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OECD Survey on Budgeting Practices for Health LAC and CESEE countries: preliminary
results
Ivor Beazley Senior Policy Analyst GOV/BUD
Public Financing for UHC: Towards Implementation
Montreux, 31 October - 2 November 2017
Joint Network on Fiscal Sustainability of Public Health Systems
Reduce poverty and increase economic growth
Surveys
Annual meetings
Case studies
Analytical research
Benchmark good practices and identify bottlenecks
Catalyze processes for better alignment between
budgeting and health
Increase coverage and improve service quality
More effective and efficient use of financial resources
Reduce morbidity and increase life expectancy
Document health budget
tools and practices
Improve capacity
and create dialogue
Global transfer of knowledge – the OECD Joint Network on Fiscal Sustainability of Health Systems
OECD countries (annual) next meeting February 2019
Latin America & Caribbean July 2016 April 2018
Central Eastern Europe December 2016, December 2018
Asia May 2017, May 2109
Africa (w/CABRI) December 2015, November 2018
+ country case studies + surveys on budgeting practices for health
Who is the survey targeted to?
Officials working in Budget Authorities who focus on health issues
Officials working in the Ministry of Health in relation with the budget authorities
Region Status Countries
LAC (short
version)
Fully implemented
13 (Argentina, Peru, Uruguay, Honduras, Colombia, Mexico, Guatemala, Ecuador, Paraguay, Chile, Belize, Costa Rica and
Brazil)
CESSE Data cleaning process ongoing
12 (Armenia, Azerbaijan, Czech Republic, Estonia, Georgia, Greece, Kazakhstan, Kyrgyzstan, Lithuania, Malta, Slovakia,
and Republic of Slovenia)
Asia and Oceania
Implementation ongoing
9 (Australia, South Korea, Japan, Laos, Myanmar, New Zealand, Philippines,
Papua New Guinea and Vietnam)
Africa About to start
What is the current status?
What is the scope of the survey?
1. Basic characteristics of health systems 2.Health budget formulation
4. Budget monitoring 3.Purchasing and provider payments, Health Budget
execution
6. Budgeting for social insurance funds/agencies
7. Management of development assistance for health
8. Decentralization
5. Fiscal sustainability
Health financing systems remain highly fragmented in the LAC region
0% NI 0% 0%
6% 4%
18%
6%
19%
2% 0%
7% 5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
BRA PRY BLZ ARG ECU GTM HND MEX PER COL URY CHL CRI
Government financing scheme Social health insuranceVoluntary private insurance Compulsory private insuranceOther Not covered by any explicit arrangement
Popu
lati
on c
over
ed
In both regions, countries are planning to increase publicly funded health coverage
No 38%
Yes 62%
• Increase population coverage remains the first priority in both regions
• Many countries are also seeking to increase service coverage and financial protection
Most countries have a separate budget for the social health insurance system
KGZ
LTU
AZE
GRCSVN
SZE
EST
SVK
Yes 75 %
No 25 %No 8%
Yes 92%
CESSE LAC
Use of ceilings
ARG
URY
CHL
BLZ
HND ECU
GTM
MEX
PRY
PER
COL None 27%
Floors 27%
Ceilings 27%
Floors and ceilings
18% ARM
EST
LTU
AZE
MLT SZE
KAZ
SVK
GRC
SVN
KGZ
Floors 8%
Ceilings 17%
None 75%
LAC CESEE
In LAC, reporting delays vary depending on the health financing scheme
Source : Question 9 Survey on Budget Practices for Health in LAC countries (2015)
Most budget agencies in the LAC region have a multi-year vision of health spending
Source : Question 21 Survey on Budget Practices for Health in LAC countries (2015)
Number of future years estimated in the budget for health care spending
CESE countries tend to estimate less years in the budget for health care spending
Source : Question 21 Survey on Budget Practices for Health in LAC countries (2015)
Number of future years estimated in the budget for health care spending
URY
MEX
CRI
CHL
COL
PERGTM
ECU
PRY
HND
BLZ
ARG
BRA
No 71%
Yes 29%
Long term projections are less common
CESE LAC
Public health expenditure has outpaced economic growth in OECD countries in the last couple of decades and is expected to continue growing as a share of GDP in the decades to come.
23
AUS
AUT BEL
CAN
CHL
CZE
DNK
EST
FIN
FRA
DEU
GRC HUN
ISL
IRL
ISR
ITA
JPN
KOR
LUX
MEX
NLD NZL
NOR
POL
PRT
SVK
SVN
ESP
SWE CHE
TUR
GBR
USA
0%
2%
4%
6%
8%
0% 2% 4% 6% 8%
Gro
wth
in r
eal h
ealt
h s
pen
din
g p
er c
apit
a
Growth in real GDP per capita
Average annual growth rate of real total health spending and GDP p.c. 1990-2012 (or nearest year)
5.5
7.9
11.8 0.8
1.6
2.1
0
2
4
6
8
10
12
14
16
OECD
% Health careLong term care
Average (2006-2010)
Cost-containment scenario: 2060
Cost-pressure scenario: 2060
Projected public health and long-term care expenditure as % of GDP in 2060
Source: De La Maisonneuve and Oliveira Martins, 2013
Source: OECD Statistics
Most OECD countries enjoy universal health coverage. Their main challenge is ensuring the fiscal sustainability of the system
• Increasing publicly funded health coverage • Reducing fragmentation and increase
coordination of functions across subsystems (LAC)
• Fully execute budget allocated to health • Improve cost containment strategies • Develop long term projections
In contrast, for non-OECD countries some of the bigger challenges are:
• Decentralization in the health sector and capacity building at the subnational level
• Reasons behind under-spending and ways to overcome it
• Budget rigidities and mechanisms to increase flexibility
• Additions and cuts in budget allocations made during the budget execution year
• Effectiveness and challenges of using performance budgeting tools
Areas for further research
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