing system as well as health financing sub-systems and specific health financing schemes. In particular, it reviews and assesses the three health financing functions: resource mobilization, pooling and purchasing/provision. OASIS also pays attention to the stewardship function in health systems.
OASIS is intended to be used by health financing experts and senior technical staff at Ministries of Health, Finance, Planning, Labour as well as other health financing stakeholders outside government that have a policy advisory role in health financing.
Target audience of the OASIS analysis and recommendations
OASIS’ target audience includes health financing policy-makers of Ministries of Health, Finance, Planning and Labour, or other ministries, health insurance organizations and other actors in health financing.