![Page 1: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/1.jpg)
Sources of Health Care Financing
![Page 2: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/2.jpg)
The Elements of Health System
Management
Resource Inputs(trained staff,drugs, knowledge,
facilities,etc.)
Organization(ministry, hospitals, etc.)
Financial support
Service Provision
![Page 3: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/3.jpg)
Health Sector Reform:
• Civil service and public sector reform
• Development in financing the social sector
• Managed-market health care reforms
• Development in epidemiology and health economics
![Page 4: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/4.jpg)
Health Sector Reform -2-
• HSR occurs as part of changes in public sector reforms.
• Changes in health financing: the need to assess the advantages and disadvantages of user fees, community financing, voucher systems and different forms of insurance
• Traditional bureaucratic structures do not necessarily sufficient incentives to guarantee cost-effective or user-friendly services, neither are unregulated private markets capable of achieving the mix of objectives that health systems seek to satisfy.
![Page 5: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/5.jpg)
Need versus Demand
![Page 6: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/6.jpg)
0
10
20
30
40
50
60
70
80
90
diarrhea
pneumonia
accident
heart disease
cancer
AIDSestimated
AIDSreported
![Page 7: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/7.jpg)
![Page 8: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/8.jpg)
Aging and Economic Growth
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Year:Japan
Korea
Thailand / Sri Lanka
0
0.05
0.1
0.15
0.2
0.25
0.3
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
population 65+ (%) Japanpopulation 65+ (%) Koreapopulation 65+ (%) Thailandpopulation 65+ (%) Sri LankaGNP per capita, JapanGNP per capita, KoreaGNP per capita, ThailandGNP per capita, Sri Lanka
![Page 9: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/9.jpg)
Low-income Countries HaveWeak Capacity to Raise Revenues
• Governments often raise less than 20% of GDP in public revenues;
• The tax structure in many low-income countries is often regressiveTota
l G
overn
men
t R
even
ues a
s %
GD
P
0
20
40
60
80
100
Per capita GDP $ (Log scale)
10,000 100,0001,000100
Source: IMF data 2000
![Page 10: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/10.jpg)
Epidemiological Changes
Nature of health care (quantity + quality)
Not necessarily all public goods
Higher service costs
Less and less passive acceptance of service
( Customers’ satisfaction, better quality of service)
Accountability to be sought after
![Page 11: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/11.jpg)
Major challenges for health financing
Epidemiological transition
Financial constraints
Allocative inefficiency of health sector resources
Lack of management capacity
![Page 12: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/12.jpg)
Recurrent Costs Problems in Developing Countries
![Page 13: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/13.jpg)
(1) Private foreign investment• foreign direct investment
• foreign portfolio investment (stocks, bonds and notes)
(2) Public and private development assistance• bilateral and multilateral donor agencies
(grants and loans)• nongovernmental organizations (NGOs)
The International Flow of Development Resources
![Page 14: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/14.jpg)
Government Budget 1. Development (Capital) Budget (資本予算)– Domestic Financing
– External Financing (development assistance, etc.)
2. Recurrent Budget (経常予算)– Domestic resources (tax, user fees)
Absorptive capacity ( 援助 の吸収能
力 )
Foreign currency portion
Local currency portion
Local currency portion
![Page 15: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/15.jpg)
0
1
2
3
4
5
6
7
8
2000 2001 2002 2003 2004
Development(Capital ) Budget
Actual Recurrent Budget
Shortage in recurrent budget
User Fees
Recurrent Resource Gap
(by Y.Uchida)
![Page 16: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/16.jpg)
Recurrent cost constraints threaten the productivity of past
investment
A mismatch between capital investment* and recurrent financial capacity
(*one-off investment)
“R”co-efficient: the ratio of recurrent expenditure to total investment outlay
District hospitals 0.33 every $1000 spent on the initial capital development of a district hospital results in $333 of expenditure per year
![Page 17: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/17.jpg)
external assistance
・ Development (capital) budget + recurrent budget
・ Foreign currency portion + local currency portion
A mismatch between capital investment*and recurrent financial capacity (*one-off investment)
![Page 18: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/18.jpg)
Symptoms of the recurrent cost problems
New facilities unable to function because of recurrent resources
Faculties supplied with equipment but no qualified staff to operate
Poorly maintained buildings, equipment, facilities, etc.
Transportation difficulties and immobile vehicle fleets caused by lack of spares, fuel, etc.
A large number of unfilled posts
![Page 19: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/19.jpg)
The consequences of these
problems
![Page 20: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/20.jpg)
Causes for the recurrent cost problems
Poor project design Weak planning, budgeting and resource mechanisms
( dual budgeting, PIP) Resource availability factors
(low per capita income, low growth rates, low savings rations, weak business sectors)
Weak management capacity
![Page 21: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/21.jpg)
Balance Sheet: B/S AssetsCurrent assets
(Short-term assets)
Fixed assets
(Long-term assets )
LiabilitiesCurrent Liabilities
Long-term Liabilities
Stockholders’ Equity
![Page 22: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/22.jpg)
Aid Coordination
and
Resource Management
![Page 23: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/23.jpg)
Coordination of external resources is central to the development agenda in many countries.
