How do countries budget for health?

Results from the Health System Characteristics survey and next steps

Camila Vammalle

OECD Public Governance and Territorial Development Directorate

2nd Annual Meeting of the Joint Network

25-26 March 2013

PART 1: RESULTS FROM THE HEALTH CHARACTERISTICS SURVEY

1. Financial resources for health

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

General Taxation Taxes earmarked to the health system

Payroll contributions to social health

insurance

Mandatory health insurance premiums

Australia

Belgium

Canada

Denmark

Finland

France

Germany

Greece

Iceland

Ireland

Italy

Japan

Luxembourg

Netherlands

New Zealand

Norway

Portugal

Spain

Sweden

Switzerland

United Kingdom

United States

2. Is it possible to isolate health budget deficits?

Possible to isolate health budget deficits?

Yes No

Belgium Finland

Chile Greece

Czech Republic Iceland

Denmark France

Luxembourg

Mexico

Ireland Poland

Israel Slovak Republic

Italy Sweden

Korea United States

Netherlands

New Zealand

Norway

Portugal

Slovenia

Spain

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

3. Budget approval vs. entitlement expenditure

0

2

4

6

8

10

12

14

Subject to budget

approval

Both types of expenditure

exist

Authorised by

permanent legislation

None of the Above

Nu

mb

er

of

co

un

trie

s (

29

an

sw

er

s)

Budget approval vs. entitlements

0

2

4

6

8

10

12

14

Subject to approval in the

executive budget proposal

Estimates included in the

budget for presentational

purposes

Not presented in the budget

NA

Nu

mb

er

of

co

un

trie

s (

29

an

sw

er

s)

How are entitlements treated in the budget?

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

4. Level of detail of health budgets

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

0

2

4

6

8

10

12

14

16

18

20

Budget allocation (or health expenditure ceilings) by category of health care

services

Budget allocation to specific health objectives

Budget allocations/transfers to lower levels of

governments

Distinction between operating and capital costs

in the budget for health

Nu

mb

er

of

co

un

trie

s (

30

an

sw

er

s)

5.1. Health spending by level of government

Participation of Each Level of Government Health Spending, 2009.

Source: OECD National Accounts and OECD Fiscal Decentralization database.

5.2. Types of grants to sub-national governments

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

0

2

4

6

8

10

12

14

16

Subnational Grants For Specific Health Programs

and Objectives

Subnational Grants For a Broad Range of Health

Responsibilities

General Subnational Grants (Also Covering Health)

Unspecified Subnational Grants

Nu

mb

er

of

co

un

trie

s (

19

an

sw

er

s)

6. Involvement of Ministries of Finance and of Health

in the budget cycle

0

5

10

15

20

25

Proposal Approval Monitoring Proposing readjustments

Implementing Readjustmetns

Ex-post evaluation

Nu

mb

er

of

co

un

trie

s (

22

an

sw

er

s)

Ministry of Health participates Ministry of Finance participates

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

7.1. Budget tools available if health spending

exceeds targets – by option

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

7.2. Budget tools available if health spending

exceeds targets – by country

Source: OECD Health Committee Survey on Health Systems Characteristics 2012

PART 2: CHARACTERISTICS OF THE

PROPOSED SURVEY

1. Policymaking

2. Setting expenditure levels

3. Expenditure management and controls

4. Accountability and performance

5. Regulatory management

1. Main issues to be covered

THANK YOU camila.vammalle@oecd.org