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TRANSCRIPT
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
