glimpse of world health financing pptx
TRANSCRIPT
Glimpse of
World Health FinancingPrepared by
Shiva Ram KhatiwodaMPH, MMC/IOM/TU, Kathmandu, Nepal
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Peer reviewed by
Man Bahadur KunwarMPH, MMC/IOM/TU, Kathmandu, Nepal
Why to finance health?
• Health is fundamental human right (WHO; and constitutions of many countries)
• No one should get financial hardship/ruin to get health care services they need (Universal Health Coverage/UHC, adopted by many countries)
• Health is the real wealth. Only healthy people can contribute towards greater good of the society; for peace, for prosperity, and development. Poor health can cause poverty and vice versa.
• Country is responsible to people, and people are responsible to country. It is reciprocal relation.
• Health is resources to people; people are resource to country.
• To get something, something is spent, and there must be someone who funds/mediates.
• Question How to finance sustainably and equitably ?
[WHO = World Health Organization; UHC = Universal Health Coverage]
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How to finance?Alternative way of financing
Some countries have dominant of any, while some have mixed of some of the following financing models:
Use of Pooled fund: (Tax or premium collection pooling using for health care)
• General Tax Revenue: people do not have to pay at the time of service utilization, (UK and other countries);
• Insurance (risk sharing, pre-saving for future, premium collection): different insurance mechanisms: - employer deducted social insurance, government managed/mediated non-profit insurance, privately managed insurances (not for profit, or for profit), community managed insurances; it is a dominant models in many developed countries.
• Co-payments: (in the case of pooled fund) in some cases service users have to contribute some to the cost of service.
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How to finance?Alternative way of financing ….Out-of-pocket (OOP)/Household: people directly pay at the time of service
utilization, pay fully by themselves; in case of pooled fund system in some situation people have to pay fully by their pocket/household income for services which are not covered; less than 20% of OOP indicates better health coverage; currently Nepal’s OOP is more than 49%; in such system poor and marginalized may not be able to use service for basic care, while people of high socioeconomic level may find it hard to bear the cost of service in some cases. It is a dominant model in low and middle income countries. Whoever can afford gets services while others get no service or poor quality of service
Charities/Donations/Aid/Loans: Foreign or internal charity/donations/aid /loans; Example- governments or some organizations subsidize the cost or provide free services to the care of children, elderly, mothers, poor, disabled etc.
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How to finance?Alternative way of financing ….Some direct or indirect ways of cost reduction and/or collection of fund:-
• Prevention and promotion (e.g. awareness/education; provision of basic water and sanitation/toilet; nutrition; cutting down or stopping smoking/alcohol; responsible living; proper food and exercise; park/space/hall for play; use of personal protective equipment; immunization; screening; enforcement of environmental and traffic laws; counseling; coordination; availability, access and utilization of appropriate services on time; etc.)
• Efficient cum effective management of services so that wastage is reduced and quality is ensured, no unnecessary/over use (e.g., gate keeping) and everyone gets necessary service on time (not giving up of service when needed);
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How to finance?Alternative way of financing ….Some direct or indirect ways of cost reduction and/or collection of fund:- ….
• Use of generic medicines;
• Collecting small amount from other services (like each rupee/dollar/cent from each ticket of airplane/flight);
• Health tax/Sin tax (e.g., tax on alcohol, tobacco, sugar, ..) for health care of the people;
• Cost rationalizing / cost coordination mechanism, provision of reviewing panel/board; Supervision & monitoring;
• Equity, social justice; Income generation, employment, savings ..
• etc.
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Country’s spending on health care(Method of selection - some countries were selected as per MPH curriculum, while some other were selected just out of curiosity, trying to view different regions/economy of the world; from WHO database as mentioned in ‘source’ below.)
Country Total Spending on Health (US $)
Nepal 1.1 billionBhutan 68 millionBangladesh 4.9 billionIndia 97 billionChina 575 billionSri Lanka 2.6 billionAfganistan 1.8 billionSingapore 15 billionJapan 471 billionS. Korea 104 billionMalaysia 14 billionPhilippines 13 billionQatar 4.6 billionAustralia 140 billionCanada 187 billionUK 253 billionUSA 2,986 billionCuba 9.3 billionArgentina 26 billionChile 20 billionBrazil 195 billionSudan 5.1 billionRwanda 595 million
0
5E+11
1E+12
1.5E+12
2E+12
2.5E+12
3E+12
3.5E+12
Nep
al
Bh
uta
n
Ban
glad
esh
Ind
ia
Ch
ina
Sri L
anka
Afg
anis
tan
Sin
gap
ore
Jap
an
S. K
ore
a
Mal
aysi
a
Ph
ilip
pin
es
Qat
ar
Au
stra
lia
Can
ada
UK
USA
Cu
ba
Arg
enti
na
Ch
ile
Bra
zil
Sud
an
Rw
and
a
Country's Total Spending on Health
7Source: WHO. Health System Financing Country Profile, 2014. http://apps.who.int/nha/database/Country_Profile/Index/en (Internet Accessed on 14 June 2016)
6882,485 1,094 1,601
7,565
3,635691
55,910
36,201
27,943
10,933
2,871
96,310
64,009
50,641
43,166
54,855
7,384
12,64514,608
11,383
1,540 697
0
20000
40000
60000
80000
100000
120000
GDP Per Capita Income (US $)
8
40 89 31 75
420127 57
2,752
3,703
2,060
465
135
2,106
6,031
5,292
3,935
9,403
817605
1,137947
130 52
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Per capita spending on health (US $)
9
8794
88
99 100 99
77
100 100 100 100 99 100 100 100 100 100 100 99 100 100 97
54
136
12
1 0 1
23
0 0 0 0 1 0 0 0 0 0 0 1 0 0 3
46
0
20
40
60
80
100
120
Source of Funding
Domestic Abroad
10
48
25
6762
32
42
64
55
14
36 35
54
7
1914
10 11
4
31 3225
76
28
40
73
28
30
56
56
36
42
84
54 55
34
8667
7183
48
96
55
4946
21
38
12
15
812
2 03 3
10 10 127
14 15
7
41
0
14
29 28
3
34
WHO PAYS HOW MUCH FOR SERVICE
Household Government Other
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Countries with higher government share have low household share, this reduces burden to poor household.Household expense (or OOP) less than 20% is supposed to indicate better coverage of health services.
