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NATIONAL HEALTH ACCOUNTS STUDY School of Public Health The Ministry of Health, Turkey Salih MOLLAHALILOGLU MD, MSc Mehtap KARTAL MD 2017-05-23 *Results of Draft Final Report 1 NATIONAL HEALTH ACCOUNTS STUDY Key questions which will be helpful for answering NHA; • • • • How big are the health system and its components in economy? Who, How much does someone pay? What are those payment mechanisms? How do the resources are distributed among service providers and kinds of service? • How does the financial value of the benefits is distributed ? • Where do we stand when we are compared with other countries? 2017-05-23 *Results of Draft Final Report 2 NATIONAL HEALTH ACCOUNTS STUDY TURKEY*; • Health financing highly fragmented • Difficult to ascertain spending across different functions by different agents • Different funding sources have different incentive implications affecting provider and consumer behavior differently • Difficult to ensure efficiency and equity in public spending • Fragmentation increases administrative costs *Mukesh CHAWLA, World Bank, Presentation of NHA Training, Turkey 2017-05-23 *Results of Draft Final Report 3 NATIONAL HEALTH ACCOUNTS STUDY Health Financing Flows Sources Financing Agents Public Taxes Health Providers Public Institutions Public Payments Public Social Security Funds Liabilities Credits Private Loans Private Sector / Private Insurance Enterprices Private Employers Aids Out-of-Pocket Expenditures Private Household Out-of Pocket Employers 2017-05-23 *Results of Draft Final Report 4 NATIONAL HEALTH ACCOUNTS STUDY Health Financing Flows Financing Agents 2017-05-23 Central Government Local Government Financing Mechanism s Budgets Hospitals MOH Hospitals Social Security Fund for workers Other Social Security Funds Revolving Funds SSK Hospitals *Results of Draft Final Report Private Insurance Out of pocket Foundations/ Associations University Hospitals 5 NATIONAL HEALTH ACCOUNTS STUDY Prepared Data Collection Tools; • Associations (Sample prepared for 3704 associations related with health ) • Foundations (Questionnaires sent to all 256 foundations related with health which were given by General Directorate of Foundations) • Private Hospitals (via Association of Private Health Institutions) • Private Health Insurance (via Turkey Insurance and Reasurance Companies Associations) • Private Business Enterprise (Addresses provided from Ministry of Labor) 2017-05-23 *Results of Draft Final Report 6 NATIONAL HEALTH ACCOUNTS STUDY Prepared Data Collection Tools; • State-owned economic Enterprise (provided through the agency of the Treasury, only 1 is missing) • Privatization Administration (The information has been partly reached) • Social Security Units under the provisional article of 20 of Social Insurance Organization Law (Provided through Ministry of Labor) • Municipalities (Questionnaires sent to all 3200 municipalities by Ministry of Internal Affairs) • Private Provincial Administrations (Questionnaires answered by all 81 provinces) 2017-05-23 *Results of Draft Final Report 7 NATIONAL HEALTH ACCOUNTS STUDY Hospital Study; Determining how payments are provided for Service Providers/hospitals and how these financial resources including general budget are spent and used for which services by service providers. Data base depends on, hospitals’ curative care division by; Inpatient curative care Outpatient curative care Dental care Services of Rehabilitative care and – Education-training of Health personnel – – – – according their ratio within the hospitals. 2017-05-23 *Results of Draft Final Report 8 NATIONAL HEALTH ACCOUNTS STUDY Household Study; The general goal of the Household Survey is to estimate out-of-pocket expenditures on all levels of health care for a representative sample of 10,675 household. The answering rate is generally 91.85%. As we do not have the final report we don’t have the details of this study. But some results presented in the last meeting on 19-20 June 2003. • The insurance coverage is 67.20%. 2017-05-23 *Results of Draft Final Report 9 NATIONAL HEALTH ACCOUNTS STUDY Annual Per Capita Health Expenditures by Region Health Expenditures (TL) 160,000,000 140,000,000 120,000,000 100,000,000 80,000,000 60,000,000 40,000,000 20,000,000 0 North South East & S.East Central Average West Regions 2017-05-23 *Results of Draft Final Report 10 NATIONAL HEALTH ACCOUNTS STUDY Total Health Expenditures (2000) Corporations Direct Expenditure 3,6% Other 1,4% Central Government 24,2% Household out of Pocket Spending 27,5% Local Government 4,0% Private Insurance Enterprices 3,6% Private Social Insurance 0,7% 2017-05-23 Social Security Funds 35,0% *Results of Draft Final Report 11 2017-05-23 0 *Results of Draft Final Report 5,9 5,9 5,4 12 Turkey previous 6 Mexico 6 Slovak Republic 6,2 Korea 6,8 6,7 6,6 6,5 Luxembourg 10,7 10,6 Poland 12 Turkey Finland Ireland 7,3 7,2 Hungary Czech Republic 7,9 7,9 7,8 7,8 7,7 United Kingdom Spain Norway Japan 8 OECD Average 8 Sweden 8 New Zealand 8,3 8,3 8,3 8,2 8,1 8,1 Austria Netherlands Italy Portugal Greece Denmark 9,1 8,9 8,7 Hungary Belgium Iceland 9,5 Canada 10 France Germany 14 Switzerland United States Percent of GDP NATIONAL HEALTH ACCOUNTS STUDY Total Expenditure on Health as a Percent of GDP (2000) 13 Turkey 5,1 4 2 2017-05-23 Public Share *Results of Draft Final Report United States Korea Mexico Greece Switzerland Turkey Netherlands Turkey Previous Austria Spain Poland Portugal Belgium Canada Australia OECD Average Italy Germany Finland Hungary Ireland France Japan New Zealand United Kingdom Denmark Iceland Norway Slovak Republic Czech Republic Luxembourg Percent of Total Expenditure on Health NATIONAL HEALTH ACCOUNTS STUDY Public and Private Shares of Total Expenditure on Health (2000) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Private Share 13 NATIONAL HEALTH ACCOUNTS STUDY Main Challenges of the Study; • Institutionalization SPO take NHA as a project to be done by SIS and its budget given to SIS • Regular, standart data collections • Use of data by Policy-makers 2017-05-23 *Results of Draft Final Report 14