Payment systems instruments

Carbon taxes are dynamic economic instruments that offer a continuum incentive to reduce emissions. In fact, technological and procedural improvements and their subsequent efficient diffusion lead to reductions in tax payment. In addition, trading systems are able to self-adjust because emission goals will be easier to meet there will be a decrease in permits demand and in their price but not as rapidly as taxes. 

In Chapter 7, professor B. Gonzalez Lopez-Valcarcel of the University of Las Palmas de Gran Canaria analyses the participation of the insuree in the payment of the price of the pharmaceutical. In spite of the widespread application of pharmaceutical co-payment in European health systems, the author observes that this mechanism does not appear to have been very effective in cost containment. Co-payments represent a way of making the user share the burden of the cost rather than an essential source of income for the public system. Theory and comparative experience of the system alike indicate that the indiscriminate application of co-payments is a source of inequalities, and that in any event its effects on consumption depend largely on prescriber incentives. For this reason the author recommends that co-payments should not be uniform for different population groups, and that they should not be applied in isolation, as their effectiveness is enhanced in combination with other instruments. 

However, these results are not applicable to compulsory pubhc insurance, nor to National Health Systems. The most notable differences between drag co-payment in an insurance market and in a National Health System or compulsory public insurance environment lie in their voluntariness or otherwise (users ability to choose their coverage) and the ultimate financing of the services (risk-adjusted premiums as opposed to taxes or social insurance contributions adjusted according to economic capacity). Hence, in compulsory public insurance systems, co-payment regulation is used not only as a health policy instrument but also as one of redistribution of income. 

However, the extensive and varied experience undergone in Europe and its trend towards greater participation by the user in the financing of pharmaceuticals does not seem to have made any substantial contribution to cost containment. Practically all European countries use drag co-payment with the imphcit objective of making the user jointly responsible for the cost, but not as an essential source of revenue for the public health care system, nor has it proved to be a political instrument with the ability to contain costs or substantially improve efficiency. 

The consensual identification and control of the unit of payment together with an agreed approach towards profit sharing seemed to be the most time-consuming and sophisticated steps during the development of the model. Instruments such as UNIDO s Toolkit or quality assurance systems will be supportive in managing that critical and important stage. 

Payment mechanisms shouid be affordabie, safe, reiiabie, and accessibie to aii beneficiaries. A number of different payment instruments are avaiiabie, inciuding cash, checks, vouchers, and in-kind benefits, that can be deiivered using banks, automated teiier machines (ATMs), mobiie pay points, private or pubiic shops, and so on. The choice of appropriate deiivery mechanisms depends on objectives, operationai needs, administrative capabiiities, and iocai infrastructure conditions, investments in administrative systems and equipment reiated to payments can heip increase service standards, reduce corruption and ieakage, and reduce costs in the iong run. 

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