The following growing recognitions:The following growing recognitions:
Unmanageable proliferation of Unmanageable proliferation of projects, policies and demands projects, policies and demands on sector ministrieson sector ministries
![Page 24: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/24.jpg)
Unmanageable proliferation of projects, Unmanageable proliferation of projects, policies and demands on sector policies and demands on sector
ministriesministries
Fragmented (overlapped) sector activities Fragmented (overlapped) sector activities = = projectisationprojectisation
Little resource fungiblilityLittle resource fungiblility
Several technical specificationsSeveral technical specifications
Some disbursement rules and financial years among donorsSome disbursement rules and financial years among donors
Enormous works with donors’ missions – heavy administrative Enormous works with donors’ missions – heavy administrative burdenburden
Parallel management system Parallel management system
![Page 25: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/25.jpg)
Parallel Management System Parallel Management System
Excessive separate systemsExcessive separate systems created great confusion. The disbursement and created great confusion. The disbursement and
accounting arrangements made financial control very difficult and accounting arrangements made financial control very difficult and
rendered it impossible to gain an overview of the resources employed or rendered it impossible to gain an overview of the resources employed or
to analyse expenditures.to analyse expenditures.
The fragmentation of control over civil works initiativesThe fragmentation of control over civil works initiatives hindered the hindered the
development of rational capital planning policies and paid inadequate development of rational capital planning policies and paid inadequate
attention to the aggregate recurrent cost consequences.attention to the aggregate recurrent cost consequences.
![Page 26: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/26.jpg)
Unmanageable proliferation of projects, Unmanageable proliferation of projects, policies and demands on sector ministriespolicies and demands on sector ministries
Fragmented sector activitiesFragmented sector activities
Little resource fungiblilityLittle resource fungiblility
Several technical Several technical specificationsspecifications
A few different disbursement A few different disbursement rules and financial yearsrules and financial years
Enormous works with donors’ Enormous works with donors’ missionmission
Asymmetric power relationships
Informal networking between key policymakers /managers in both donor and recipient organizations
![Page 27: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/27.jpg)
Ugandan national health plans since 1986
![Page 28: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/28.jpg)
SWAps (sector-wide approaches):
The concept of coordination, best compressed in the SWAps.
SWAps represents a next generation approach to aid, and set out to provide a broad framework within which all resources are coordinated in a coherent and well-managed way .
![Page 29: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/29.jpg)
Definition of SWAps (sector-wide approaches):
All significant public funding for the sector
supports a single sector policy and
expenditure program, under Government
leadership, adopting common approaches
across the sector, so as to disburse and
account for all public expenditure.
![Page 30: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/30.jpg)
SWAP Arrangements
Coordination mechanism:A steering committee: 1) A Code of Conduct which establishes principles and
mechanisms on which SWAp is to be based
2) Formulating and sharing a sector policy(a set of medium and long term performance indicators)
3) Allocation of development resources and technical assistance Basket Fund (pooling arrangement)
![Page 31: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/31.jpg)
KSM, UOCH 31
Six Building Blocks of a Health System
Source: Strengthening Health Systems to Improve Health Outcomes, WHO’s Framework for Action – WHO 2007
Purposeful change aimed at improving health system performance for:
System Inputs
![Page 32: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/32.jpg)
KSM, UOCH 32
Overview of HCF
![Page 33: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/33.jpg)
KSM, UOCH 33
Exchange Model
• Bilateral exchange model for goods
Consumers Providers
Service
Money
![Page 34: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/34.jpg)
KSM, UOCH 34
Exchange Model
• Trilateral Exchange Model for Goods
Consumers Providers
FinancingOrganization
Treasury
Premiums
Payments
Services
User’s fee
Taxes
![Page 35: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/35.jpg)
KSM, UOCH 35
Determinants of Health Inqualities
1. Natural, biological variation
2. Differential health-damaging behavior that is freely chosen3. Differential health-promoting
behavior that is freely chosen4. Differential health-damaging or
health-promoting behavior, where choices are restricted
5. Differential exposure to unhealthy, stressful conditions (home, work, etc…)
6. Inadequate access to basic social and essential health services
7. Health-related social mobility
Generally perceived as unavoidable or fair
Generally perceived as avoidable or unfair
![Page 36: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/36.jpg)
KSM, UOCH 36
Efficiency Measures Overview
1. Perspective
2. Output
3. Type of Efficiency
Function of Health system esp in Health Care Financing
Revenue collection, risk pooling, purchasing
Allocative,Technical/ Productive and
Social Efficiency
It is organized in three tiers
![Page 37: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/37.jpg)
KSM, UOCH 37
Efficiency OverviewSociety
Providers PurchasersHealth Plans
Health Care Financing
Individuals
Revenue collection, Risk pooling Purchasing
Technical Productive Social
Per
spec
tive
Out
put
Typ
e
![Page 38: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/38.jpg)
KSM, UOCH 38
Public Finance Challenge
Environmental sanitation
Family Planning
Vector control
Maternal and Child Health
OP hospital referrals
Health center OP curative
OP hospital self-referrals
2nd class IP care
VIP IP care
Kidney dialysis
Open heart surgery
Cosmetic surgery
Water supply
Pure Public Goods
Pure Private Goods
Curative
Preventive
Government policy dictates most resources flow here
Actual funding ends up here
RichPoor
![Page 39: Sources of Health Care Financing. The Elements of Health System Management Resource Inputs (trained staff,drugs, knowledge, facilities,etc.) Organization](https://reader030.vdocument.in/reader030/viewer/2022032604/56649e595503460f94b5251d/html5/thumbnails/39.jpg)