Download risks, equity, acceptability with health care cost. Background 1. Poor

Fair and Sustainable
Health Financing
Mohammed Shaheen
School of public health
AlQuds University
Background
1. Sustaining health financing is a big challenge in all
countries specially in poor and politically instable
countries.
2. There is no best model for health care financing it
should try to address the different dimensions of
country context on continuous basis.
3. The challenge is how can we balance quality of care
(efficiency & effectiveness), risks, equity,
acceptability with health care cost.
Health Challenges
1. Poor countries are facing huge excess premature
mortality, low life expectancy and most of the
Health MDG targets are not met
2. Foe example; 80% of the 11 million deaths per
year that occur in Africa results from preventable
diseases
3. HIV/AIDS, lower respiratory tract infection, malaria,
diarrhoeal diseases and maternal and prenatal
conditions accounts for 54% of the deaths
4. This heavy burdens of disease have contributed
significantly to chronically poor economic
performance and poverty in poor countries.
Socio-Economic Context - Poverty
1. For example: More than 50 percent of the countries
in the African region are severely indebted
2. Big informal sector and high unemployment
3. High levels of poverty and inequitable distribution
of income; the human poverty index is 40%
4. 44% of population are living on less than one USD
per day
Water, Education and Sanitation
1. 40% of the population lack access to safe
drinking water
2. 40% of adults in the region are illiterate
3. Primary school enrolment is 63% and secondary
school enrolment is 21%
4. 47% of the population in the region lack access
to adequate sanitation facilities
Total Health Expenditure
1. African countries spend in average 5.7% of their
GDP on health, (same as in 1995, 8.2% for all
countries worldwide)
2. 35 countries (76% of all) spend less than USD 34 per
capita, regarded as the minimum for providing an
essential health care package
3. The proportion of governmental health spending of
total government spending is 8%
4. 44 countries (96% of all) spend less than 15% (Abuja
benchmark) of national budgets on health
Private/Public Health Expenditure
1. Private health expenditure amounts to be 56% of
total health expenditure (2 times more than in
Europe)
2. The health systems of most African countries
depend largely on household’s direct out-of-pocket
payments; averaged 28% of total health spending
3. Government spending on health is 44% of the total
health expenditure
4. The poorest and most indebted countries rely
heavily on external resources; 28% of total
governmental health expenditures (4% in richer
countries)
Prepayments
1. 17 countries in the region (35% of all) are using
some type of pre paid plans
2. Few countries in the region have introduced
social health insurance schemes; corresponding
to 3% of the total health expenditure
3. Several countries in the region have been
implementing community health insurance
schemes and some medical savings accounts
Health Financing Challenges
1. Failure of establishing cost recovery safety
net mechanisms in protecting the poor
2. Lack of financial resources to produce good
health for all
3. Low income countries have a small revenue
base to generate domestic resources
4. Inefficient use of available health resources
5. Lack of human resources is a major
bottleneck in achieving efficient health care
Health Financing Challenges
6. High turnover of health staff, mainly due to
poor financial incentives
7. Weak management capacity to provide
essential and quality health care services
8. Limited technical capacity to manage complex
health financing and equity issues
9. Weak monitoring and analytical capacity and
evidence not being used in health policy
making and management
HEALTH SYSTEM FRAMEWORK
FUNCTIONS
Stewardship
Oversight
Resources
OUTCOMES
Responsiveness
People’s non-medical
expectations
Investment and
training
Delivering
services
Health
Provision
Financing
Collecting, Pooling,
Purchasing
Fair financing
Health Financing
Functions
Pooling
Purchasing/
payments
Service
providers
Collection
Population
resource
base
GDP
Out-of-pocket Private Insurance
Co-payments Companies
Labor Market
External Aid
Natural
Resource
Revenues
Capitation
Income
Tax Systems
Region
Voluntary
Prepayment
Demographics Mandatory
Prepayment
Economic
Activity
Health Risk
Fee for Service Professionals
NGOs
Public Insurance
Agencies
Centrl Government
Indir Taxes
Local Governments
Direct Taxes
Public/private
facilities
Budgeting
NGOs
Salaries
Hospitals
Prospective
Districts
Retrospective
Health Financing Instruments
1. General tax revenue/earmarked taxes
2. User fees (cost-sharing/cost-recovery)
3. Health insurance
- Social
- Community
- Private
4. Medical savings accounts
5. Donor funds
Fair and Sustainable Health Financing
1. Financial protection
- Reduce the risk that households will face
catastrophic health expenditures
- Cross subsidisation of the poor and
vulnerable by healthy and wealthy sectors
of society
- Minimize large out-of-pocket spending on
health, such as user fees
- Introduce or strengthen prepaid plans such
as health insurance and publicly subsidised
services
Fair and Sustainable Health Financing
2.
Improve equity and efficiency in allocation,
access to and utilization of existing health care
resources
3. Increase external and domestic funding to
benefit the poor
- Mobilize domestic resources by using
efficient revenue collection methods
4. Optimise the use of different financing sources
and payments mechanisms to create balanced
incentives for health providers with regard to
equity, efficiency, productivity and quality of
health care delivery
Contextual Approach
Recognize the importance of the country's:
1. Health situation and epidemiology
2. Structure and capacity of the health system
3. Macroeconomic constraints
4. Socioeconomic conditions
5. Cultural values
6. Political situation
Integration - Interaction
Health financing strategies and action plans
to be developed with reference to:
1. National Health Policies and Strategies
2. Millennium Development Goals (MDGs)
3. Poverty Reduction Strategy Paper (PRSP)
frameworks
4. Collaboration between governments and
development partners, guided by the Paris
Declaration of 2005 of Alignment and
Harmonization, e.g. effectiveness, division
labour, use of SWAps
of
Use of Evidence Based Information
1. Analysis of current levels of health spending,
sources and the use of those sources (NHA data)
2. Economic viability analyses of various financing
options
3. Health policy analysis
4. Legal analysis
5. Socio-political environment analysis
6. Training and research
Implementation Constraints
1. High disease burden and high levels of
poverty
2. Huge informal sector, high unemployment
and narrow tax base
3. Lack of human resources and management
capacity in health care
4. Limited analytical capacity in monitoring and
evaluation
5. Limited evidence based data available for use
in health policy and management
Enabling Factors in Implementation
1. Strong political commitment
2. Acceptability to clients, professionals,
politicians, collaboration partners and
the general public
3. Proper management, monitoring and
evaluation
Enabling Factors in Implementation
4. Good governance, transparency and
accountability
5. Active partnership, coordination and
collaboration between governments,
development partners, training and
research institutions
6. Adequate financial and technical support