67
6365 65
74
71
48
82 83
80
73
70
78
82 81 80 79 78
75
79
73
59 59
0
10
20
30
40
50
60
70
80
90
Life Expectancy
12
380
200
340
230
38 39
1400
9 6 18 31
94
8 8 12 12 2453 70
2658
750
540
0
200
400
600
800
1000
1200
1400
1600
MMR per 100,00 live births
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Country
Country's Total
Spending on
healthcare
(US $)
Per capita
spending
on health
(US $)
GDP
per capita
income
(US $)
Life
Expectancy
(years)
MMR (maternal
mortality ratio
per 100,000
live births)
Funding for Health
Source %
Who pays for services ?
%
Domestic Abroad Household Government Other
Nepal 1.1 billion 40 688 67 380 87 13 48 40 12
Bhutan 68 million 89 2,485 63 200 94 6 25 73 1
Bangladesh 4.9 billion 31 1,094 65 340 88 12 67 28 5
India 97 billion 75 1,601 65 230 99 1 62 30 8
China 575 billion 420 7,565 74 38 100 0 32 56 12
Sri Lanka 2.6 billion 127 3,635 71 39 99 1 42 56 2
Afganistan 1.8 billion 57 691 48 1400 77 23 64 36 0
Singapore 15 billion 2,752 55,910 82 9 100 0 55 42 3
Japan 471 billion 3,703 36,201 83 6 100 0 14 84 3
S. Korea 104 billion 2,060 27,943 80 18 100 0 36 54 10
Malaysia 14 billion 465 10,933 73 31 100 0 35 55 10
Philippines 13 billion 135 2,871 70 94 99 1 54 34 12
Qatar 4.6 billion 2,106 96,310 78 8 100 0 7 86 7
Australia 140 billion 6,031 64,009 82 8 100 0 19 67 14
Canada 187 billion 5,292 50,641 81 12 100 0 14 71 15
UK 253 billion 3,935 43,166 80 12 100 0 10 83 7
USA 2,986 billion 9,403 54,855 79 24 100 0 11 48 41
Cuba 9.3 billion 817 7,384 78 53 100 0 4 96 0
Argentina 26 billion 605 12,645 75 70 99 1 31 55 14
Chile 20 billion 1,137 14,608 79 26 100 0 32 49 29
Brazil 195 billion 947 11,383 73 58 100 0 25 46 28
Sudan 5.1 billion 130 1,540 59 750 97 3 76 21 3
Rwanda 595 million 52 697 59 540 54 46 28 38 34
14Source: WHO. Health System Financing Country Profile, 2014. http://apps.who.int/nha/database/Country_Profile/Index/en (Internet Accessed on 14 June 2016)
My Hypotheses/Assumptions on this matter –
• Countries are improving their systems and are trying to care all their people in a better way, in a more welfare oriented way, than before.
• Countries with good economy can have better health care system.• Countries with political stability can have better health care system.• Countries with better social security system provide better care to the
people.• Countries who promote innovations can have better system and better
outcome.• Countries who consider its their responsibility to care people and execute
the responsibility, provide better care to the people.• Countries with high morals (sense of good conduct, social responsibility) –
of bureaucrats, politicians, private sectors, scholars and people in general –can have better health care system.
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Acknowledgement –I consulted following papers and portals:
• WHO. Health System Financing Country Profile, 2014. http://apps.who.int/nha/database/Country_Profile/Index/en(Internet Accessed on 14 June 2016)
Note: Get updated data (most of data used here are from 2008), there have been significant changes in the decade in the world.
• What is Universal Health Coverage? 2014 December [cited 2016 Jun 3rd ]. Available from: http://www.who.int/features/qa/universal_health_coverage/en/.
• Anne M. Health Care Systems in Low- and Middle-Income Countries. New England Journal of Medicine. 2014(370):552-7.
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What is your country’s latest situation?(Assignment: fill in the blanks; update the information; compare with time before and other countries)
Data Source Remarks
Total Spending on Health
Per capital spending on health
Per capital income
Domestic + Abroad
Household + Gov + Other
OOP
Poverty
Population and Health workforce status …
Disparities …
IMR
MMR
Life expectancy
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I expect feedback. Thank you!
(Hint- Include components of input, process, and output)