COMPARATIVE PATIENT PAYMENT POLICIES OF BAINE COUNTRIES

Presentation on Patient Payment Policy (Group Work, BAINE)

1. Etleva Dervishi, Albania

2. Shoeb Ahmad Ilyas, India

3. Md. Mizanur Rahman, Bangladesh

4. Mohan Paudel, Nepal

5. Zemuy Ghirmay, Eritrea

19th March, 2010University of Corvinus

BAINE: Bangladesh, Albania, India, Nepal, Eritrea

Geographical location

CONTENT OF PRESENTATION

1. Patient Payment Policy2. Types 3. Main Policy Objectives4. Possible Effects5. Health Care System and Country Comparison5.1 Health and Socio-economic indicators5.2 Similarities and Differences5.3 Health Care Financing5.4 Official Fees and Co-payments5.5 Role of Out of Pocket Payments6. Conclusion

PATIENT PAYMENT POLICY

DefinitionAll types of out-of-pocket payments that health

care consumers make at the time of using health care services (e.g. out-patient and in-patient services) or purchasing health care commodities (e.g. appliances and pharmaceuticals) are called patient paymentsFormal Fees: Official feesInformal charges: Indirect payments, under

the table payments

TYPES

Co-payment: flat-rate patient payment made by the patient when using health care service.

Co-insurance: patient payment that is equal to a percentage of the total costs of the service used.

Deductibles: patient payment that covers the service cost up to a fixed amount.

MAIN POLICY OBJECTIVES

• Macro-level objectives – Controlling the overall health care

expenditure. cost-containment– Generating additional resources for the health

care system• Meso- and micro-level objectives

– Discouraging unnecessary use of health care services

– Allowing hospitals/clinics to generate additional resources. (improvement of service quality)

– Increasing the income of individual health care providers.

• informal patient payments

POSSIBLE EFFECTS Influence the behavior of health care consumers:

cost-consciousness diminish the level of moral hazard on the side of the

consumers Reduce excess demand due to free heath care Decline in Health care utilization Generates additional revenue Can improve health sector service provision Can develop quality health care Simultaneously, it can create inequality among vulnerable

groups in low income context Applied in low- and middle-income countries Minimization of informal payments, make services affordable to

a large number of poor pop

HEALTH CARE SYSTEM AND COUNTRY COMPARISON

• Health and Socio-economic indicators• Similarities and Differences• Health Care Financing• Official Fees and Co-payments• Role of Out of Pocket

HEALTH AND SOCIO-ECONOMIC INDICATORS

Source: CIA 2009 est.

Source: WHO 2009

CONTD…………

Source: country data 2006/007

Source: WHO 2009

Source: WHO 2009

Health Care Financing

Contd………………..

Source: WHO 2009

Characteristics

Albania Bangladesh

Eritrea India Nepal

Degree of Regional Responsibility

Centralized Centralized

Centralized

Decentralized On process of decentralization

Health Insurance Coverage (Public)

There is insurance coverage (88% public employees covered)

no health insurance

no health insurance system

100% Central government health insurance, Central govt. Health scheme.(CGHS).

no health insurance

Health care system

CONTD………Characteristics

Albania Bangladesh

Eritrea India Nepal

Health Insurance (Private)

53% of the employees in private sector

in 1999-2000, only 0.02%

No private coverage system

Different states have different types of schemes

very limited

OFFICIAL FEES AND CO-PAYMENTS

Countries Albania Bangladesh

Eritria India Nepal

User Fees  Yes Yes No for primary health care, but yes for secondary and tertiary care

 Exempted for PHC  and for district and city hospitals user fees apply but exempted for white card holders

No for primary health care, but yes for secondary and tertiary care

Co-Payments

 Yes  NA NA NA NA

Informal Payment

 No specific data

 Almost 9% of total out-of-pocket expenditure

No specific data  No specific data

No specific data

Beneficiary

 Ministry of Health

Hospital State  50%  to treasury and 50%  to the Hospital

Secondary and Tertiary Care Hospital

Countries

Albania Bangladesh Eritria India Nepal

Revenue from official fees

24.6 of total health expenditure from pharmaceutical drugs’ sales.

No specific data for other health care sections.

roughly 12% of annual recurrent expenditures for district hospitals and 3% for medical college hospitals

80% of the revenue come from registration, diagnostic care fee at MOH health facilities, and 20% from drug fee (World bank,2004

100% of revenue from user fees in few states goes to Hospital Development Society for Maintenance and purchase of drugs and in some states only 50% revenue goes to Hospital.

No specific data

There is no specific peculiar differences among the countries in regard to the effects of patient payment. However, these are the common attributes among the countries

1. Revenue generation2. Extra burden for poor people, Extra administrative costs

and corruption for its collection3. Declining utilization of health services4. Informal fees and other costs associated with seeking

and receiving health services are not alleviated by official fees

5. Un predictable nature of informal fees and other costs will work against user fees exemption mechanism

6. Service and official fees barriers to health care

Effects of Patient Payment Policies

ROLE OF OUT OF POCKET PAYMENT

1. Major share of health economy in nationals2. Inequality in accessing healthcare3. increasing poverty burden4. increasing the healthcare cost5. increasing corruption6. Declining use of health care facilities7. Over prescription of drugs & unnecessary

interventions on patients8. Increasing rate of hospitalization9. Exposed poor people to poor quality of health care

CONCLUSION1. According to the world bank classification, all the countries

are lower and upper middle income countries except Eritrea.

2. There is no considerable difference in the life expectancy of these countries except in Albania.

3. The health care system is tax based, however, the revenue generated contributes to the health care facilities in many of the countries except in Eritrea where it goes directly to treasury.

4. There is no social health insurance except in Albania & India. The role of out of Pocket Payment is above the 85 % in all countries.

5. There are limited data on informal health spending & revenue generation in all countries.

6. The magnitude of user fees in these countries are not available, however they all implement user fee schemes with exemption policies for vulnerable groups.

Any Questions…………??????