Download Expenditure tracking in health

Expenditure tracking in health
care
National Health Accounts
Tomas Roubal
WHO, South Africa
Two messages
• What is the health accounts, and what
information do they give?
• How NHAs can help us in accessing the value
for money expenditures?
1) System of Health Accounts
• Internationally recognized accounting system for
health
– Expenditures by provider, type of care and source of
financing
• Updated version was published in 2011 – System of
Health Accounts 2011
• What is new is to measures spending per beneficiary
groups
– expenditure by disease and condition (including maternal
health)
– expenditure by age
– also by region
International commitment
• WHO convened a meeting in Geneva in February 2014
to discuss the information needs and what NHAs may
or may not respond
• Participants:
– Countries (Tanzania, Burkina, ground, Liberia, Ghana,
Thailand, Burundi, China)
– Development partners (UNAIDS, GAVI, UNFPA, WHO,
Global Fund, Gates, USAID, SIDA, World Bank, NIDI, CHAI,
Abt, Futures, PEPFAR, OECD)
• Agreement that expenditure tracking are integrated
through the System of Health Accounts
Data sources
• Data from the public sector
–
–
–
–
Ministry/department of health
Ministry of finance (e.g. other departments)
Healthcare providers (Hospitals, clinics, etc.)
District data (often must be collected in person because
the details are lost at central level)
– Social security insurance systems
• Data from the private sector
– Private insurance, surveys on household expenditures,
expenditures by companies, NGOs
• External resources
– Mostly donor money
Description of the money flows
• Who pools resources
• How is the payment
organized
(voluntary/mandatory)
Where do the
money come
Who does
provide services
• Which providers
receive the money
• What goes to
administration,
investment and care
• Who receives the care
• Which care has been
provided (acute,
rehabilitation, LTC,
pharmaceuticals)
To whom which
services
16%
14%
12%
10%
8%
6%
4%
2%
0%
Liberia
Sierra Leone
Lesotho
Rwanda
Malawi
Djibouti
South Africa
Togo
Swaziland
Namibia
Burundi
Uganda
Sao Tome and Principe
Sudan
Niger
Côte d'Ivoire
Tunisia
Tanzania
Zambia
Mozambique
Mauritania
Guinea
Burkina Faso
Nigeria
Guinea-Bissau
Mali
DRC (Congo)
Botswana
Algeria
Ghana
Cameroon
Gambia
Egypt
Senegal
Mauritius
Kenya
Equatorial Guinea
Seychelles
Comoros
Benin
Madagascar
Libya
Cabo Verde Republic of
Ethiopia
Central African Republic
Chad
Angola
Gabon
Results – Total health expenditure as %
GDP in 2012
8.8%
Source: - WHO, NHA indicators
Reforms are based on?
8.5%
8.0%
7.5%
8.9%
8.9%
9.0%
8.3%
8.0%
7.4%
8.3%
8.7%
8.8%
8.5%
8.0%
7.8%
7.0%
6.5%
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
6.0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Government expenditure as % of total exp
Total health expenditure % GDP
Source: - WHO, NHA indicators
2) Short history in South Africa
• 1990s – Health Expenditure Review
– geographic disparities, disproportionate spending on
hospital-based care in the public sector, and severe cost
escalation in the private sector
• late 1990s – National Health Accounts (NHA) Project
– evaluates reforms, reveals two eras of public health sector
financing
– data from 1998/99 indicate falling per capita financing of
health care by government, a reversal of re-distribution
trends between provinces and limited growth in PHC
expenditure
– decline in value for-money in the private sector, prior to
the implementation of the Medical Schemes Act
NHA – macro view on expenditures
• Where is South Africa internationally
– % GDP on health
– % of public expenditures on health
– Out of pocket payments
• How do provinces compare
– Role of public and private financing
– How much is spent on investment & administration
• What are the changes over time
• On which diseases are spending money
Benefits for South Africa
• Budget preparation for 2017-2019 on provincial and central
level
• Support NDoH and provincial DoH in discussion on raising
resources for health
• Evaluate expenditures of provinces on hospitals, clinics,
primary care
• Private/public sector expenditure comparison
• Administrative costs of the health system on various levels
(central, provincial, district)
• How much are people paying out-of-pocket in hospitals,
clinics, pharmacies (in various provinces/districts)
Evaluation of reforms
• Monitor the impact of recently introduced
resource re-allocation policies in time;
• Provide data to assist in the development of threeyear rolling budgets for the public sector;
• Evaluate health sector efficiency;
• Are expenditures linked to burden of diseases; and
• Inform the development of new policies.
Answers on questions
• Who controls the resources and their flows
– Public x private, central x provincial x provider
• Who is paid to provide health services
– Primary care, hospitals, specialists, clinics
• Do we channel the money to care the
population needs
– Diseases, age/gender information, type of care
• Is our system efficient
– Investments x administrative costs x health services
Thank you very much!
[email protected]