Health financing system indicators: A scoping review

Health system financing is the process of collecting,  pooling, and managing financial resources for purchasing healthcare services needed by the society in order to promote, restore, or maintain their health, while financially protecting them against health costs. Financing, as one of the most important functions of the health system, plays an important role in achieving universal health coverage. Therefore, this study aimed to identify indicators for measuring health system financing.

Following a scoping review approach, we systematically searched six databases to identify relevant documents for the period of January 1, 1975, to May 20, 2020. A total of 79 documents were reviewed and analyzed using MAXQDA software.

Overall, 31 health financing indicators were identified, which were categorized into three categories of collecting financial resources, pooling financial resources, and purchasing healthcare services. Out-of-pocket health expenditures, catastrophic health expenditures, total health expenditure as a percentage of gross domestic product, global health spending, general government expenditure on health, medical impoverishment, domestic private health expenditure, and household financial contribution were the most frequently used health financing indicators.

Adequacy of financial resources, risk sharing, efficiency, equity, and sustainability are important criteria for evaluating the health financing system. The use of indicators is essential for evaluating the health financing system.