1 wb-ihpp workshop on the development of models for sustainable health care financing wb-thai...

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WB-IHPP Workshop on the Development of Models for Sustainable WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing Health Care Financing WB-Thai Development Partnership in Health (CDP-H) WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz ILO - Social Security Department Holiday Inn Silom Hotel Bangkok, 11 & 12 June 2007 Modeling Modeling Sustainable Sustainable Health Financing Health Financing in Thailand in Thailand

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Page 1: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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WB-IHPP Workshop on the Development of Models for Sustainable Health WB-IHPP Workshop on the Development of Models for Sustainable Health Care FinancingCare Financing

WB-Thai Development Partnership in Health (CDP-H)WB-Thai Development Partnership in Health (CDP-H)

Wolfgang ScholzILO - Social Security Department

Holiday Inn Silom HotelBangkok, 11 & 12 June 2007

Modeling Sustainable Modeling Sustainable Health FinancingHealth Financing

in Thailandin Thailand

Page 2: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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The ModelThe Model: overview: overview

Population (sex and single ages)

Labour supply (sex and single ages)

Economy (wages, prices, employment, etc.)

Health expenditure (revenue) outputs

NHSO SSO CSMBS IHPP

CapitationCapitation Base Rate NHA

Page 3: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure ModelHealth Expenditure Model

ExpScheme = PopScheme * Frequency of contactsScheme * Costs per contactScheme

e0 Sch

e1 Sch

e2 Sch

...

...

...

e100 Sch

p0 Sch

p1 Sch

p2 Sch

...

...

...

p100 Sch

f0 Sch

f1 Sch

f2 Sch

...

...

...

f100 Sch

c0 Sch

c1 Sch

c2 Sch

...

...

...

c100 Sch

Costs per contactScheme = Costs per contactHospitals

?SUMe SUMp

Capitation = SUMe / SUMp

Page 4: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model

with

PopTOT =: PopUC + PopSSO + PopCSMBS + PopOTH

PopUC =: UC covered population (age: 0 to 100)

PopSSO =: SSO covered population (age: 15 to [69])

PopCSMBS =: CSMBS covered population (age: 15 to [100])

PopOTH =: Residual (non-CSMBS public (age: 15 to [100])schemes; residency abroad; others)

PopUC = PopTOT – PopSSO – PopCSMBS – PopOTH

Page 5: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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How do population How do population models work?models work?

PopulationStock (t+1)

= PopulationStock (t)

+ ImmigrationFlow (t+1) – EmigrationFlow (t+1)alternative:

[EntriesFlow (t+1) – ExitsFlow (t+1)]

+ NewbornsFlow (t+1) – DeathsFlow (t+1)

Page 6: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Id e a o f co h o rtId e a o f co h o rt --w ise p ro jec tio nw ise p ro jec tio n-- d e m o g ra p h ic p ro je c tio nsd e m o g ra p h ic p ro je c tio ns

Ye a rA g e T T +1 T +2

+ N e w b irth0 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )

- D e a th

1 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )- D e a th

2 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )- D e a th

3

4...

1 0 0

How do population models How do population models work?work?

Page 7: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Base population in year tRates of survival by sex and ageby sex and age

Net migrationby sex and age Population in year t+1

by sex and age (age>1)

Rates of fertility Population in year t+1by age of mothers by sex and age

Number of the newbornSex ratio

of the newbornNumber of thenewborn by sex

Population of age 0in year t+1 by sex

How do population models How do population models work?work?

Page 8: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model

PopTOT =: Data base MoI

Weakness: fertility and mortality data

Solution: standard UN parameters (?)

PopOTH = k * PopTOT k =: PopOTH / PopTOT => exog; constant (?)

PopSSO =: Data base SSO

Problem: labour market entries & exits; mortality

Solution: construction of theoretical rates (?)

PopCSMBS =: Data base CSMBS

Problem: dependents (children; spouses; parents) = f (actives)

Solution: ??? [under investigation]

Problems / solutions:

Page 9: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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How do population How do population models work?models work?

PopulationStock (t+1)

= PopulationStock (t)

+ ImmigrationFlow (t+1) – EmigrationFlow (t+1)alternative:

[EntriesFlow (t+1) – ExitsFlow (t+1)]

+ NewbornsFlow (t+1) – DeathsFlow (t+1)

Page 10: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model

Scheme specific

UC SSO CSMBS

Frequencies of contacts:

Page 11: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model

Scheme specific

UC [« hospital costs / shadow fees »] SSO [« hospital costs / shadow fees »] CSMBS [« hospital fees for service »]

Costs per contact:

Page 12: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Health Expenditure Model:Health Expenditure Model:Hospital Expenditure StructureHospital Expenditure Structure

Month YearOperating expense / personell expense

Salary and wagesSalary X XWages X XTemporary wages X XOther salary and wages X X

Other personal expense X XNon-operating expense

Compensation X XSundries X XCost of goods

Drugs X XMedical material X X

SuppliesEquipment X XOther X X

Public utility X XDepreciation and amortization

Depreciation X XAmortization X X

Other operating expense

Bad debt X XDoubtful accounts X XCross expense X XReimbursement to other hospitals X X

Other expense X XTotal operating expense

Non-operating expenseGovernment revenue (tax) expense X XTotal expense

Item

Page 13: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Hospital labour costs:

Per capita wages (by profession (?)) =: Cost indexNumber of staff (by profession (?)) =: Volume index

Hospital non-labour costs:

For Sundries,Pharmaceutical drugs,Medical material (goods),Equipment, Other supplies,Electricity / energy

Price Indexes to be developed=> Volume indexes follow

Hospital Expenditure Structure:Hospital Expenditure Structure:Cost and Volume IndicatorsCost and Volume Indicators

Page 14: 1 WB-IHPP Workshop on the Development of Models for Sustainable Health Care Financing WB-Thai Development Partnership in Health (CDP-H) Wolfgang Scholz

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Open questionsOpen questions

Permanently many.