shield project: strategies for health insurance for equity in less developed countries
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Modelling the resource requirements for universal coverage: A case study of South Africa. SHIELD project: Strategies for Health Insurance for Equity in Less Developed Countries. Di McIntyre Health Economics Unit University of Cape Town. Background. - PowerPoint PPT PresentationTRANSCRIPT
Modelling the resource requirements for
universal coverage: A case study of South Africa
Di McIntyreHealth Economics Unit
University of Cape Town
SHIELD project: Strategies for Health Insurance for Equity in Less Developed Countries
Background
• Proposal to introduce universal coverage in South Africa:– Heated debate with particular concerns about
‘affordability’
• Modelling useful to explore likely implications of different financing reforms:– Resource requirements (and impact of key design
features)– Revenue potential
Broad approach used
• Identified the key scenarios:– What kind of financing reforms are being
considered, proposed, or might be feasible?• Resource requirements:– Population x utilisation x unit costs (Excel
spreadsheet model)– Absolute amount and relative to GDP
• Revenue: – Health sector share of government budget;
additional tax or mandatory contributions
Reform scenarios
• Status quo:– Limited growth in private insurance (<20% of
population); limited improvement in public sector• Extended schemes:– Mandatory extension of private insurance to all
formal sector workers and dependents (<40%)• Universal system:– Core of substantially improved public services;
access to all; mainly tax funded including additional payment by formal sector
Core methods and assumptionsBenchmarked baseline 15 year projections
Population Sources: Census, schemes, SHIELD household surveysDisaggregation: Age & sex, insurance status
Reliable projections (AIDS impact not adequately accounted for in official stats)
Utilisation Source: SHIELD household surveys; benchmarked against HMIS & scheme dataDisaggregation: Age & sex, insurance status, type of service
Normative targets and cross-checked with international experience
Unit costs Data from Treasury & HMISScheme claims
Real increases: trends & improved resources
Expenditure benchmark
Audited public & scheme expenditure
Excerpt of model
Coverage and utilisation
Total expenditure as % GDP
Public expenditure as % GDP
Public funding requirements
• Status quo:– Will decline to 10.5% of government budget
• Extended schemes:– Will decline to 9.4% of government budget (but
increased costs of covering civil servants)• Universal system:– Increase share of government budget to 15% plus– Proportional income tax of 4% (2% employer & 2%
employee)– Or, progressive income tax of 1.2% to 6%
Conclusions
• UC is lowest cost option in SA, but places greatest burden on public funds and requires:• Increased allocations for health in line with Abuja
target, and• Additional taxes
• Modelling illustrates likely resource requirements for reform scenarios, but also provides insights into reform design (sensitivity analyses)
Pre-conditions for success
• Cost containment:– Minimise unit costs, careful purchasing from non-
government providers– Minimise administration costs: avoid
fragmentation– Contain utilisation: strengthen primary &
community services; improved gate keeping– Need for ongoing M&E, refine model with
updated data
SHIELD partners
For more informaton visit: http://web.uct.ac.za/depts/heu/SHIELD/about/about.htm
Funding: European Commission and IDRC